The Diagnostic Value Of Magnifying Endoscope Combined With Narrow-band Imaging In Laterally Spreading Tumor

Background and ObjectiveWith the improvement of living standards in China,the incidence of colorectal cancer(CRC)is increasing year by year.As an important precancerous lesion of CRC,a laterally spreading tumor(LST)can be developed into cancer within 3 years.LST refers to the superficial and elevated lesion extending along the intestinal wall,but not to the deep vertical infiltration.LST could be divided into granular type and non-granular type,granular type could be subdivided into homogeneous type and nodular mixed type,and non-granular type could be subdivided into flat bump type and pseudoconcave type.Different types of LST have different clinicopathologic features.LST don't have specific mucosal changes under ordinary white light endoscopy(WLI),so the missed diagnosis rate is higher.With the development of endoscopy and the recognition of LST by clinicians,the screening rate of LST was improved gradually.Magnifying endoscopy with narrow band imaging(ME-NBI)is a new technique,its application in colorectal lesions is increasing year by year.In this study,we observed the morphological characteristics of LST from January 2015 to November 2018 in the Center of Digestive Endoscopy of our hospital under the ME-NBI model.Combined with the sex,age,size and location of the lesion,the Pit pattern classification of the surface glandular orifice of LST was carried out.The classification of mucosal capillaries Sano and postoperative pathological types were comprehensively analyzed.By analyzing the predictive value of ME-NBI to the pathological types of LST,the diagnostic value of ME-NBI for LST was evaluated in order to better select the therapeutic scheme of LST.Materials and MethodsCases with complete clinical data diagnosed as LST were retrospectively analyzed from January 2015 to November 2018 in the Center of Endoscopy of Digestive Endoscopy of the second affiliated Hospital of Zhengzhou University.A total of 67 cases were included,including 31 males and 36 females,with an average age of 62.00±13.69 years,and an average diameter of 24.40±15.72 millimetre.Research based on the LST endoscopic morphology characteristics of endoscopic classification,the opening of the gland was observed under the ME-NBI micro-structure type,such as capillary parting surface,combined with the lesion size,location,pathological type and so on carries on the comprehensive analysis.To explore the ME-NBI for LST pathological type of predictive value and the value of diagnosis.All data were analyzed by SPSS 24.0 software.Results(1)The relationship between LST endoscopic typing and the age,diameter and sex of the patients.In 67 cases,18 cases were LST-G-H,24 cases were LST-G-M,23 cases were LST-NG-F and 2 cases were LST-NG-PD.The mean age of LST patients was 62.00±13.69 years,and the mean diameter was 24.40±15.72 millimetre.Among them,31 cases were male and 36 cases were female.The lesion was mainly located in rectum,accounting for 38.8%(26/67).LST-G-H and LST-G-M mainly occurred in the rectum,LST-NG-F occurred mainly in the descending colon,2 cases of LST-NG-PD,one occurred in the descending colon,another occurred in the descending colon.There was no statistically significant difference in the LST endoscopic typing,age,diameter or gender.(P>0.05)(2)The relationship between LST Endoscopic typing and pathological typesIn 67 cases of lateral developmental tumors,the main pathological types were tubular adenomas,accounting for 40.3%(27/67).There was significant difference between endoscopic classification and pathological type by Fisher's accurate probability analysis(P < 0.01).The endoscopic classification of all the 6 cases of intramucosal carcinoma was LST-G-M,and among the 3 cases of submucosal carcinoma,2 cases were LST-G-M and 1 case was LST-NG-F,indicating that LST-G-M and LST-NG-F of lesions had higher cancer rate.(3)The relationship between glandular orifice,capillary classification and pathological type of LSTIn 67 cases of LST,the main types of ductal orifice were type ?L(50.7%)and type ?(26.9%),and capillary classification was mainly CP type ?(61.2%).The accurate probability test of Fisher's showed that there were significant differences between pathological type and glandular orifice and capillary classification(P < 0.01).If the opening of inferior glandular duct in ME-NBI is type ?I or ?N,and the type of capillaries is CP?A and CP?B,the possibility of intramucosal and invasive carcinoma should be highly vigilant.ConclusionsEndoscopic classification is LST-G-M and LST-NG-F,the opening of inferior glandular duct in ME-NBI is type ?I or ?N,the capillary type is CP?A,CP?B,it is necessary to pay close attention to the carcinogenesis of the lesion.It is recommended that ESD be performed for complete resection of the lesion.