Value of macrobiopsies and transanal endoscopic microsurgery in the histological work-up of rectal neoplasms:A retrospective study

• 作者: Guus MJ B?kkerink Gert-Jan van der Wilt Dirk de Jong Han HJM van Krieken Robert P Bleichrodt Johannes HW de Wilt Andreas JA Bremers
• 来源期刊: 世界胃肠肿瘤学杂志：英文版（电子版）
• 学科: 医学
• 关键词: 直肠的癌症 组织学 活体检视 Macrobiopsy Transanal 内视镜的 microsurgery 采样错误
• 年，卷（期）: 2017,（6）
• 页码范围: 251-256
• 页数: 6页
• 分类号: R735.37

摘要

AIM To evaluate a step up approach: Taking macrobiopsies and performing excision biopsies in patients with suspected rectal cancer in which biopsies taken though the flexible endoscope showed benign histology. METHODS Patients with a rectal neoplasm who underwent flexible endoscopy and biopsies were included. In case of benign biopsies rigid rectoscopy and macrobiopsies were employed. If this failed to prove malignancy, transanalendoscopic microsurgery(TEM) was used in a final effort to establish a certain preoperative diagnosis. The preoperative results were compared with the findings after surgical excision and follow up to calculate the reliability of this algorithm.RESULTS One hundred and thirty-two patients were included. One hundred and ten patients with a carcinoma and 22 with an adenoma. Seventy-five of 110 carcinomas were proven malignant after flexible endoscopy. With the addition of rigid endoscopy and taking of macrobiopsies, this number increased to 89. Performing TEM excision biopsies further enlarged the number of proven malignancies to 100.CONCLUSION The step-up approach includes taking macrobiopsies through the rigid rectoscope and performing excision biopsies using transanal endoscopic microsurgery in addition to flexible endoscopy. This approach, reduced the number of missed preoperative malignant diagnoses from 32% to 9%.