| Background and purposeSuperficial submucosal carcinoma is rarely associated with metastasis and endoscopic resection is an effective treatment.However,deep submucosal carcinoma has a greater risk of lymph node metastasis,which requires surgical resection.The main methods of preoperative evaluation of colorectal tumors include magnifying chromoendoscopy,narrow band imaging and endoscopic ultrasonography.These endoscopic examinations can effectively evaluate the characteristics of the lesion and the depth of invasion,but it is unclear which endoscopic examination is more accurate in evaluating the depth of invasion of early colorectal cancer.Nowadays,less attention has been paid to the evaluation of the depth of laterally spreading tumor(LST)by three types of endoscopy mentioned above.Therefore,we conducted a single-center,prospective clinical study to compare the accuracy of magnifying chromoendoscopy,narrow band imaging and endoscopic ultrasonography in assessing the depth of colorectal laterally spreading tumor.MethodsThis study is a single-center,prospective,observational clinical trial.All the patients had completed the three kinds of preoperative endoscopic examinations including magnifying chromoendoscopy,narrow band imaging and endoscopic ultrasonography,received endoscopic resection or surgery,and the postoperative pathological results had been obtained.Most of the patients were followed up at 3,6,12 and 24 months after treatment.In this study,postoperative pathological diagnosis was used as the gold standard to evaluate the diagnostic accuracy of magnifying chromoendoscopy,narrow band imaging and endoscopic ultrasonography in the preoperative depth evaluation of colorectal LST.Results101 cases of LST were eventually enrolled.52 were male and 49 were female,and the male to female ratio of cases was 1.06:1.The age range was 40-82 years old,and the average age of onset was 61.92±1.01 years old.There were 10 cases(7.9%)in the cecum,17 cases(16.8%)in the ascending colon,10 cases(9.9%)in the transverse colon,8 cases(7.9%)in the descending colon,1 case(1.0%)in the descending sigmoid junction,5 cases(5.0%)in the sigmoid colon,and 50 cases(49.5%)in the rectum.There were 72 cases(71.3%)of the lesions with nodular-mixed type,10 cases(9.9%)with homogeneous granular type,15 cases(14.8%)with flat elevate type,and 4 cases(4.0%)with pseudo-depressed type.The lesions range in size from 10 to 80mm,with an average size of 33.56±17.30mm.EMR was performed in 8 cases(7.9%),ESD in 84 cases(83.2%),and surgery in 9 cases(8.9%).There were 5 cases(5.0%)of pathological low-grade intraepithelial neoplasia,87 cases(83.8%)of high-grade intraepithelial neoplasia,4 cases(4.0%)of superficial submucosal cancer,5 cases(5.0%)of deep submucosal cancer.The accuracies of magnifying chromoendoscopy,narrow band imaging and endoscopic ultrasonography in determining the depth of colorectal LST were 83.2%(84/101),89.1%(90/101)and 62.4%(63/101),respectively,with statistically significant differences(P<0.001).The accuracy of magnifying chromoendoscopy and narrow band imaging was significantly higher than that of endoscopic ultrasonography(P<0.001).There was a statistically significant difference(P=0.001)in the accuracy of endoscopic ultrasonography in evaluating the depth of LST between the<40mm group and the≥40mm group.The size of the lesion was an influential factor in the accuracy of endoscopic ultrasonography in evaluating the depth of LST(P=0.001,OR=7.611).ConclusionThe accuracy of magnifying chromoendoscopy and narrow band imaging in evaluating the depth of colorectal LST was significantly higher than that of endoscopic ultrasonography.The size of lesion may be one of the factors influencing the accuracy of endoscopic ultrasonography in evaluating the depth of colorectal LST.Magnifying chromoendoscopy and narrow band imaging can more effectively assess the depth of colorectal LST,and endoscopic ultrasonography can be used as an alternative examination method. |
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