Establishment Of A Novel Model Predicting Postoperative Pathology In Colorectal High-grade Intraepithelial Neoplasia

AIM: To analyze the consistency between colonoscopic biopsy and pathological diagnosis of colorectal high-grade intraepithelial neoplasia,and to explore the value of preoperative examination in differentiating high-grade intraepithelial neoplasia from invasive carcinoma.METHODS: A retrospective analysis of clinical and pathological data of preoperative endoscopic biopsy for diagnosis of colorectal high-grade intraepithelial neoplasia in Union Hospital of Tongji Medical College,Huazhong University of Science and Technology from January 2012 to December 2017 was made.RESULTS: In this study,79 patients with colorectal high-grade intraepithelial neoplasia diagnosed by colonoscopic biopsy were enrolled.After operation,57(72.8%)were diagnosed as invasive carcinoma and 22(27.8%)were diagnosed as high-grade intraepithelial neoplasia.Univariate analysis revealed that the tumor size ≥3cm(P=0.001),high-grade intraepithelial neoplasia without adenoma(P=0.002),platelet to lymphocyte ratio(P=0.004),neutrophil to lymphocyte ratio(P=0.045)and lymph node enlargement(P=0.005)and spiculation of the peri-intestinal fat on computed tomography(P<0.001)were associated with a high incidence of postoperative invasive carcinoma.Multivariate analysis showed that the longest diameter ≥3cm ofthe lesion(P=0.002),preoperative diagnosis of high-grade intraepithelial neoplasia without adenoma(P=0.007)and spiculation of the peri-intestinal fat(P=0.014)were independent factors for the high incidence of postoperative invasive carcinoma.According to the weight of three independent factors in binary logistic regression analysis,a comprehensive scoring model was established.When the comprehensive scoring was more than 1.5,the sensitivity and specificity for the diagnosis of invasive carcinoma in the study were 86.0% and 81.8% respectively.Using the prediction index,the area under the ROC curve is 0.869.CONCLUSIONS: Colonoscopy diagnosis of colorectal high-grade intraepithelial neoplasia is poorly consistent with postoperative pathological diagnosis.The scoring model of colorectal infiltrating carcinoma established in this study is simple and feasible.When the comprehensive score is more than 1.5,active surgical treatment should be considered.