To investigate the risk factors that affected pathological diagnosis upgrading after resection of colorectal adenoma.
Methods:
From January 2017 to December 2022, a total of 1 059 patientswho underwent adenoma resection after pathologically diagnosed as adenoma by endoscopic forcepsbiopsy(EFB)were included in General Hospital of Ningxia Medical University. The patients were divided into the pathologically no difference group (1 003 cases) and the pathologically upgraded group (56 cases) based on the comparison of pathological diagnosis of EFB specimens and the specimens after adenoma resection. Clinical information and endoscopic characteristics of the adenoma were compared between the 2 groups. The clinical information included smokinghistory, familyhistory of colorectal cancer, and the endoscopic characteristics included maximum diameter, morphological characteristics, surface depression, erosion or ulceration, and surface color of adenoma. Chi-square test and Fisher′s exact test were used for statistical analysis. Multivariate logistic regression model was used to analyze the risk factors for pathological diagnosis upgrading after adenoma resection.
Results:
The proportions of patients with smokinghistory, familyhistory of colorectal cancer, concomitant hypertension, and coronary heart disease in the pathologically upgraded group were higher than those in the pathologically no difference group (46.43%, 26/56 vs.26.12%, 262/1 003; 8.93%, 5/56 vs.0.70%, 7/1 003; 46.43%, 26/56 vs.30.11%, 302/1 003; 21.43%, 12/56 vs.9.27%, 93/1 003), and the differences were statistically significant( χ2=11.05, Fisher′s exact test, χ2=6.61 and 8.78; all P<0.05). There were statistically significant differences between the pathologically no difference group and pathologically upgraded group in the maximum diameter (929 cases (92.62%) and 23 cases (41.07%) of < 20 mm, and 74 cases (7.38%) and 33 cases (58.93%) of ≥20 mm, respectively), morphological characteristics (220 cases (21.93%) and 28 cases (50.00%) with pedicle, and 783 cases (78.07%) and 28 cases (50.00%) without pedicle, respectively), surface color (347 cases (34.60%) and 3 cases (5.36%) of near normal mucosa, 613 cases (61.12%) and 50 cases (89.29%) of red surface color, and 43 cases (4.29%) and 3 cases (5.36%) of white surface color, respectively), erosion or ulceration (78 cases (7.78%) and 36 cases (64.29%) had erosion or ulceration, and 925 cases (92.22%) and 20 cases (35.71%) had no erosion or ulceration, respectively), and surface depression (6 cases (0.60%) and 8 cases (14.29%) of depression, and 997 cases (99.40%) and 48 cases (85.71%) of non depression, respectively) ( χ2=155.18, 23.30, 20.58 and 176.31, Fisher′s exact test; all P<0.001). The result of multivariate logistic regressionanalysis showed that surface depression ( OR=25.198, 95% confidence interval (95% CI) 5.812 to 109.246, P<0.001), erosion or ulceration( OR=9.913, 95% CI 4.652 to 21.124, P<0.001), red surface color ( OR=4.276, 95% CI 1.053 to 17.363, P=0.042), white surface color ( OR=8.803, 95% CI 1.398 to 55.435, P=0.021), maximum diameter≥20 mm ( OR=4.689, 95% CI 2.265 to 9.706, P<0.001), familyhistory of colorectal cancer ( OR=8.764, 95% CI 1.418 to 54.162, P=0.019) and smokinghistory ( OR=2.713, 95% CI 1.376 to 5.349, P=0.004) were independent risk factors for pathological diagnosis upgrading after adenoma resection.