Clinical Features Of Colorectal Neuroendocrine Neoplasms And The Consistency Between Endoscopic Ultrasonography And Pathology

Objective:The clinical records,colonoscopy and endoscopic ultrasonography(EUS)findings of colorectal neuroendocrine neoplasms(NENs)were retrospectively analyzed to further investigate the clinical characteristics of colorectal NENs and the accuracy and application of preoperative EUS diagnosis.The purpose of this study is to further investigate the clinical characteristics of colorectal NENs and the accuracy and application value of preoperative EUS diagnosis,so as to improve the understanding and diagnosis and treatment of these diseases.Method:A total of 138 patients with clearly diagnosed colorectal NENs were collected at The Affiliated Hospital of Inner Mongolia Medical University from January 2018 to December2022,and the basic clinical information,colonoscopy,EUS and other imaging findings,pathology and immunohistochemistry,surgical records and postoperative complications of the patients were retrospectively analyzed,and SPSS25.0 statistical software was applied for data processing to further The correlation of each relevant clinical index with different pathological grading was analyzed as well as the accuracy and application value of EUS examination was clarified by the consistency analysis of EUS and pathological results.Results:1.138 patients with colorectal NENs had a male-to-female ratio of 1.19:1.The age range was 21-72 years,mostly concentrated in the age group of 41-60 years(85 cases,61.6%).Statistical analysis of the age distribution of the patients by gender showed no statistically significant differences(P > 0.05).According to the classification of patients’ symptoms at the first visit,59 cases(42.8%)were found asymptomatic by physical examination,while the other 79 cases showed some abdominal non-specific symptoms,including abdominal discomfort(abdominal pain,bloating,etc.)in 34 cases(24.6%),change in bowel habits(constipation,diarrhea,anal swelling,etc.)in 28 cases(20.3%)and change in stool characteristics(blood in stool,unformed stool,etc.)in 17 cases(12.3%).No manifestation of carcinoid syndrome was seen in this study.2.All cases were examined by colonoscopy in our hospital,and 4 cases(2.9%)of colon lesions were unifocal tumors,located in the left hemicolectomy;among 134 cases(97.1%)of rectal lesions,130 cases(97.0%)were unifocal and 4 cases(3.0%)were multifocal.The rectal lesions were classified according to the distance from the anal verge at colonoscopy as low rectum in 62 cases(44.9%),intermediate rectum in 65 cases(47.1)and high rectum in 7 cases(5.1%).The endoscopic morphology was flat bulge in 28 cases(20.3%),hemispherical/spherical bulge in 107 cases(77.5%)and cicatricial type in 3 cases(2.2%).The surface color of the lesions was colored with the surrounding mucosa in 49 cases(35.5%),yellowish/yellowish white in 85 cases(61.6%)and reddish on the surface in 4 cases(2.2%).The mean tumor diameter was 0.68±0.26 cm,of which 109 patients(79.0%)had a diameter of <1 cm,28 patients(20.3%)had a diameter between 1-2 cm,and only 1 patient(0.7%)had a diameter >2 cm.109 patients(79.0%)had a diameter of <1 cm,28 patients(20.3%)had a diameter between 1-2 cm,and only 1 patient(0.7%)had a diameter of >2 cm.There were 92patients(66.7%)with good mobility and 46 patients(33.3%)with poor mobility of the lesion.The biopsy forceps were hard/tough in 116 cases(84.1%)and soft in 22 cases(15.9%).Among them,55 cases(39.9%)had preoperative EUS examination,and the EUS results on the depth of infiltration of lesions showed that 16 cases(29.1%)originated from the mucosal layer,36 cases(65.5%)from the submucosal layer,and 3 cases(5.5%)were found to infiltrate into the intrinsic muscular layer,and no positive cases were reported for invasion of the plasma layer or surrounding vascular lymph nodes.The vast majority of lesions were internally hypoechoic(53 cases,96.4%),with uniform internal echogenicity(49 cases,89.1%)and clear borders(51 cases,92.7%).3.A total of 138 patients had G1 grade 115 cases(83.3%),G2 grade 22 cases(15.9%),G3 grade 0 case,Mi NENs 0 case,and NEC 1 case(0.7%).The results of the depth of lesion infiltration in the postoperative pathology showed that the lesions originated in the mucosal muscle layer in 32 cases(23.2%),in the submucosal layer in 100 cases(72.5%),infiltrated into the lamina propria in 5 cases(3.6%),and protruded into the plasma membrane layer in 1case(0.7%).The immunohistochemical results showed that the positive rates of Cg A,Syn,CD56,and AE1/AE3 were 46.1%,97.7%,82.0%,and 98.0%,respectively.Statistical analysis of the positive expression rates of the different immunohistochemical markers showed statistically significant differences(P < 0.05).The results of univariate analysis of the clinicopathological,colonoscopic and EUS characteristics of the tumors with G1 and G2 grades showed that the lesion diameter,rectal morbidity site,depth of infiltration,Cg A positive expression,and EUS border condition were associated with the tumor pathological grade,and the difference was statistically significant(P < 0.05).4.The accuracy rate of EUS in determining the depth of lesion infiltration and diagnostic conclusion was 100% and 81.8%,respectively.5.There were 133 cases of 138 colorectal NENs treated by endoscopy and 5 cases by surgery,and 42 cases had positive margins.The positive margin rate for endoscopic treatment was 30.1%,while the positive margin rate for endoscopic mucosal resection(EMR)was54.5% and for endoscopic mucosal dissection(ESD)was 27.9%.Submucosal dissection(ESD)had a positive margin rate of 27.9%,but the positive margin rate tended to decrease overall with the recent years.Bleeding(23.9%)and fever(4.3%)were common complications of endoscopic treatment in this study,and no adverse events of perforation occurred.Conclusion:1.The high incidence of colorectal NENs is in the age group of 41-60 years,slightly more common in males,often asymptomatic or non-specific,and the lesions are mostly solitary and <1 cm in diameter,common in the middle and low rectum.2.Endoscopy and EUS are of great clinical value in the diagnosis,pathological grading and treatment of colorectal NENs,and the assessment of lesion diameter,depth of infiltration and diagnostic conclusion by EUS is in good agreement with pathological findings.3.Most lesions of colorectal NENs can be treated endoscopically,and ESD can be the preferred modality for endoscopic treatment.