Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2017; 9(6): 251-256
Published online Jun 15, 2017. doi: 10.4251/wjgo.v9.i6.251
Value of macrobiopsies and transanal endoscopic microsurgery in the histological work-up of rectal neoplasms: A retrospective study
Guus M J Bökkerink, Gert-Jan van der Wilt, Dirk de Jong, Han H J M van Krieken, Robert P Bleichrodt, Johannes H W de Wilt, Andreas J A Bremers
Guus M J Bökkerink, Johannes H W de Wilt, Andreas J A Bremers, Department of Surgery, Radboud University Nijmegen Medical Center, 6525 GA Nijmegen, The Netherlands
Gert-Jan van der Wilt, Department of Health Evidence, Radboud University Nijmegen Medical Center, 6525 GA Nijmegen, The Netherlands
Dirk de Jong, Department of Gastroenterology, Radboud University Nijmegen Medical Center, 6525 GA Nijmegen, The Netherlands
Han H J M van Krieken, Department of Pathology, Radboud University Nijmegen Medical Center, 6525 GA Nijmegen, The Netherlands
Robert P Bleichrodt, Department of of Surgery, Saint Francis Hospital, Katete, Zambia
Author contributions: Bökkerink GMJ designed the study, collected the data, performed analysis and wrote the manuscript; de Jong D provided the endoscopy-reports and contributed to the discussion; van der Wilt GJ assisted in the statistical analysis and calculations to compare various work-up schemes; van Krieken HHJM provided the histopathological reports and contributed to the discussion; de Wilt JHW supervised the first author; Bleichrodt RPB and Bremers AJA designed the study, performed the definitive surgery and supervised the first author.
Institutional review board statement: This study was performed in accordance to the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments; this study was exempted from informed consent according to Dutch regulations.
Informed consent statement: This study was exempted from informed consent according to Dutch regulations.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Guus MJ Bökkerink, MD, Department of Surgery, Radboud University Nijmegen Medical Center, P.O.Box 9101, 6525 GA Nijmegen, The Netherlands. guus.bokkerink@radboudumc.nl
Telephone: +31-24-3617365 Fax: +31-24-3540501
Received: January 11, 2017
Peer-review started: Janaury 12, 2017
First decision: March 7, 2017
Revised: April 3, 2017
Accepted: May 22, 2017
Article in press: May 24, 2017
Published online: June 15, 2017
Abstract
AIM

To evaluate a step up approach: Taking macrobiopsies and performing excision biopsies in patients with suspected rectal cancer in which biopsies taken though the flexible endoscope showed benign histology.

METHODS

Patients with a rectal neoplasm who underwent flexible endoscopy and biopsies were included. In case of benign biopsies rigid rectoscopy and macrobiopsies were employed. If this failed to prove malignancy, transanal endoscopic microsurgery (TEM) was used in a final effort to establish a certain preoperative diagnosis. The preoperative results were compared with the findings after surgical excision and follow up to calculate the reliability of this algorithm.

RESULTS

One hundred and thirty-two patients were included. One hundred and ten patients with a carcinoma and 22 with an adenoma. Seventy-five of 110 carcinomas were proven malignant after flexible endoscopy. With the addition of rigid endoscopy and taking of macrobiopsies, this number increased to 89. Performing TEM excision biopsies further enlarged the number of proven malignancies to 100.

CONCLUSION

The step-up approach includes taking macrobiopsies through the rigid rectoscope and performing excision biopsies using transanal endoscopic microsurgery in addition to flexible endoscopy. This approach, reduced the number of missed preoperative malignant diagnoses from 32% to 9%.

Keywords: Rectal cancer, Histology, Biopsy, Macrobiopsy, Transanal endoscopic microsurgery, Sampling error

Core tip: Increasing the number of biopsies taken through a flexible endoscope, taking macrobiopsies and performing excision biopsies with transanal endoscopic microsurgery can reduce the number of missed preoperative malignant diagnoses in patients with rectal cancer.