Endoscopic and clinicopathological analysis of 188 cases of laterally spreading tumor
Objective To summarize and evaluate the clinicopathological and endoscopic characteristics of laterally spreading tumor(LST).Methods A retrospective analysis was conducted on patients diagnosed with LST who under-went endoscopic treatment at the Department of Gastroenterology,Beijing Shijitan Hospital,Capital Medical University from Dec.2010 to Dec.2019.Based on the endoscopic characteristics of LST lesions,they were divided into two sub-groups and four subtypes.Relevant data such as general clinical data,endoscopic characteristics,histopathological fea-tures,and treatment methods were summarized and analyzed.Results(1)Endoscopic features:a total of 176 patients with LST(188 lesions)were collected.The LST-NG subgroup had the highest proportion of lesions.The diameter range of LST lesions was(22.48±12.26)mm(10-65 mm).The LST-G group had a larger lesion diameter than the LST-NG group(P<0.001).LST-G and LST-NG were more common in the ascending colon,while LST-G was more common in the rectum than LST-NG(χ2=42.360,P<0.001).The sensitivity and specificity of NICE classification for the diagno-sis of non-neoplastic polyps,cancer and precancerous lesions were 97.9%and 82.6%,respectively,with a Kappa val-ue of 0.820(P<0.001).NICE classification showed high consistency with the pathological gold standard.(2)Patho-logical features:the LST subgroup was mainly composed of tubular adenomas.The cancer transformation rate of LST-NG(including HGIN)was 41.9%higher than that of LST-G(χ2=14.63,P<0.01).There were no significant differences in microsatellite instability,p53 expression,and Ki-67 proliferation index between LST subgroups(P>0.05).(3)Treatment methods:for colon lesions,EMR and ESD treatment were often chosen.For rectal lesions,ESD and surgical treatment were often chosen(χ2=19.596,P<0.01).For lesions smaller than 20 mm,EMR treatment was often cho-sen.For lesions larger than 20 mm,ESD treatment was often chosen.For lesions larger than 30 mm,the proportion of surgical treatment gradually increased(χ2=102.725,P<0.01).Conclusion The clinical characteristics and endo-scopic manifestations of LST have certain specificity.Clinical attention should be paid to identifying LST lesions,impro-ving LST detection,and adopting appropriate treatment plans for different lesions.
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