Endoscopic mucosal ressection: aspects and histopathology of colorrectal lesions

Abstract

BACKGROUND: Colorectal cancer stands out globally in prevalence and mortality among all malignant neoplasms. Endoscopic mucosal resection (EMR) is a colonoscopic technique for removing large colorectal lesions, which have no apparent signs of invasive cancer but can be pre-malignant. These lesions are noticed regarding some important aspects: anatomical location, size, morphology by the Paris Classification, laterally spreading tumors (LST) subtype if lesion ≥10 millimeters (mm), crypts pattern on its surface according to the Kudo Classification, en bloc or piecemeal resection technique, and, ultimately, its histopathology by the classification of colon and rectum tumors of the World Health Organization. OBJETIVE: This study aimed to analyze the endoscopic and histopathological aspects of lesions submitted to EMR, during the colonoscopy, in a private clinic that has local influence in Southern of Santa Catarina, Brazil. METHODS: In a private clinic that has local influence in Southern of Santa Catarina, was performed a selection of medical records containing EMR performed between January 2016 and July 2020, followed by secondary data collection. Problems related to missing endoscopic elements in the medical records were solved with the with the specialist (M.C.B.C.) who performed most of the EMR procedures, via analysis of the images (photos) of the colonoscopy exams. The next step took place at three histopathological analysis laboratories, where the resected lesions were sent, and the remaining data were collected. Finally, the data gathered were then transcribed to an electronic media and analyzed statistically, using the IBM Statistical Package for the Social Sciences software, version 21.0. RESULTS: Low-grade tubulovillous adenoma had a higher mean size when compared to histopathological types of low-grade tubular adenoma and hyperplastic polyp (p = 0.031). There was an association (p = 0.033) between lesion with size from 0 to 9 mm and low-grade tubular adenoma, 10 to 19 mm and sessile serrated lesion, and ≥ 30 mm and low-grade tubulovillous adenoma. Sessile serrated lesions were mostly located in the ascending colon, while low-grade tubulovillous adenomas were located in the rectum (p = 0.003). When LSTs were analyzed, there was statistical significance (p < 0.001) in those classified as granular for the low-grade tubular adenoma and low-grade tubulovillous adenoma types, as well as those classified as non-granular for the sessile serrated lesion and polyp hyperplastic. Regarding the pattern of Kudo crypts, there was statistical significance (p < 0.001) in the comparison between type II and hyperplastic polyp, between type IIO and the sessile serrated lesion, between type IIIL and low tubular adenoma grade, and between types IV and IIIL + IV and low grade tubulovillous adenoma.