Compound Endoscopic Morphological Features for Identifying Non-Pedunculated Lesions ≥20 mm with Intramucosal Neoplasia

Background: The major limitation of piecemeal endoscopic mucosal resection (EMR) is the inaccurate histological assessment of the resected specimen, especially in cases of submucosal invasion. Objective: To classify non-pedunculated lesions ≥20 mm based on endoscopic morphological features, in order...

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Autores principales:	João Pedro da Costa-Seixas, María López-Cerón, Anna Arnau, Òria Rosiñol, Miriam Cuatrecasas, Alberto Herreros-de-Tejada, Ángel Ferrández, Miquel Serra-Burriel, Óscar Nogales, Luisa de Castro, Jorge López-Vicente, Pablo Vega, Marco A. Álvarez-González, Jesús M. González-Santiago, Marta Hernández-Conde, Pilar Diez-Redondo, Liseth Rivero-Sánchez, Antonio Z. Gimeno-García, Aurora Burgos, Francisco Javier García-Alonso, Marco Bustamante-Balén, Eva Martínez-Bauer, Beatriz Peñas, Daniel Rodríguez-Alcalde, Maria Pellisé, Ignasi Puig
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	early colorectal cancer NBI optical diagnosis Paris classification NICE classification ESD Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/bdc4f6e7a9344af2b7241e202b55688f
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spelling	oai:doaj.org-article:bdc4f6e7a9344af2b7241e202b55688f2021-11-11T15:27:59ZCompound Endoscopic Morphological Features for Identifying Non-Pedunculated Lesions ≥20 mm with Intramucosal Neoplasia10.3390/cancers132153022072-6694https://doaj.org/article/bdc4f6e7a9344af2b7241e202b55688f2021-10-01T00:00:00Zhttps://www.mdpi.com/2072-6694/13/21/5302https://doaj.org/toc/2072-6694Background: The major limitation of piecemeal endoscopic mucosal resection (EMR) is the inaccurate histological assessment of the resected specimen, especially in cases of submucosal invasion. Objective: To classify non-pedunculated lesions ≥20 mm based on endoscopic morphological features, in order to identify those that present intramucosal neoplasia (includes low-grade neoplasia and high-grade neoplasia) and are suitable for piecemeal EMR. Design: A post-hoc analysis from an observational prospective multicentre study conducted by 58 endoscopists at 17 academic and community hospitals was performed. Unbiased conditional inference trees (CTREE) were fitted to analyse the association between intramucosal neoplasia and the lesions’ endoscopic characteristics. Result: 542 lesions from 517 patients were included in the analysis. Intramucosal neoplasia was present in 484 of 542 (89.3%) lesions. A conditional inference tree including all lesions’ characteristics assessed with white light imaging and narrow-band imaging (NBI) found that ulceration, pseudodepressed type and sessile morphology changed the accuracy for predicting intramucosal neoplasia. In ulcerated lesions, the probability of intramucosal neoplasia was 25% (95%CI: 8.3–52.6%; <i>p</i> < 0.001). In non-ulcerated lesions, its probability in lateral spreading lesions (LST) non-granular (NG) pseudodepressed-type lesions rose to 64.0% (95%CI: 42.6–81.3%; <i>p</i> < 0.001). Sessile morphology also raised the probability of intramucosal neoplasia to 86.3% (95%CI: 80.2–90.7%; <i>p</i> < 0.001). In the remaining 319 (58.9%) non-ulcerated lesions that were of the LST-granular (G) homogeneous type, LST-G nodular-mixed type, and LST-NG flat elevated morphology, the probability of intramucosal neoplasia was 96.2% (95%CI: 93.5–97.8%; <i>p</i> < 0.001). Conclusion: Non-ulcerated LST-G type and LST-NG flat elevated lesions are the most common non-pedunculated lesions ≥20 mm and are associated with a high probability of intramucosal neoplasia. This means that they are good candidates for piecemeal EMR. In the remaining lesions, further diagnostic techniques like magnification or diagnostic +/− therapeutic endoscopic submucosal dissection should be considered.João Pedro da Costa-SeixasMaría López-CerónAnna ArnauÒria RosiñolMiriam CuatrecasasAlberto Herreros-de-TejadaÁngel FerrándezMiquel Serra-BurrielÓscar NogalesLuisa de CastroJorge López-VicentePablo VegaMarco A. Álvarez-GonzálezJesús M. González-SantiagoMarta Hernández-CondePilar Diez-RedondoLiseth Rivero-SánchezAntonio Z. Gimeno-GarcíaAurora BurgosFrancisco Javier García-AlonsoMarco Bustamante-BalénEva Martínez-BauerBeatriz PeñasDaniel Rodríguez-AlcaldeMaria PelliséIgnasi PuigMDPI AGarticleearly colorectal cancerNBIoptical diagnosisParis classificationNICE classificationESDNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancers, Vol 13, Iss 5302, p 5302 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	early colorectal cancer NBI optical diagnosis Paris classification NICE classification ESD Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	early colorectal cancer NBI optical diagnosis Paris classification NICE classification ESD Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 João Pedro da Costa-Seixas María López-Cerón Anna Arnau Òria Rosiñol Miriam Cuatrecasas Alberto Herreros-de-Tejada Ángel Ferrández Miquel Serra-Burriel Óscar Nogales Luisa de Castro Jorge López-Vicente Pablo Vega Marco A. Álvarez-González Jesús M. González-Santiago Marta Hernández-Conde Pilar Diez-Redondo Liseth Rivero-Sánchez Antonio Z. Gimeno-García Aurora Burgos Francisco Javier García-Alonso Marco Bustamante-Balén Eva Martínez-Bauer Beatriz Peñas Daniel Rodríguez-Alcalde Maria Pellisé Ignasi Puig Compound Endoscopic Morphological Features for Identifying Non-Pedunculated Lesions ≥20 mm with Intramucosal Neoplasia
description	Background: The major limitation of piecemeal endoscopic mucosal resection (EMR) is the inaccurate histological assessment of the resected specimen, especially in cases of submucosal invasion. Objective: To classify non-pedunculated lesions ≥20 mm based on endoscopic morphological features, in order to identify those that present intramucosal neoplasia (includes low-grade neoplasia and high-grade neoplasia) and are suitable for piecemeal EMR. Design: A post-hoc analysis from an observational prospective multicentre study conducted by 58 endoscopists at 17 academic and community hospitals was performed. Unbiased conditional inference trees (CTREE) were fitted to analyse the association between intramucosal neoplasia and the lesions’ endoscopic characteristics. Result: 542 lesions from 517 patients were included in the analysis. Intramucosal neoplasia was present in 484 of 542 (89.3%) lesions. A conditional inference tree including all lesions’ characteristics assessed with white light imaging and narrow-band imaging (NBI) found that ulceration, pseudodepressed type and sessile morphology changed the accuracy for predicting intramucosal neoplasia. In ulcerated lesions, the probability of intramucosal neoplasia was 25% (95%CI: 8.3–52.6%; <i>p</i> < 0.001). In non-ulcerated lesions, its probability in lateral spreading lesions (LST) non-granular (NG) pseudodepressed-type lesions rose to 64.0% (95%CI: 42.6–81.3%; <i>p</i> < 0.001). Sessile morphology also raised the probability of intramucosal neoplasia to 86.3% (95%CI: 80.2–90.7%; <i>p</i> < 0.001). In the remaining 319 (58.9%) non-ulcerated lesions that were of the LST-granular (G) homogeneous type, LST-G nodular-mixed type, and LST-NG flat elevated morphology, the probability of intramucosal neoplasia was 96.2% (95%CI: 93.5–97.8%; <i>p</i> < 0.001). Conclusion: Non-ulcerated LST-G type and LST-NG flat elevated lesions are the most common non-pedunculated lesions ≥20 mm and are associated with a high probability of intramucosal neoplasia. This means that they are good candidates for piecemeal EMR. In the remaining lesions, further diagnostic techniques like magnification or diagnostic +/− therapeutic endoscopic submucosal dissection should be considered.
format	article
author	João Pedro da Costa-Seixas María López-Cerón Anna Arnau Òria Rosiñol Miriam Cuatrecasas Alberto Herreros-de-Tejada Ángel Ferrández Miquel Serra-Burriel Óscar Nogales Luisa de Castro Jorge López-Vicente Pablo Vega Marco A. Álvarez-González Jesús M. González-Santiago Marta Hernández-Conde Pilar Diez-Redondo Liseth Rivero-Sánchez Antonio Z. Gimeno-García Aurora Burgos Francisco Javier García-Alonso Marco Bustamante-Balén Eva Martínez-Bauer Beatriz Peñas Daniel Rodríguez-Alcalde Maria Pellisé Ignasi Puig
author_facet	João Pedro da Costa-Seixas María López-Cerón Anna Arnau Òria Rosiñol Miriam Cuatrecasas Alberto Herreros-de-Tejada Ángel Ferrández Miquel Serra-Burriel Óscar Nogales Luisa de Castro Jorge López-Vicente Pablo Vega Marco A. Álvarez-González Jesús M. González-Santiago Marta Hernández-Conde Pilar Diez-Redondo Liseth Rivero-Sánchez Antonio Z. Gimeno-García Aurora Burgos Francisco Javier García-Alonso Marco Bustamante-Balén Eva Martínez-Bauer Beatriz Peñas Daniel Rodríguez-Alcalde Maria Pellisé Ignasi Puig
author_sort	João Pedro da Costa-Seixas
title	Compound Endoscopic Morphological Features for Identifying Non-Pedunculated Lesions ≥20 mm with Intramucosal Neoplasia
title_short	Compound Endoscopic Morphological Features for Identifying Non-Pedunculated Lesions ≥20 mm with Intramucosal Neoplasia
title_full	Compound Endoscopic Morphological Features for Identifying Non-Pedunculated Lesions ≥20 mm with Intramucosal Neoplasia
title_fullStr	Compound Endoscopic Morphological Features for Identifying Non-Pedunculated Lesions ≥20 mm with Intramucosal Neoplasia
title_full_unstemmed	Compound Endoscopic Morphological Features for Identifying Non-Pedunculated Lesions ≥20 mm with Intramucosal Neoplasia
title_sort	compound endoscopic morphological features for identifying non-pedunculated lesions ≥20 mm with intramucosal neoplasia
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/bdc4f6e7a9344af2b7241e202b55688f
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Compound Endoscopic Morphological Features for Identifying Non-Pedunculated Lesions ≥20 mm with Intramucosal Neoplasia

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