| Objective: To investigate the risk factors of colorectal lateral spreading tumors(LSTs)with high grade intraepithelial neoplasia(HGIN)or cancerization by analyzing the clinicopathological charecteristics of LSTs,to select appropriate endoscopic resection modalities,and to explore the accuracy of JNET classification in predicting malignant potential.Methods: Clinical information,endoscopic characteristics of lesions,endoscopic treatment-related data,and pathological data were collected from patients who underwent endoscopic treatment for LSTs at the endoscopy center of the First Affiliated Hospital of Dalian Medical University from July 1,2021 to August 31,2022.LSTs were grouped according to locations,morphological classifications,resection modalities,and whether accompanied by HGIN or cancerization,to study the respective characteristics in different locations and morphological classifications,to investigate the risk factors of LSTs with HGIN or cancerization and select appropriate endoscopic resection modalities.Meanwhile,we derived the independent risk factors of LSTs with HGIN or cancerization through the multivariate logistic regression analysis.Finally,the relationship between each subtype of JNET and histopathology was evaluated to explore its diagnostic accuracy.Results:1.Basic information: A total of 237 patients with LSTs and 255 LSTs lesions were included in this study.157 patients(66.2%)were ≥ 60 years old,and 125 patients(52.7%)were male in the study.The majority of lesions were from 10 to 20 mm in diameter(66.7%),and the location of the lesions was mainly in the right colon(67.8%).The nongranular flat elevated type(LST-NG-FE)was the main morphological classification(55.3%),and adenoma was the main pathological type of LSTs(71.4%).2.Clinicopathological characteristics of LSTs with different morphological classifications and locations:The lesions of LST-NG-FE type were mainly located in the right colon(76.6%),which were significantly higher than that of non-granular pseudo-depressed type(LST-NG-PD,33.3%,P < 0.05)and the granular nodular mixed type(LST-G-M,55.4%,P < 0.05).The dominating pathological type of LST-NG-FE was sessile serrated lesion(SSL),the rate of SSL was significantly higher than that in other subtypes(vs the granular homogenous type(LST-G-H),46.8% vs 5.9%,P < 0.05;vs LST-G-M,46.8% vs 3.1% P < 0.05;vs LST-NG-PD,46.8% vs 0.0%,P < 0.05).The rates of HGIN or cancerization were 80.0% in LST-NG-PD and 66.2%in LST-G-M,and both were significantly higher than that of LST-G-H(23.5%,P< 0.05)and LST-NG-FE(17.7%,P < 0.05).Regarding LSTs located in the rectum: The median diameter(19 mm)of LSTs located in the rectum was significantly larger than that in other locations(vs right colon 15 mm,P = 0.011;vs left colon 15 mm,P = 0.004).The proportion of LST-G-M subtype(58.5%)was significantly higher than that in other locations(vs right colon 20.8%,P < 0.05;vs left colon 12.2%,P < 0.05).The proportion of tubulovillous adenomas(68.3%)was significantly higher than that in other locations(vs right colon 24.9%,P < 0.05;vs left colon 26.8%,P < 0.05).The proportion of LSTs with HGIN or cancerization(70.7)was significantly higher than that in other locations(vs right colon 25.4%,P < 0.05;vs left colon36.6%,P < 0.05).3.Univariate and multivariate analysis of risk factors of LSTs with HGIN or cancerization:Univariate analysis showed that gender(P = 0.021),age ≥ 60 years(P =0.004),diameter ≥ 20 mm(P < 0.001),location in the rectum(P < 0.001),chicken skin mucosa(P < 0.001),combined with advanced adenoma(P = 0.025)and morphological classification(P < 0.001)were the risk factors of LSTs with HGIN or canceration.Further multivariate logistic regression analysis showed that male(OR = 2.994,95% CI 1.385-6.472,P = 0.005),location in the rectum(OR = 2.719,95% CI 1.012-7.304,P = 0.047),chicken skin mucosa(OR = 6.792,95% CI 2.569-17.962,P < 0.001),diameter ≥20 mm(OR = 5.412,95% CI2.564-11.423,P < 0.001),LST-G-M with large nodule(OR = 16.725,95% CI4.155-67.322,P < 0.001)and LST-NG-PD(OR= 22.456,95% CI 3.797-132.802,P = 0.001)were the independent risk factors of LSTs with HGIN or canceration.4.Diagnostic performance of JNET classification: The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of JNET type 1 for the diagnosis of hyperplastic polyp(HP)/ SSL were 94.3%,98.4%,95.7%,97.8%,and 97.3%,respectively;JNET type 2A for the diagnosis of adenoma/low grade intraepithelial neoplasia(LGIN)were 88.7%,70.3%,64.7%,91.0%,and 77.3%,respectively;JNET type 2B for the diagnosis of HGIN / superficial submucosal invasive carcinoma(SM-s)were 49.4%,93.5%,79.2%,78.7%,and 78.8%,respectively.Conclusions:1.Men aged ≥ 60 years old are the high-risk population of LSTs.Adenoma is the most common pathological type in LSTs.2.The morphological classification and the pathological type of rectal LSTs are mainly LST-G-M and tubulovillous adenoma,respectively.Meanwhile,rectal LSTs show larger lesion diameter and higher malignant potential than that of other locations.Morphological classification of the LSTs in the right colon is mainly LST-NG-FE,and the pathological type is mainly SSL.3.LSTs complicated with advanced adenoma may be a predictor of HGIN or canceration.4.Male,location in the rectum,chicken skin mucosa,diameter ≥ 20 mm,LST-G-M with large nodule,and LST-NG-PD are independent risk factors of LSTs with HGIN or canceration.5.JNET type 1 is a reliable indicator for the diagnosis of HP / SSL,and type 2A for the diagnosis of adenoma / LGIN and type 2B for HGIN/SM-s also have good clinical significance. |
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