Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2023; 15(6): 1062-1072
Published online Jun 15, 2023. doi: 10.4251/wjgo.v15.i6.1062
Chicken skin mucosa surrounding small colorectal cancer could be an endoscopic predictive marker of submucosal invasion
Ying-Jie Zhang, Wu Wen, Fan Li, Yi Jian, Chuan-Ming Zhang, Meng-Xia Yuan, Ye Yang, Feng-Lin Chen
Ying-Jie Zhang, Wu Wen, Fan Li, Yi Jian, Chuan-Ming Zhang, Meng-Xia Yuan, Department of Digestive Diseases, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
Ye Yang, Feng-Lin Chen, Graduate School, Chengdu Medical College, Chengdu 610000, Sichuan Province, China
Author contributions: All authors contributed to the study's conception and design; Zhang YJ, Wen W, and Yuan MX performed the material preparation, data collection, and analysis; Zhang YJ wtote the first draft; all authors commented on the previous versions of the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: The study was approved by the Ethics Committee of the Second People's Hospital (approval No: 2021018).
Informed consent statement: The requirement for informed consent was waived because our study does not involve personal privacy and has little risk to patients.
Conflict-of-interest statement: The authors declare no competing interests.
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: Meng-Xia Yuan, MD, Doctor, Department of Digestive Diseases, Chengdu Second People’s Hospital, No. 10 Qingyun South Street, Chengdu 610000, Sichuan Province, China. 1062274198@qq.com
Received: January 13, 2023
Peer-review started: January 13, 2023
First decision: February 9, 2023
Revised: February 23, 2023
Accepted: April 23, 2023
Article in press: April 23, 2023
Published online: June 15, 2023
Processing time: 152 Days and 15.5 Hours
Abstract
BACKGROUND

Chicken skin mucosa (CSM) surrounding colon polyps is a common endoscopic finding with pale yellow-speckled mucosa during a colonoscopy screening. Although reports about CSM surrounding small colorectal cancer are scarce, and its clinical significance in intramucosal and submucosal cancers is unclear, previous studies have suggested it could be an endoscopic predictive marker for colonic neoplastic and advanced polyps. Currently, because of the inaccurate preoperative evaluation by endoscopists, many small colorectal cancers, particularly lesions with a diameter < 2 cm, are improperly treated. Therefore, more effective methods are required to better assess the depth of the lesion before treatment.

AIM

To explore potential markers of small colorectal cancer early invasion under white light endoscopy, providing patients with better treatment alternatives.

METHODS

This retrospective cross-sectional study included 198 consecutive patients [233 early colorectal cancers (ECCs)] who underwent endoscopy or surgical procedures at the Digestive Endoscopy Center of Chengdu Second People’s Hospital between January 2021 and August 2022. The participants had pathologically confirmed colorectal cancer with a lesion diameter < 2 cm and received endoscopic or surgical treatment, including endoscopic mucosal resection and submucosal dissection. Clinical pathology and endoscopy parameters, including tumor size, invasion depth, anatomical position, and morphology, were reviewed. Fisher’s exact test, the χ2 test, and Student’s t-test were used to analyze the patient’s basic characteristics. Logistic regression analysis was used to examine the relationship between morphological characteristics, size, CSM prevalence, and ECC invasion depth under white light endoscopy. Statistical significance was set at P < 0.05.

RESULTS

The submucosal carcinoma (SM stage) was larger than the mucosal carcinoma (M stage) with a significant difference (17.2 ± 4.1 vs 13.4 ± 4.6 mm, P < 0.01). M- and SM-stage cancers were common in the left colon; however, no significant differences were found between them (151/196, 77% and 32/37, 86.5%, respectively, P = 0.199). The endoscopic features of colorectal cancer revealed that CSM, depressed areas with clear boundaries, and erosion or ulcer bleeding were more common in the SM-stage cancer group than in the M-stage cancer group (59.5% vs 26.2%, 46% vs 8.7%, and 27.3% vs 4.1%, respectively, P < 0.05). CSM prevalence in this study was 31.3% (73/233). The positive rates of CSM in flat, protruded, and sessile lesions were 18% (11/61), 30.6% (30/98), and 43.2% (32/74), respectively, with significant differences (P = 0.007).

CONCLUSION

CSM-related small colorectal cancer was primarily located in the left colon and could be a predictive marker of submucosal invasion in the left colon.

Keywords: Chicken skin mucosa; Colonoscopy; Colorectal cancer; Submucosal invasion; White light endoscopy; Endoscopic features

Core Tip: Chicken skin mucosa (CSM) surrounding colorectal polyps is a relatively common clinical feature. Previous studies have found that it could be an endoscopic predictor of neoplastic and advanced colorectal polyps. However, it is unclear whether it is associated with early colorectal cancer or invasion. In our study, CSM-related small colorectal cancer was mainly found in the distal colon; this could be a potential predictive marker of submucosal invasion cancers located in the left colon. Since these cancers cannot be treated as a normal polyp, biopsy snare, cold-snare polypectomy, and cold-snare endoscopic mucosal resection may not be the appropriate options.