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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 Gastroenterology, 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
ARTICLE HIGHLIGHTS
Research background
Pathological assessment of tumor size often differs from preoperative evaluation, which could render treatment difficult. This study retrospectively investigated size discrepancies between endoscopic and pathological assessment and factors influencing this discordance.
Research motivation
The preoperative estimation of the tumor size is often different from the postoperative histological size, and when a novice endoscopist is to treat an unexpectedly large lesion, unfavorable events can occur with a long procedural time. Accordingly, an accurate understanding of tumor characteristics including tumor size, is significant for a safe and time-saving procedure.
Research objectives
To analyze the discrepancy between tumor size in endoscopic and pathological assessment and the factors influencing this discrepancy will enable a more accurate prediction of tumor size in the preoperative phase.
Research methods
We included 377 lesions removed with colorectal endoscopic submucosal dissection (ESD) at our hospital between April 2018 and March 2022. We classified three groups to analyze the discrepancy by size variation: Overestimation, underestimation, and the correct diagnosis groups. We compared clinicopathological characteristics among these groups.
Research results
We showed that the larger the lesion, the more likely it is to be underestimated. This preoperative underestimation was contrary to previous reports for small polyps. The larger the lesion, the longer the ESD treatment time needed because ESD treatment time is influenced by lesion size. The present study results revealed that larger lesions should be assumed to require longer-than-predicted treatment time.
Research conclusions
Recognizing that the larger the lesion appears, the more likely it is to be a larger lesion, optimal conditions for safe and reliable ESD can be prepared according to the operator’s judgment, including an operation room for longer procedure times and the degree of sedation required.
Research perspectives
To investigate how tumor size discrepancies between endoscopic and pathological assessment affect ESD outcomes.
