• colorectal cancer
• histology
• risk assessment

• cancer gland rupture
• early colorectal cancer
• lymph node dissection
• lymph node metastasis
• submucosal invasion depth
• tumor budding

• Humans
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Lymphatic Metastasis
• Male
• Female
• Risk Factors
• Middle Aged
• Aged
• Neoplasm Invasiveness
• Adult
• Intestinal Mucosa/pathology
• Intestinal Mucosa/surgery
• Neoplasm Staging
• Lymph Nodes/pathology
• Lymph Nodes/surgery
• Lymph Node Excision
• Aged, 80 and over

• T1 colorectal cancer
• additional surgery
• artificial intelligence
• lymph node metastasis
• predictive factor

• colorectal cancer
• hematoxylin
• lymph node metastasis
• meta‐analysis
• staining

• Humans
• Colorectal Neoplasms/pathology
• Lymph Nodes/pathology
• Lymphatic Metastasis/pathology
• Neoplasm Invasiveness/pathology
• Neoplasm Staging
• ROC Curve
• Staining and Labeling/methods

• JP21K21121 Japan Society for the Promotion of Science
• JP23K16289 Japan Society for the Promotion of Science

• colorectal neoplasms
• histology
• lymph nodes
• neoplasm metastasis

• Humans
• Colorectal Neoplasms/pathology
• Prognosis
• Lymphatic Metastasis/pathology
• Risk Assessment
• Lymph Nodes/pathology
• Risk Factors
• Retrospective Studies
• Neoplasm Staging

• Lymphatic metastasis
• Lymphovascular invasion
• Submucosal invasion
• T1 colorectal carcinoma
• Tumor budding

• colorectal cancer
• malignant polyp
• metastasis
• risk factors

• Humans
• Colonic Polyps/pathology
• Neoplasm Invasiveness/pathology
• Colorectal Neoplasms/pathology
• Adenocarcinoma/pathology
• Carcinoma/pathology
• Risk Factors

• carcinoma
• colon
• pT1
• polyp

Endoscopic submucosal dissection (ESD) can provide a high en bloc resection rate and has been widely applied as curative treatment for early colorectal cancer (ECC). However, surgical treatment is occasionally required, and reports on the long-term prognosis of ESD are insufficient. This study aimed to investigate the long-term outcomes of ECC removal by ESD, including local recurrence and metastasis.

This multicenter study was conducted retrospectively on 450 consecutive patients with ECC who were treated with ESD between November 2003 and December 2013. Clinical, pathological, and endoscopic data were collected to determine tumor depth, resection margin, lymphovascular invasion, and recurrence.

The median follow-up period was 53.8 (12–138 months). The en bloc resection rate was 85.3% (384) and in intramucosal cancer being 84.1% and in superficial submucosal invasion (SM1) cancer being 89.8% (p = 0.158). The curative resection rate was 76.0% (n = 342), and there was no statistical difference between the two groups (77.3% vs. 71.4%, p = 0.231). The overall recurrence free survival rate (RFS) was 98.7% (444/450). In patients with curative resection, there was no statistically significant difference in RFS according to invasion depth (intramucosal: 99.3% vs. SM1: 97.1%, p = 0.248).

Patients with curatively resected ECC treated with ESD showed favorable long-term outcomes. Curatively resected SM1 cancer has a RFS similar to that of intramucosal cancer.

• Clinical outcome
• Early stage
• Local treatment
• Radical resection
• Rectal cancer
• pT1

The cornerstone of treating colorectal cancer (CRC) is generally a surgical resection with lymph node (LN) dissection. The tools for predicting lymph node metastasis (LNM) in submucosal (SM) CRC are useful to avoid unnecessary surgical resection.

Retrospectively, we analyzed 526 consecutive patients with SM CRC who underwent surgical resection at the Osaka International Cancer Institute, Osaka University Hospital, and Minoh City Hospital, Japan, between 1984 and 2012. The Osaka International Cancer Institute group and the Osaka University Hospital group were randomly divided into a training set and a test set of 2:1. The prediction model was validated in Minoh City Hospital.

We partitioned patients using three risk factors involved in the presence or absence of LNM in SM CRC: lymphatic invasion (Ly), budding grade (BD) and the depth of submucosal invasion (DSI) (cut-off value 2789 μm) that were significantly different in the multivariate analysis. As a result, a predictive model of “LNM <5%” when “Ly negative and DSI <2789 μm” was evaluated. We similarly partitioned by DSI 3000 μm as easy-to-evaluate values in clinical use. We developed the additional model for predicting LNM is 1.05%, that is, LNM <5%, when there are “Ly negative and DSI <3000 μm.”

As a limitation, only patients who underwent surgical resection were included in this study. This predictive model could help clinicians and CRC patients decide on the additional surgery required after endoscopic resection.

• Deep Submucosal Invasion
• Lymph Node Metastasis
• Risk Stratification
• T1 Colorectal Cancer

• T1 colorectal cancer
• lymph node metastasis
• recurrence
• risk factor
• treatment strategy
• tumor location

Colorectal malignant polyps (MP) are polyps with invasive cancer into the submucosa harboring a variable risk of lymph node involvement, which can be estimated through evaluation of morphological, endoscopic, and histologic features. The recent advances in imaging endoscopic techniques have led to the possibility of performing an optical diagnosis of T1 colorectal cancer, allowing the selection of the best therapeutic modality to optimize outcomes for the patient. When MP are diagnosed after endoscopic removal, their management can be challenging. Differentiating low- and high-risk histologic features that influence the possibility of residual tumor, the risk of recurrence and the risk of lymph node metastasis, is crucial to further optimize treatment and surveillance plans. While the presence of high-risk features indicates a need for surgery in the majority of cases, location, comorbidities and the patient’s preference should be taken in account when making the final decision. This is a particularly important issue in the management of low rectal MP presenting with high-risk features, where chemoradiotherapy followed by a watch-and-wait strategy has demonstrated promising results. In this review we discuss the important prognostic features of MP and the most modern approaches regarding their management.

• Colorectal malignant polyp
• colorectal cancer
• endoscopic resection
• surveillance

• Colorectal cancer
• Depth of submucosal invasion
• Lymph node metastasis
• Submucosal invasive cancer

• AI
• Artificial intelligence
• deep learning
• digital pathology
• early colorectal cancer
• inflamed adipose tissue
• metastasis
• new predictive biomarker
• pT1 and pT2 bowel cancer
• prediction LNM

• Adipose Tissue/pathology
• Biopsy
• Colorectal Neoplasms/pathology
• Deep Learning
• Diagnosis, Computer-Assisted
• Early Detection of Cancer
• Humans
• Image Interpretation, Computer-Assisted
• Lymph Nodes/pathology
• Lymphatic Metastasis
• Microscopy
• Neoplasm Staging
• Predictive Value of Tests
• Proof of Concept Study
• Reproducibility of Results
• Retrospective Studies
• Risk Assessment
• Risk Factors

• 104914 Wellcome Trust
• 104914 Wellcome Trust

• colorectal neoplasms
• diagnostic screening programs
• morphological and microscopic findings

• Early invasive rectal adenocarcinoma
• Prognosis of T1 rectal adenocarcinoma
• Submucosal invasion
• T1 rectal adenocarcinoma
• TEM
• TEO

Transanal endoscopic microsurgery (TEM) is considered the technique of choice for adenoma and low-risk T1 rectal cancer. The adequacy of such treatment for high-risk T1 tumours, however, is still controversial. The aim of the study is to evaluate our results with local excision of high-risk T1 cancers.

Demographic, clinical data pertaining to patients undergoing TEM for T1 rectal cancer between 1999 and 2015 was retrospectively collected. Long-term outcomes were assessed for the entire cohort. Patients were classified into two groups: favourable and high-risk cancer features.

Three hundred and fifty-five TEM procedures were recorded in the study period. Forty-three patients were included in the present study. There were 20 females and 23 males, the median age was 69 ± 9. The median tumour distance from the anal verge was 6 cm (range 1–13 cm). Post-operative histopathology showed well/moderately differentiated T1 adenocarcinoma in 30 patients and poorly differentiated in 13. The overall survival for patients with favourable and high-risk features groups were 93.5% and 77%, respectively, while the local recurrence (LR) was 3.5% and 23.1%, respectively. Nine patients with high-risk features received adjuvant radiotherapy; one (11.1%) of them experienced LR.

Local excision by TEM augmented by adjuvant radiotherapy may be a feasible alternative for selected patients with high-risk T1 rectal cancer. The addition of radiotherapy seems to decrease the rates of LR.

• Adjuvant radiation
• high-risk T1 rectal cancer
• local excision
• radiation

• Blood Vessels/pathology
• Colorectal Neoplasms/pathology
• Lymph Nodes/pathology
• Lymphatic Metastasis
• Lymphatic Vessels/pathology
• Neoplasm Grading
• Neoplasm Invasiveness
• Peripheral Nerves/pathology
• Risk Factors
• Tumor Burden

• BRAF
• KRAS
• colorectal adenomas
• dysplasia
• serrated lesions

• Area
• Early rectal cancer
• Lymph node metastasis
• Submucosal invasion
• T1 colorectal cancer
• Width

• Colorectal
• cancer
• malignant
• polyp
• treatment

• Análisis de decisiones
• Cirugía completa
• Cirugía de rescate
• Cirugía radical
• Completion radiotherapy
• Completion surgery
• Cáncer de recto inicial
• Decision analysis
• Early rectal cancer
• Escisión local
• Local excision
• Radical surgery
• Radioterapia completa
• Revisión sistemática
• Salvage surgery
• Systematic review

Endoscopic mucosal resection (EMR) is an effective and minimally invasive alternative to surgery for large polyps and laterally spreading lesions. Gross morphology and surface characteristics may help predict submucosal invasion of the lesion (SMIL) during endoscopic evaluation. This is one of the largest single-center studies reporting endoscopic mucosal resection for larger (≥ 20 mm) colorectal lesions in the United States.

To determine the recurrence rate of adenomas and endoscopic features that may predict submucosal invasion of colonic mucosal neoplasia.

This is a retrospective cohort study of all the patients referred for endoscopic mucosal resection for lesions ≥ 20 mm, spanning a period from January 2013 to February 2017. The main outcome measure was identifying features that may predict submucosal invasion of mucosal lesions and predict recurrence of adenomas on follow-up surveillance colonoscopy performed at 4-6 mo.

A total of 480 patients with 500 lesions were included in the study. The median age was 68 (Inter quantile range: 14) with 52% males. The most common lesion location was ascending colon (161; 32%). Paris classification 0-IIa (Flat elevation of mucosa - 316; 63.2%); Kudo Pit Pattern IIIs (192; 38%) and Granular surface morphology (260; 52%) were most prevalent. Submucosal invasion was present in 23 (4.6%) out of 500 lesions. The independent risk factors for SMIL were Kudo Pit Pattern IIIL + IV and V (Odds ratio: 4.5; P value < 0.004) and Paris classification 0-IIc (Odds ratio: 18.2; P value < 0.01). Out of 500, 354 post-endoscopic mucosal resection scars were examined at surveillance colonoscopy. Recurrence was noted in 21.8% (77 cases).

There was overall low prevalence of SMIL in our study. Kudo pit pattern (IIIL + IV and V) and Paris classification 0-IIc were the only factors identified as an independent risk factor for submucosal invasion. The independent risk factor for recurrence was adenoma size (> 40 mm). Almost all recurrences (98.8%) were treated endoscopically.

• Endoscopy
• Polyp
• Endoscopic mucosal resection
• Recurrence
• Submucosal invasion

• Malignant colonic polyps (MP)
• T1 colon cancer
• colon cancer

• Colorectal cancer
• Mismatch repair
• Resection margin
• Screening
• Tumor budding
• Tumor infiltrating lymphocytes
• Vascular invasion

The aim of this study was to identify clinicopathological factors that affect the number of lymph nodes (LNs) (12 or more) retrieved from patients with colorectal cancer (CRC), particularly those with pathologic T1 (pT1) disease.

From 429 CRC patients, 75 pT1 cancers were identified and digitally scanned. Binary logistic regression analysis was performed to identify the clinicopathological factors affecting the number of LNs retrieved from all 429 patients and from the subset of patients with pT1 CRC.

For the 429 patients, the mean number of harvested LNs per specimen was 20 (median, 19). The number of retrieved LNs was independently associated with maximum tumor diameter > 2.3 cm and right-sided tumor location. The mean number of LNs retrieved from the 75 patients with pT1 CRC was 14 (median, 15); retrieval of 12 or more LNs from this group was independently associated with maximum tumor diameter > 14.1 mm.

The number of LNs retrieved from patients with CRC was associated with maximum tumor diameter and right-sided tumor location. For patients with pT1 CRC, maximum tumor diameter was independently associated with the harvesting of 12 or more LNs.

• Colorectal cancer
• adenocarcinoma
• harvest
• lymph node
• pT1
• retrieval

Through the implementation of national bowel cancer screening programmes we have seen a three-fold increase in early pT1 colorectal cancers, but how these lesions should be managed is currently unclear. Local excision can be an attractive option, especially for fragile patients with multiple comorbidities, but it is only safe from an oncological point of view in the absence of lymph node metastasis. Patient risk stratification through careful analysis of histopathological features in local excision or polypectomy specimens should be performed according to national guidelines to avoid under- or over-treatment. Currently national guidelines vary in their recommendations as to which factors should be routinely reported and there is no established multivariate risk stratification model to determine which patients should be offered major resectional surgery. Conventional histopathological parameters such as tumour grading or lymphovascular invasion have been shown to be predictive of lymph node metastasis in a number of studies but the inter- and intra-observer variation in reporting is high. Newer parameters including tumour budding and poorly differentiated clusters have been shown to have great potential, but again some improvement in the inter-observer variation is required. With the implementation of digital pathology into clinical practice, quantitative parameters like depth/area of submucosal invasion and proportion of stroma can be routinely assessed. In this review we present the various histopathological risk factors for predicting systemic spread in pT1 colorectal cancer and introduce potential novel quantitative variables and multivariable risk models that could be used to better define the optimal treatment of this increasingly common disease.

• Early colorectal cancer
• Bowel cancer screening
• Local resection
• Major resection
• Morphological risk factors
• Conventional histopathology parameters
• Novel histopathology parameters
• Risk stratification models
• Digital pathology

• Adenocarcinoma/diagnosis
• Adenocarcinoma/pathology
• Adenocarcinoma/surgery
• Colectomy/standards
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Early Detection of Cancer/methods
• Early Detection of Cancer/standards
• Humans
• Intestinal Mucosa/pathology
• Intestinal Mucosa/surgery
• Lymph Nodes/pathology
• Lymphatic Metastasis/diagnosis
• Mass Screening/methods
• Mass Screening/standards
• Neoplasm Grading
• Neoplasm Invasiveness/pathology
• Neoplasm Staging
• Observer Variation
• Practice Guidelines as Topic
• Proctectomy/standards
• Prognosis
• Risk Assessment/methods
• Risk Factors

• Laterally spreading tumor
• Prognosis
• Recurrence
• T1 colorectal carcinoma
• Treatment

• lymph node
• rectal cancer
• surgical treatment

• Cancer in adenomas
• Malignant polyp
• Polypectomy
• pT1 colorectal cancer

• Adult
• Aged
• Cohort Studies
• Colectomy/methods
• Colonic Polyps/mortality
• Colonic Polyps/pathology
• Colonic Polyps/surgery
• Colonoscopy/methods
• Colonoscopy/mortality
• Colorectal Neoplasms/mortality
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Databases, Factual
• Denmark
• Disease-Free Survival
• Female
• Humans
• Male
• Middle Aged
• Prognosis
• Propensity Score
• Proportional Hazards Models
• Retrospective Studies
• Risk Assessment
• Survival Analysis
• Treatment Outcome
• Watchful Waiting

• Chemoradiotherapy
• Early rectal cancer
• Local excision

• Colorectal cancer
• Invasive tumor front
• Metastases
• MiR-17/92
• MicroRNA
• Microarray
• pT1

• Colon cancer
• Computed tomography
• Staging

• Aged
• Colonic Neoplasms/diagnostic imaging
• Colonic Neoplasms/pathology
• Colonic Neoplasms/surgery
• Female
• Humans
• Male
• Neoplasm Staging
• Patient Selection
• Sensitivity and Specificity
• Tomography, X-Ray Computed

• Colonoscopy
• Colorectal neoplasm
• Lymphatic metastasis

• National Cancer Center

To evaluate a novel grading system to predict lymph node metastasis (LNM) in patients with submucosal invasive colorectal carcinoma (SICRC).

We analyzed the associations between LNM and various clinicopathological features in 252 patients with SICRC who had undergone radical surgery at the Seoul Saint Mary’s hospital between 2000 and 2015.

LNM was observed in 31 patients (12.3%). The depth and width of the submucosal invasion, lymphatic invasion, tumor budding, and the presence of poorly differentiated clusters (PDCs) were significantly associated with the incidence of LNM. Using multivariate analysis, the receiver operating characteristic curvewas calculated and the area under curve (AUC) was used to compare the ability of the different parameters to identify the risk of LNM. The most powerful clinicopathological parameter for predicting LNM was lymphatic invasion (difference AUC = 0.204), followed by the presence or absence of tumor budding (difference AUC = 0.190), presence of PDCs (difference AUC = 0.172) and tumor budding graded by the Ueno method (difference AUC = 0.128).

Our results indicate that the tumor budding and the depth multiplied by the width measurements of submucosal invasion can provide important information for patients with SICRC.

• Colorectal cancer
• Neoplasm invasion
• Lymph node
• Metastasis

• Adult
• Aged
• Aged, 80 and over
• Colonoscopy
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Female
• Humans
• Incidence
• Japan
• Lymph Node Excision/statistics & numerical data
• Lymph Nodes/pathology
• Lymph Nodes/surgery
• Lymphatic Metastasis
• Male
• Middle Aged
• Neoplasm Grading
• Neoplasm Invasiveness/pathology
• Prognosis
• Retrospective Studies
• Risk Factors
• Treatment Outcome

Early rectal cancer (ERC) assessment should include prediction of the potential excision plane to safely remove lesions with clear deep margins and feasibility of organ preservation.

MRI accuracy for differentiating ≤T1sm2 (partially preserved submucosa) or ≤T2 (partially preserved muscularis) versus >T2 tumours was compared with the gold standard of pT stage T1sm1/2 versus ≤pT2 versus >pT2. N stage was also compared. The MRI protocol employed a standard surface phased array coil with a high resolution (0.6×0.6×3 mm resolution). The staging data were analysed from a prospectively recorded database of all ERC (≤mrT3b) treated by primary surgery.

Of 65 <mrT3b tumours, 45 were ≤pT2 and 14 were ≤pT1sm2. MRI accuracy for ≤T1sm2 was 89% (95% CI 63% to 87%), positive predictive value (PPV) 77% and negative predictive value (NPV) 92%, and for ≤T2 89% (95% CI 79% to 95%), PPV 93% and NPV 81%. Interobserver agreement between two experienced radiologists was >0.7 suggesting good agreement. 44 out of 65 patients underwent radical surgery and 22 out of 44 were ≤mrT2. MRI accuracy to predict lymph node status was 84% (95% CI 70% to 92%), PPV 71% and NPV 90%. Among the 21 out of 65 (32%) patients undergoing local excision or TEM, 20 out of 21 were staged as MR≤T2 and confirmed as such by pathology. On follow-up, none had relapse. If the decision had been made to offer local excision on MRI TN staging rather than clinical assessment, a significant increase in organ preservation surgery from 32% to 60% would have been observed (difference 23%, 95% CI 9% to 35%).

MRI is a useful tool for multidisciplinary teams (MDTs) wishing to optimise treatment options for ERC; these study findings will be validated in a prospective multicentre trial.

• ABDOMINAL MRI
• COLORECTAL CANCER
• ENDOSCOPIC POLYPECTOMY
• STAGING

• Follow-Up Studies
• Humans
• Medical Oncology/standards
• Neoplasm Grading
• Neoplasm Staging
• Rectal Neoplasms/diagnosis
• Rectal Neoplasms/pathology
• Rectal Neoplasms/therapy