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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2024; 16(3): 136-147
Published online Mar 16, 2024. doi: 10.4253/wjge.v16.i3.136
Tumor size discrepancy between endoscopic and pathological evaluations in colorectal endoscopic submucosal dissection
Takeshi Onda, Osamu Goto, Toshiaki Otsuka, Yoshiaki Hayasaka, Shun Nakagome, Tsugumi Habu, Yumiko Ishikawa, Kumiko Kirita, Eriko Koizumi, Hiroto Noda, Kazutoshi Higuchi, Jun Omori, Naohiko Akimoto, Katsuhiko Iwakiri
Takeshi Onda, Osamu Goto, Shun Nakagome, Tsugumi Habu, Yumiko Ishikawa, Kumiko Kirita, Eriko Koizumi, Hiroto Noda, Kazutoshi Higuchi, Jun Omori, Naohiko Akimoto, Katsuhiko Iwakiri, Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Bunkyo-ku 113-8603, Tokyo, Japan
Osamu Goto, Endoscopy Center, Nippon Medical School Hospital, Bunkyo-ku 113-8603, Tokyo, Japan
Toshiaki Otsuka, Department of Hygiene and Public Health, Nippon Medical School, Bunkyo-ku 113-8603, Tokyo, Japan
Yoshiaki Hayasaka, Center for Medical Education, Nippon Medical School, Bunkyo-ku 113-8603, Tokyo, Japan
Author contributions: Onda T collected the research study data, analyzed the data, and wrote the manuscript; Goto O conceived the study and design and interpreted the data; Otsuka T and Hayasaka Y performed the statistical analyses; Nakagome S, Habu T, Ishikawa Y, Kirita K, Koizumi, E, Noda H, Higuchi K, Omori J, and Akimoto N critically revised the manuscript for important intellectual content; Iwakiri K provided research supervision.
Institutional review board statement: The study was reviewed and approved by the Nippon Medical School, Graduate School of Medicine Institutional Review Board (Approval No. 30-02-1077).
Informed consent statement: Informed consent was obtained by opting out, not in writing, as this is a retrospective analysis.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Osamu Goto, PhD, Associate Professor, Department of Gastro
enterology, Nippon Medical School, Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku 113-8603, Tokyo, Japan.
o-goto@nms.ac.jp
Received: November 22, 2023
Peer-review started: November 22, 2023
First decision: December 7, 2023
Revised: December 22, 2023
Accepted: January 29, 2024
Article in press: January 29, 2024
Published online: March 16, 2024
Processing time: 112 Days and 20 Hours
BACKGROUND
Tumor size impacts the technical difficulty and histological curability of colorectal endoscopic submucosal dissection (ESD); however, the preoperative evaluation of tumor size is often different from histological assessment. Analyzing influential factors on failure to obtain an accurate tumor size evaluation could help prepare optimal conditions for safer and more reliable ESD.
AIM
To investigate the tumor size discrepancy between endoscopic and pathological evaluations and the influencing factors.
METHODS
This was a retrospective study conducted at a single institution. A total of 377 lesions removed by colorectal ESD at our hospital between April 2018 and March 2022 were collected. We first assessed the difference in size with an absolute percentage of the scaling discrepancy. Subsequently, we compared the clinicopathological characteristics of the correct scaling group (> -33% and < 33%) with that of the incorrect scaling group (< -33% or > 33%), which was further subdivided into the underscaling group (-33% or less of the discrepancy) and overscaling group (33% or more of the discrepancy), respectively. As secondary outcome measures, parameters on size estimation were compared between the underscaling and correct scaling groups, as well as between the overscaling and correct scaling groups. Finally, multivariate analysis was performed in terms of the following relevant parameters on size estimation: Pathological size, location, and possible influential factors (P < 0.1) in the univariate analysis.
RESULTS
The mean of absolute percentage in the scaling discordance was 21%, and 91 lesions were considered to be incorrectly estimated in size. The incorrect scaling was significantly remarkable in larger lesions (40 mm vs 28 mm; P < 0.001) and less experience (P < 0.001), and these two factors were influential on the underscaling (75 lesions; P < 0.001). Conversely, compared with the correct scaling group, 16 lesions in the overscaling group were significantly small (20 mm vs 28 mm; P < 0.001), and the small lesion size was influential on the overscaling (P = 0.002).
CONCLUSION
Lesions indicated for colorectal ESD tended to be underestimated in large tumors, but overestimated in small ones. This discrepancy appears worth understanding for optimal procedural preparation.
Core Tip: Tumor size impacts the technical difficulty and histological curability of colorectal endoscopic submucosal dissection (ESD). However, the preoperative evaluation of tumor size is often different from histological assessment. We retrospectively investigated the colorectal tumor size discrepancy between endoscopic and pathological evaluations and influential factors on the discordance. Conclusively, the data demonstrated that the accuracy in the size estimation of candidates for colorectal ESD was influenced by the tumor size and much experience. These lesions tended to be underestimated in large tumors, but overestimated in small ones. This discrepancy appears worth understanding for optimal procedural preparation.
