Comparison Of Diagnostic Accuracies Of Three Endoscopic Examination Techniques For Evaluating The Invasion Depth Of Colorectal Laterally Spreading Tumors

Background and purposeIt was found that the risk of lymph node metastasis in superficial submucosal invasive carcinoma(the depth of infiltration<1000 m)was very low.Superficial submucosal invasive carcinoma can be removed by endoscopic resection,while deep submucous invasive carcinoma requires surgical treatment.At present,the endoscopic methods used for preoperative assessment of colorectal cancer invasive depth include magnifying chromoendoscopy,magnifying endoscopy with narrow band imaging and endoscopic ultrasonography.The three kinds of endoscopy are effective methods to determine the nature of the lesion and the depth of invasion.However,there is no consensus on which endoscopic examination is more effective in determining the invision depth of early colorectal cancer.Currently,the assessment of the invision depth of colorectal laterally spreading tumors(LSTs)is rarely discussed.Therefore,we conducted a single-center retrospective study with pathological diagnosis as the gold standard to evaluate the diagnostic accuracies of magnifying chromoendoscopy,magnifying endoscopy with narrow band imaging,and endoscopic ultrasonography for the preoperative evaluation of colorectal LSTs.Clinical data and methods1.Clinical Data:Retrospective analysis of 68 cases of LSTs.All lesions completed magnifying endoscopy,magnifying endoscopic narrow-band imaging and endoscopic ultrasonography before endoscopic or surgical treatment.2.Research Methods:With the postoperative pathological diagnosis as gold standard,the diagnosis accuracies of three endoscopic methods of preoperative invasive depth assessment for colorectal LSTs were compared.(accuracy=the number of cases consistent with preoperative pathological and preoperative endoscopic assessment/total number of preoperative endoscopy assessments).Results1.Study Subjects:68 patients with 68 cases of LSTs were eventually enrolled.2.Basic Condition of Patients:31 were male and 37 were female,and the male to female ratio of cases was 1:1.19.The age range was 28～82 years,and the average age of onset was(61.66+11.03)years.3.Basic Condition of Lesions:There were 43 cases(63.2%)of the lesions in the rectum,3 cases(4.4%)in the rectosigmoid junction,3 cases(4.4%)in the sigmoid colon,2 cases(2.9%)in the descending colon,6 cases(8.8%)in the transverse colon,4 cases(5.9%)in the ascending colon,7 cases(10.3%)in the cecum.There were 13 cases(19.1%)of the lesions with homogeneous granular type,49 cases(72.1%)with nodular-mixed type,3 cases(4.4%)with flat elevate type,and 3 cases(4.4%)with pseudo-depressed type.The size of the lesion in the range of 15～120 mm with an average size of(39.04±23.68)mm.There were 9 cases(13.2%)of 10～19 mm,10 cases(14.7%)of 20～29 mm,23 cases(33.8%)of 30～39 mm,7 cases(10.3%)of 40～49 mm,8 cases(11.8%)of 50～59 mm,7 cases(10.3%)of 50～59 mm,and 7 cases(10.3%)above 70 mm.There were 4 cases(5.9%)with endoscopic mucosal resection,57 cases(83.8%)with endoscopic submucosal dissection,and 7 cases(10.3%)with surgical resection.There were 8 cases(11.8%)of pathological low-grade intraepithelial neoplasia,52 cases(76.5%)of high-grade intraepithelial neoplasia,3 cases(4.4%)of superficial submucosal invasive cancer,5 cases(7.4%)of deep submucosal invasive cancer.4.Accuracy of Preoperative Assessment of Three Endoscopy:The diagnostic accuracies of magnifying chromoendoscopy,magnifying endoscopy with narrow band imaging and endoscopic ultrasonography for evaluating the invasion depth of colorectal LSTs were 88.2%(60/68),89.7%(61/68),75%(51/68),respectively.Although there was a difference in the accuracies of the three methods,there was no significant difference between any two of the three methods(P>0.05).Subgroup analysis was carried out according to the location,morphology and tumor size.The accuracy of preoperative evaluation of the invasion depth of colorectal LSTs by endoscopic ultrasonography was significantly different between the two groups(P=0.002).In the lesions of size greater than 40mm,the accuracy rate decreased.5.The Influencing Factors of The Accuracy of Preoperative Evaluation by Three Endoscopic Methods:The size of the lesion was an influential factor in the accuracy of endoscopic ultrasonography(P=0.014,OR=5.965).ConclusionThe accuracy of magnifying endoscopy with narrow band imaging in evaluating the invasion depth of colorectal LSTs was slightly higher than that of magnifying chromoendoscopy,and the accuracy of endoscopic ultrasonography was lower than that of magnifying chromoendoscopy and magnifying endoscopy with narrow band imaging.However,there was no statistically significant difference between any two of the three methods.The size of the lesion may affect the accuracy of endoscopic ultrasonography in evaluating the invision depth of colorectal LSTs.The accuracy of endoscopic ultrasonography had a decreasing trend in colorectal LSTs with larger diameters.