MULTICENTER STUDY ON THE EFFECT OF ENDOSCOPIC SUBMUCOSAL DISSECTION ON HISTOLOGICAL DIAGNOSIS IN COLORECTAL NEOPLASIA: A BLIND STUDY BY PATHOLOGICAL ASSESSMENT
DDW ePoster Library. Yang D. 05/02/26; 4197920; Su1398
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Abstract
Discussion Forum (0)
Background: Histopathologic diagnosis obtained by endoscopic forceps biopsy (EFB) of colorectal neoplasms have traditionally been used to aid preoperative management decisions. Discrepancy from biopsy results from EFB and final pathology can adversely impact outcomes. The aim of this study was to evaluate the effect of endoscopic submucosal dissection (ESD) on histologic diagnosis of colorectal neoplasms.
Methods:
Two-center study on all consecutive patients who underwent colorectal ESD between January 2019 to July 2025 in which EFB and ESD histological specimens were available for review. The histological concordance (upstaging or downstaging) between EFB and ESD histology was determined based on the official (chart) pathologic interpretation. To further validate our findings, two expert GI pathologists re-evaluated all EFB and ESD histology slides in a blind fashion. Interobserver variability was defined as discrepancy between chart and blind pathologic interpretations.
Results:
A total of 160 patients (median age 65 years, 50% women) underwent colorectal ESD (median lesion size 35 mm) during the study period (Table 1). Based on the official (chart) pathologic interpretation (Table 2), ESD changed the histologic diagnosis in 68 (42.5%) of the cases, of which 80.1% were upstaged and 19.1% were downstaged. Discrepancy between EFB and ESD histology remained after repeat blind pathological assessment, with ESD changing histologic diagnosis in 46.9% of the cases (Figure 1). In aggregate, 17 out of the 68 cases (25%) were upstaged on invasive cancer on ESD histopathology. Interobserver variability was significantly higher for EFB vs. ESD histology specimens (35.6% vs. 16.2%; p<0.001).
Conclusion:
ESD led to a change of diagnosis in nearly half of patients with colorectal neoplasms, including upstaging to cancer in 25% of these cases. Caution should be exerted when making decisions on treatment modality based on EFB histopathology alone. ESD may serve as a potential diagnostic and staging tool, particularly in those with suspected invasive disease.
Methods:
Two-center study on all consecutive patients who underwent colorectal ESD between January 2019 to July 2025 in which EFB and ESD histological specimens were available for review. The histological concordance (upstaging or downstaging) between EFB and ESD histology was determined based on the official (chart) pathologic interpretation. To further validate our findings, two expert GI pathologists re-evaluated all EFB and ESD histology slides in a blind fashion. Interobserver variability was defined as discrepancy between chart and blind pathologic interpretations.
Results:
A total of 160 patients (median age 65 years, 50% women) underwent colorectal ESD (median lesion size 35 mm) during the study period (Table 1). Based on the official (chart) pathologic interpretation (Table 2), ESD changed the histologic diagnosis in 68 (42.5%) of the cases, of which 80.1% were upstaged and 19.1% were downstaged. Discrepancy between EFB and ESD histology remained after repeat blind pathological assessment, with ESD changing histologic diagnosis in 46.9% of the cases (Figure 1). In aggregate, 17 out of the 68 cases (25%) were upstaged on invasive cancer on ESD histopathology. Interobserver variability was significantly higher for EFB vs. ESD histology specimens (35.6% vs. 16.2%; p<0.001).
Conclusion:
ESD led to a change of diagnosis in nearly half of patients with colorectal neoplasms, including upstaging to cancer in 25% of these cases. Caution should be exerted when making decisions on treatment modality based on EFB histopathology alone. ESD may serve as a potential diagnostic and staging tool, particularly in those with suspected invasive disease.
Background: Histopathologic diagnosis obtained by endoscopic forceps biopsy (EFB) of colorectal neoplasms have traditionally been used to aid preoperative management decisions. Discrepancy from biopsy results from EFB and final pathology can adversely impact outcomes. The aim of this study was to evaluate the effect of endoscopic submucosal dissection (ESD) on histologic diagnosis of colorectal neoplasms.
Methods:
Two-center study on all consecutive patients who underwent colorectal ESD between January 2019 to July 2025 in which EFB and ESD histological specimens were available for review. The histological concordance (upstaging or downstaging) between EFB and ESD histology was determined based on the official (chart) pathologic interpretation. To further validate our findings, two expert GI pathologists re-evaluated all EFB and ESD histology slides in a blind fashion. Interobserver variability was defined as discrepancy between chart and blind pathologic interpretations.
Results:
A total of 160 patients (median age 65 years, 50% women) underwent colorectal ESD (median lesion size 35 mm) during the study period (Table 1). Based on the official (chart) pathologic interpretation (Table 2), ESD changed the histologic diagnosis in 68 (42.5%) of the cases, of which 80.1% were upstaged and 19.1% were downstaged. Discrepancy between EFB and ESD histology remained after repeat blind pathological assessment, with ESD changing histologic diagnosis in 46.9% of the cases (Figure 1). In aggregate, 17 out of the 68 cases (25%) were upstaged on invasive cancer on ESD histopathology. Interobserver variability was significantly higher for EFB vs. ESD histology specimens (35.6% vs. 16.2%; p<0.001).
Conclusion:
ESD led to a change of diagnosis in nearly half of patients with colorectal neoplasms, including upstaging to cancer in 25% of these cases. Caution should be exerted when making decisions on treatment modality based on EFB histopathology alone. ESD may serve as a potential diagnostic and staging tool, particularly in those with suspected invasive disease.
Methods:
Two-center study on all consecutive patients who underwent colorectal ESD between January 2019 to July 2025 in which EFB and ESD histological specimens were available for review. The histological concordance (upstaging or downstaging) between EFB and ESD histology was determined based on the official (chart) pathologic interpretation. To further validate our findings, two expert GI pathologists re-evaluated all EFB and ESD histology slides in a blind fashion. Interobserver variability was defined as discrepancy between chart and blind pathologic interpretations.
Results:
A total of 160 patients (median age 65 years, 50% women) underwent colorectal ESD (median lesion size 35 mm) during the study period (Table 1). Based on the official (chart) pathologic interpretation (Table 2), ESD changed the histologic diagnosis in 68 (42.5%) of the cases, of which 80.1% were upstaged and 19.1% were downstaged. Discrepancy between EFB and ESD histology remained after repeat blind pathological assessment, with ESD changing histologic diagnosis in 46.9% of the cases (Figure 1). In aggregate, 17 out of the 68 cases (25%) were upstaged on invasive cancer on ESD histopathology. Interobserver variability was significantly higher for EFB vs. ESD histology specimens (35.6% vs. 16.2%; p<0.001).
Conclusion:
ESD led to a change of diagnosis in nearly half of patients with colorectal neoplasms, including upstaging to cancer in 25% of these cases. Caution should be exerted when making decisions on treatment modality based on EFB histopathology alone. ESD may serve as a potential diagnostic and staging tool, particularly in those with suspected invasive disease.
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