Research On The Pathological Change Basis Of JNET Classification And Its Correlation With EMT In Colorectal Tumor

Objective:To investigate the pathological basis of JNET classification of colorectal tumors and its correlation with EMT.Methods: 81 cases with colorectal tumor lesions who completed narrow-band imaging combined with magnifying endoscopy and obtained postoperative pathological specimens(endoscopic surgery or surgical surgery)and 8 cases with colorectal cancer who underwent surgical surgery after routine imaging examination were collected from Affiliated Hospital of Guizhou Medical University from January 2015 to June 2018.A total of 89 cases of colorectal neoplastic lesions were studied.Among them,34 cases were adenomas,32 cases were high-grade intraneoplasia,14 cases were SM-1 4 cases,and 19 cases were SM-D.The narrow-band imaging combined with magnifying endoscopic images of the above 81 colorectal tumor lesions were reviewed,and JNET typing diagnosis and endoscopic features were recorded by senior endoscopic physicians.The accuracy,specificity,sensitivity,positive predictive value and negative predictive value of JNET typing diagnosis were calculated based on pathological diagnosis as gold standard.The above-mentioned 89 cases of colorectal neoplastic lesions were collected,the pathological characteristic records(epithelial exfoliation and necrosis of glandular fossa,necrotic structure of surface mucosa,sieve-like structure of surface mucosa,fibrogenic reaction,no residue of mucosal muscle,cancerous interstitial reaction)were completed by senior pathologists,and the expression of E-cad,a-SMA,P53,Ki-67 were determined by immunohistochemistry.Observing the pathological characteristics and immunohistochemical expression of each type in JNET typing.All the datas were statistically analyzed by SPSS22.Results: In JNET classification,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of type 2A in the diagnosis of adenoma were 82.2%,87.2%,83.3%,91.1% and 87.7% respectively.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of type 2B in the diagnosis of high-level intraepithelial neoplasia/submucosal superficial invasive carcinoma are 77.8%,84.4%,80.0%,82.6% and 81.5% respectively.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of type 3 for diagnosis of submucosal deep invasive carcinoma are 72.7%,97.1%,80.0%,95.8% and 93.8% respectively.In JNET classification,there are statistically significant differences among 2A,2B,and 3 types in surface mucosa necrosis structure,surface mucosa mesh-like structure,fibrous tissue reaction proliferation,mucosa muscle residue-free,and cancerous interstitial reaction.Among them,the frequency of surface mucosa necrosis structure is type 2A < type 2B and type 3;the frequency of the sieve-like structure of the surface mucosa is type 2A,type 3 < type 2B in JNET classification.The frequency of fibrous tissue reaction hyperplasia,no residue of mucosal muscle,and cancerous interstitial reaction is type 2A,type 2B < type 3.Whether the glandular fossa epithelium has shed or not and whether the superficial gland has necrosis or not have statistical significance between the JNET typing diagnosis coincidence group and the diagnosis non-coincidence group.Positive expression rates of a-SMA,P53,Ki67 and abnormal expression rates of E-cad are all 2A < 2B < 3 in JNET typing,with statistically significant differences.Among them,the positive rate of a-SMA and the abnormal expression rate of E-cad in type 3 are statistically significant compared with types 2A and 2B.The abnormal expression rate of E-cad was significantly different in the presence or absence of exfoliation of glandular fossa epithelium,sieve-like structure of surface mucosa,reactive hyperplasia of fibrous tissue,residual of mucous muscle and carcinomatous interstitial reaction.There was statistical significance in the presence or absence of reactive hyperplasia and carcinomatous interstitial reaction in fibrous tissue,the difference of a-SMA in fibrous tissue with or without reactive hyperplasia and carcinomatous interstitial reaction was statistically significant.The difference of p53 was statistically significant in the presence or absence of ethmoidal reticular structure,reactive hyperplasia of fibrous tissue,residual of mucous muscle and carcinomatous interstitial reaction.There were statistical differences in the presence or absence of reactive hyperplasia of fibrous tissue,residual mucosa muscle and carcinomatous interstitial reaction,the difference of Ki-67 in fibrous tissue with or without reactive hyperplasia,mucosal muscle residue and cancerous interstitial reaction was statistically significant.Conclusion: 1.The diagnostic efficiency of 2B type in JNET classification is lower than that of the other two types.2.Epithelial exfoliation and surface gland necrosis are pathological interference factors that may affect the accurate diagnosis of JNET typing.3.With the progress of colorectal adenoma,the EMT level of the lesion site gradually increases.When high-level intraepithelial neoplasia occurs,the corresponding pathological manifestation is the appearance of a sieve-like structure,which leads to the appearance of type 2B structure in JNET classification.When the lesion progresses to deep submucosal invasion,the pathological fibrous tissue hyperplasia,mucosal muscle destruction and cancerous interstitial reaction increase,resulting in the appearance of type 3 structure in JNET classification.