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Feasibility of Consensus Molecular Subtype Classification of Colorectal Cancer Using Preoperative Biopsy Specimens: A
Shunsuke Kasai1,2, Keiichi Hatakeyama3, Akio Shiomi1
1Division of Colon and Rectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Journal of the Anus, Rectum and Colon
|July 31, 2026
Summary
Preoperative biopsies can yield quality RNA for colorectal cancer (CRC) molecular subtyping. However, intratumoral heterogeneity may impact classification accuracy, necessitating cautious interpretation and further research.
Area of Science:
- Oncology
- Molecular Biology
- Gastroenterology
Background:
- Consensus Molecular Subtype (CMS) classification stratifies colorectal cancer (CRC) into four groups based on gene expression.
- CMS classification holds potential for developing tailored therapies for CRC patients.
Purpose of the Study:
- To evaluate the feasibility of performing CMS classification using preoperative biopsy specimens from colorectal cancer (CRC) patients.
- To assess RNA yield and quality from biopsy samples for molecular subtyping.
Main Methods:
- A prospective pilot study involving eight patients with primary CRC (cT2 or deeper).
- Two biopsy specimens were obtained from different tumor regions using standard and jumbo forceps during preoperative colonoscopy.
- RNA yield, quality (RNA integrity number - RIN), and CMS classification were assessed using microarray data.
Main Results:
- All biopsy procedures were safely performed without adverse events.
- Sufficient RNA yield and high quality (RIN 9.1-9.2) were obtained from biopsy specimens.
- CMS classification was successfully achieved in all samples, though three patients showed discordant classifications between forceps.
Conclusions:
- Preoperative biopsy specimens yield RNA of sufficient quality for CMS classification in colorectal cancer.
- Intratumoral heterogeneity identified via biopsy may lead to discordant CMS classifications.
- Further validation in larger cohorts is warranted to confirm the utility of preoperative biopsies for CRC molecular subtyping.