关键词: 结直肠肿瘤, 高级别上皮内瘤变, 早期结直肠癌, 内镜切除术, 病理活检, 带蒂息肉

Abstract:

Objective To provide reference for the improved pathological diagnosis of lesions of the tissues by exploring pathological differences of preoperative and postoperative endoscopic polypectomy for colorectal intraepithelial neoplasia and early colorectal cancer. Methods One hundred and twenty nine patients receiving both biopsies and surgeries based on the inclusion and exclusion criteria were selected as study samples, the specimen data and preoperative pathology biopsy data of 129 patients diagnosed with high-grade colorectal intraepithelial neoplasia or early colorectal cancer patients under endoscopic mucosal resection (EMR)/ endoscopic submucosal dissection (ESD) were retrospectively analyzed, differences in preoperative and postoperative pathological results were compared, and the risk factors associated with pathological differences in preoperative and postoperative endoscopic therapies were analyzed. Differences in the accuracy of pathological biopsies and EMR/ESD samples of patients with different parts (ascending colon, transverse colon, descending colon, sigmoid colon, rectum), lesion morphology (pedicled, sessile and lateral developmental morphology), maximum diameter of lesions, gender and age were observed. Results The diagnostic accordance rate of the postoperative pathological diagnosis of preoperative colonoscopy biopsies and endoscopic EMR/ESD therapies was 17.1% (22/129), the number of postoperative pathological ascending and descending lesions of endoscopic therapies amounted to 103 cases (79.8%) and 4 cases (3.1%), respectively, the mild-severity judgment rate of sites was 82.4%, 80.0%, 85.7%, 80.9% and 76.7%, respectively, and differences weren’t statistically significant (P>0.05). The results of single-factor Logistic regression analysis showed that the phenomenon of mild-severity judgments on preoperative biopsies was more obvious in patients with pedunculated polyps, and difference was statistically significant (P<0.05), while difference in mild-severity judgment rate for preoperative biopsies was not statistically significant for the lesion site, maximum diameter, sex, and age (P>0.05). Conclusion Both the preoperative pathological biopsy diagnosis and postoperative EMR/ESD pathological diagnosis with low compliance rate provide certain basis for selection on endoscopic follow-up and surgical treatment. Patients with pedunculated polyps are vulnerable to mild severity judgment for preoperative biopsies. Therefore, patients with pedunculated polyps are subject to intraepithelial neoplasia diagnose via biopsies, EMR/ESD surgery is supported to be selected based on the conditions in combination with narrow band imaging and magnifying endoscopy technique, and necessities for follow-up treatment and endoscopic follow-up time are supported to be determined by combining the pathological diagnosis on postoperative specimens.

Key words: colorectal neoplasms, high-grade colorectal intraepithelial neoplasia, early colorectal cancer, endoscopic polypectomy, pathological biopsy, pedunculated polyps