A Novel Model Predicts Postoperative Pathology of Colorectal High-Grade Intraepithelial Neoplasia

To analyze the consistency of endoscopic biopsy of colorectal high-grade intraepithelial neoplasia (HGIN) and pathological diagnosis and to explore the value of preoperative examination in differentiating HGIN from invasive carcinoma.

Clinicopathological data of 79 patients with colorectal HGIN undergoing preoperative endoscopic biopsy from January 2012 to December 2017 were retrospectively analyzed.

Pathologically, 57 cases (72.8%) were diagnosed as invasive carcinoma and 22 (27.8%) as HGIN. Tumor size ≥3 cm, ulcer on the surface of the lesion, HGIN without adenoma, platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, lymph node enlargement, and spiculation of the peri-intestinal fat on computed tomography were associated with postoperative invasive carcinoma. Multivariate analysis showed that a longest diameter ≥3 cm, preoperative diagnosis of HGIN without adenoma, and spiculation of the peri-intestinal fat were independent factors for a postoperative diagnosis of invasive carcinoma. Depending on the weight of these three independent factors in binary logistic regression analysis, a comprehensive scoring model was established. When the score was ≥1.5, the sensitivity and specificity for the diagnosis of invasive carcinoma were 86.0% and 81.8%, respectively. Utilizing the prediction index, the area under the receiver operating characteristic curve was 0.869.

A diagnosis of colorectal HGIN by colonoscopy is poorly consistent with the postoperative pathological diagnosis. The scoring model established in this study for identifying colorectal infiltrating carcinoma is simple and feasible. When the comprehensive score is ≥ 1.5, an aggressive approach of surgical treatment is recommended.