Kmeid Michel, Brar Rupinder, Sullivan Luz, Arslan Mustafa Erdem, Shrestha Neharika, Lee Edward C, Chen Anne, Jennings Timothy A, Lee Hwajeong
Department of Pathology, Albany Medical Center, Albany, NY, USA.
Department of Surgery, Albany Medical Center, Albany, NY, USA.
Acad Pathol. 2023 Feb 1;10(1):100063. doi: 10.1016/j.acpath.2022.100063. eCollection 2023 Jan-Mar.
Patients with rectal cancer undergo more repeat biopsies compared to those with nonrectal colon cancer prior to management. We investigated the factors driving the higher frequency of repeat biopsies in patients with rectal cancer. We compared clinicopathologic features of diagnostic and nondiagnostic (in regard to invasion) rectal (n = 64) and colonic (n = 57) biopsies from colorectal cancer patients and characterized corresponding resections. Despite similar diagnostic yield, repeat biopsy was more common in rectal carcinoma, especially in patients receiving neoadjuvant therapy (p < 0.05). The presence of desmoplasia (odds ratio 12.9, p < 0.05) was a strong predictor of making a diagnosis of invasion in both rectal and nonrectal colon cancer biopsies. Diagnostic biopsies had more desmoplasia, intramucosal carcinoma component and marked inflammation, and less low-grade dysplasia component (p < 0.05). Diagnostic yield of biopsy was higher for tumors with high-grade tumor budding, mucosal involvement by high-grade dysplasia/intramucosal carcinoma without low-grade dysplasia and diffuse surface desmoplasia irrespective of tumor location. Sample size, amount of benign tissue, appearance, and T stage did not affect diagnostic yield. Repeat biopsy of rectal cancer is primarily driven by management implications. Diagnostic yield in colorectal cancer biopsies is multifactorial and is not due to differing pathologists' diagnostic approach per tumor site. For rectal tumors, a multidisciplinary strategic approach is warranted to avoid repeat biopsy when unnecessary.
与非直肠癌患者相比，直肠癌患者在治疗前接受更多的重复活检。我们研究了导致直肠癌患者重复活检频率较高的因素。我们比较了来自结直肠癌患者的诊断性和非诊断性（关于浸润）直肠活检（n = 64）和结肠活检（n = 57）的临床病理特征，并对相应的切除术进行了特征描述。尽管诊断率相似，但重复活检在直肠癌中更为常见，尤其是在接受新辅助治疗的患者中（p < 0.05）。促纤维增生性改变的存在（比值比12.9，p < 0.05）是直肠和非直肠结肠癌活检中诊断浸润的有力预测指标。诊断性活检有更多的促纤维增生性改变、黏膜内癌成分和明显炎症，而低度异型增生成分较少（p < 0.05）。对于具有高级别肿瘤芽生、伴有高级别异型增生/黏膜内癌而无低度异型增生的黏膜受累以及弥漫性表面促纤维增生性改变的肿瘤，无论肿瘤位置如何，活检的诊断率都较高。样本大小、良性组织量、外观和T分期不影响诊断率。直肠癌的重复活检主要由治疗意义驱动。结直肠癌活检的诊断率是多因素的，并非由于不同病理学家对每个肿瘤部位的诊断方法不同。对于直肠肿瘤，有必要采取多学科战略方法以避免不必要的重复活检。
