Gorelik Yuri, Korytny Alexander, Arraf Tarek, Arsheid Nour, Mazzawi Fares, Moalem Rawia, Awadie Halim, Klein Amir
Department of Gastroenterology, Rambam Health Care Campus, HaAliya HaShniya St 8, 3109601, Haifa, Israel.
Department of Gastroenterology, Holy Family Hospital, Nazareth, Israel.
Dig Dis Sci. 2025 Feb;70(2):754-760. doi: 10.1007/s10620-024-08790-2. Epub 2024 Dec 17.
Endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps (LNPCPs) offers excellent efficacy and safety. Referral biopsies are commonly obtained prior to EMR despite their potential adverse effects. We aimed to assess the diagnostic accuracy of referral biopsy as compared with optical evaluations and the polyp's final pathology.
We analyzed a cohort from two centers that included adult patients referred for EMR of LNPCPs between 2017 and 2022. The NICE classification system was used for optical classification. We compared procedural outcomes of lesions with or without a referral biopsy and diagnostic accuracy of referral biopsy and optical evaluation to the final histopathology of the resected polyp.
Of 605 EMR procedures, 398 (65.8%) had referral biopsies. Polyp size was larger in the biopsy group. No significant differences were observed in en-bloc resection rate, adequate lifting, procedural bleeding, or surveillance recurrence rates. Optical biopsies had higher diagnostic concordance with final histology (Cohen's Kappa 0.62 vs. 0.55) and enhanced sensitivity for sessile serrated polyps/hyperplastic polyps (SSP/HP) and cancer as compared to referral biopsies (0.75 vs. 0.72, p < 0.01, and 0.19 vs. 0.0, p < 0.01, respectively). Optical evaluation was more accurate in non-biopsied lesions.
Referral biopsies do not offer additional diagnostic accuracy and may reduce the accuracy of optical evaluation for LNPCPs.
内镜黏膜切除术（EMR）治疗大肠广基息肉（LNPCP）疗效和安全性良好。尽管转诊活检可能有不良影响，但EMR术前通常会进行。我们旨在评估转诊活检与内镜评估及息肉最终病理检查相比的诊断准确性。
我们分析了两个中心的队列研究，纳入2017年至2022年间因LNPCP行EMR的成年患者。采用NICE分类系统进行内镜下分类。我们比较了进行或未进行转诊活检的病变的手术结果，以及转诊活检和内镜评估与切除息肉最终组织病理学检查的诊断准确性。
605例EMR手术中，398例（65.8%）进行了转诊活检。活检组息肉尺寸更大。整块切除率、充分抬举、手术出血或监测复发率方面未观察到显著差异。与转诊活检相比，内镜活检与最终组织学诊断的一致性更高（Cohen's Kappa值分别为0.62和0.55），对无蒂锯齿状息肉/增生性息肉（SSP/HP）和癌症的敏感性更高（分别为0.75和0.72，p < 0.01；以及0.19和0.0，p < 0.01）。内镜评估在未活检病变中更准确。
转诊活检并未提供额外的诊断准确性，且可能降低LNPCP内镜评估的准确性。
