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Risk Stratification for Covert Invasive Cancer Among Patients Referred for Colonic Endoscopic Mucosal Resection:

Nicholas G Burgess1, Luke F Hourigan2, Simon A Zanati3

  • 1Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, University of Sydney, School of Medicine, Sydney, New South Wales, Australia.

Gastroenterology
|June 7, 2017
PubMed
Summary
This summary is machine-generated.

Identifying risk factors for submucosal invasive cancer (SMIC) in large colorectal polyps is crucial. Rectosigmoid location, specific Paris classifications, surface morphology, and larger size indicate a higher risk of covert SMIC.

Keywords:
Colon CancerPredictionPrognostic FactorTumor

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Area of Science:

  • Gastroenterology
  • Oncology
  • Endoscopic Surgery

Background:

  • Accurate risk stratification for submucosal invasive cancer (SMIC) in large colorectal polyps is essential for appropriate treatment.
  • Overt SMIC necessitates surgical intervention, while covert SMIC may be managed endoscopically.
  • Identifying factors associated with covert SMIC can guide decisions between endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD).

Purpose of the Study:

  • To identify factors associated with overt SMIC in large colorectal lesions.
  • To determine factors associated with covert SMIC in lesions without obvious endoscopic signs of malignancy.
  • To inform treatment strategies for patients with large colorectal polyps based on malignancy risk.

Main Methods:

  • A prospective cohort study involving consecutive patients undergoing EMR for large (≥20 mm) sessile or flat colorectal polyps or laterally spreading lesions.
  • Data collection included patient and lesion characteristics, procedural outcomes, and histological findings.
  • Serrated lesions were excluded from the analysis of covert SMIC due to their distinct features.

Main Results:

  • Of 2277 lesions analyzed, 7.6% showed SMIC. Factors associated with overt SMIC included Kudo pit pattern V, depressed morphology, rectosigmoid location, specific Paris classifications, non-granular surface, and larger size.
  • In lesions without overt SMIC or serrated features, covert SMIC was associated with rectosigmoid location (OR, 1.87), combined Paris classification, surface morphology (ORs, 3.96–22.5), and increasing size (OR, 1.16/10 mm).

Conclusions:

  • Rectosigmoid location, combined Paris classification, surface morphology, and increasing size are significant risk factors for covert SMIC in large colorectal lesions.
  • Non-granular rectosigmoid lesions (Paris 0-Is, 0-IIa+Is) carry a high malignancy risk.
  • These findings aid in selecting the optimal treatment modality: ESD, EMR, or surgery.