Histologic discrepancy between endoscopic forceps biopsy and endoscopic mucosal resection specimens of colorectal polyp in actual clinical practice

Abstract

Background/AimsWe aimed to assess the rate of histologic discrepancy (HD) between endoscopic forceps biopsy (EFB) and totally resected specimens in colorectal polyp and analyze the risk factors of discordant group, especially under-diagnosis (UD) cases before complete removal of colorectal polyp.MethodsFrom 2010 to 2015, a total of 290 polyps in 210 patients which had baseline pathology report before endoscopic resection (ER) were analyzed. UD cases were defined as those in which the diagnosis changed to a more advanced histologic feature after ER.ResultsA change in the final histology after ER was noted in 137 cases (47.2%), and after excluding 9 insignificant cases, 128 cases were further categorized into over-diagnosed and under-diagnosed group. UD occurred in 86 cases (29.7%) and change from benign to malignancy was noted in 26 cases (8.9%). On univariate analysis, a larger polyp size (>10 mm) was significantly associated with both HD (P<0.001) and UD (P<0.001). Regarding polyp morphology, protruding or flat was not significantly important. On multivariate analysis, polyp size >10 mm was the single most significant predictor of both HD (P<0.001) and UD (P<0.001).ConclusionsThe HD and UD rates were 47.2% and 29.7%, respectively. Polyp size >10 mm was the most important predictor of both HD and UD. We should be careful in making treatment strategy of colorectal polyp based on histologic report of EFB especially when the size of polyp is >10 mm.

Potential factors predicting histopathologically upgrade discrepancies between endoscopic forceps biopsy of the colorectal low-grade intraepithelial neoplasia and endoscopic resection specimens

“…We are convinced that the larger size of target lesions could potentially increase rates of histopathologic discrepancies [32]. Our result has veri ed ≥ 1.0 cm could be a signi cant cut-off value to predict upgrade histopathology in accordance with the previous studies [10]. 1.0 cm is also considered as a cut-off value of advanced adenomas, which is another reason we used [33].…”

“…Some studies also reported histology discrepancies of colorectal polyps but failed to gure out signi cantly useful predictors [23][24][25]. Recently, a retrospective study analyzing 290 polyps reported histologic discrepancies between pretreatment EFB and EMR specimens of colorectal polyps [10]. But their inclusion criteria are not relatively strict, and their sample size is relatively small.…”

“…For the intraepithelial neoplasia in the digestive tract, it has been reported that there are some histopathological discrepancies between endoscopic forceps biopsy (EFB) and pathological outcomes of ER specimens, such as super cial esophageal squamous neoplasm, gastric epithelial neoplasia and colorectal polyps [8][9][10]. Whereas, little speci c research has been conducted to analyze the factors predicting histopathologically upgrade discrepancies between EFBs of colorectal low-grade intraepithelial neoplasia (LGIN) and ER specimens demonstrating high-grade intraepithelial neoplasia (HGIN) or adenocarcinoma.…”

Long-term Outcomes of Primary Endoscopic Resection vs Surgery for T1 Colorectal Cancer: A Systematic Review and Meta-analysis

“…Because the superficial forceps biopsy may not contain cancerous tissues, complete resection of the lesion is necessary for determining the histology accurately. 32 ER alone may be adequate for treating low-risk lesions. Although additional surgery may improve the survival outcomes for patients with high-risk lesions, the adverse events of surgery are not negligible.…”

Potential Factors Predicting Histopathologically Upgrade Discrepancies between Endoscopic Forceps Biopsy of the Colorectal Low-Grade Intraepithelial Neoplasia and Endoscopic Resection Specimens

“…For the intraepithelial neoplasia in the digestive tract, it has been reported that there are some histopathological discrepancies between endoscopic forceps biopsy (EFB) and pathological outcomes of ER specimens, such as superficial esophageal squamous neoplasm, gastric epithelial neoplasia, and colorectal polyps [ 8 – 10 ], whereas few research has been conducted to analyze the factors predicting histopathologically upgrade discrepancies between EFBs of colorectal low-grade intraepithelial neoplasia (LGIN) and ER specimens demonstrating high-grade intraepithelial neoplasia (HGIN) or adenocarcinoma. Therefore, the aim of the present study was to explore these discrepancies and intend to elucidate the potential risk factors and traits contributing to this type of upgrade histopathological diagnosis for the colorectal adenomas with LGIN forceps biopsy, which could suggest us to make a further accurate diagnosis and guide the optimal clinical management for these lesions.…”