ABSTRACT
Background: Diminutive (≤5 mm) and small (6-9 mm) polyps are the most common colorectal polyps seen clinically, and a tiny percentage of them contain advanced histology. Aims: To clarify the endoscopic characteristics of diminutive and small colorectal polyps with advanced histology. Methods: A retrospective analysis was conducted in patients undergoing colonoscopic polypectomy in Ningbo First Hospital from June 2016 to September 2021, and the clinical, endoscopic and pathological data were collected. Propensity score matching (1: 1) was performed to select the non - advanced histology controls comparable with diminutive and small polyps with advanced histology. The endoscopic characteristics related to advanced histology was identified by univariate and multivariate analyses. Results: A total of 3 631 diminutive and small adenomatous polyps were detected in 2 950 patients, among them, 14 (1.2%) diminutive polyps and 114 (4.6%) small polyps were diagnosed as advanced histology pathologically, with 14 high - grade intraepithelial neoplasia (HGIN) in diminutive polyps, and 109 HGIN and 5 submucosal invasive carcinoma in small polyps. For serrated lesions, 755 polyps less than 10 mm in diameter were detected in 504 patients, but no advanced histology was diagnosed. Multivariate Logistic regression analysis showed that chicken skin mucosa (OR=3.790, 95% CI: 1.767-8.128), congestion (OR=2.802, 95% CI: 1.450 - 5.415), hemorrhage (OR=5.074, 95% CI: 1.511 - 17.035), lobular changes (OR=2.522, 95% CI: 1.247 - 5.098) and relative depression (OR=5.317, 95% CI: 1.376-20.550) were independent risk factors for advanced histology in diminutive and small polyps, while no correlations were found between JNET classification type 2B and type 3, Paris endoscopic classification type 0 - I and advanced histology. Conclusions: When endoscopic characteristics including chicken skin mucosa, congestion, hemorrhage, lobular changes and relative depression are found in diminutive and small colorectal polyps, advanced histology should be suspected.
ABSTRACT
Objective To discuss the differential diagnostic value of confocal laser endomicroscopy (CLE)for benign and malignant non-protruding gastric lesions.Methods A total of 37 patients with nonprotruding gastric lesions diagnosed by conventional gastroscopy underwent CLE.Fluorescein sodium was intravenously injected,and target biopsy was obtained.Malignant lesionss diagnosed with CLE or biopsy were treated by endoscopy or surgery.Patients with benign lesions were give routine medication and followed up every 3 months until the lesions were cured.Results CLE diagnosed 11 malignant and 26 benign lesions.However,1 of 11 cancers was confirmed as benign by histopathology,while 1 of 26 benign lesions was confirmed cancer.Lesions in 12 patients were resected,with 3 by endoscopy,and 9 by surgery,and findings of post-operative pathology were consistent with those of target biopsy.No malignancy was found during the follow-up of benign lesions,and all lesions were healed after 3.16(3.58 ± 1.20)months.The sensitivity,specificity,and accuracy of CLE in diagnosis of malignant non-protruding gastric lesion were 90.9％,96.2％,and 90.9％,respectively.The positive and negative predictive values were 90.9％ and 96.2％,respectively.The Kappa value of CLE and histopathology was 0.871.Conclusion CLE is of significant value for the diagnosis of non-protruding gastric lesions,and may replace biopsy in real-time histological diagnosis.