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. 2017 Jun 15;9(6):251-256.
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  1 , Gert-Jan van der Wilt  1 , Dirk de Jong  1 , Han H J M van Krieken  1 , Robert P Bleichrodt  1 , Johannes H W de Wilt  1 , Andreas J A Bremers  1
Affiliations

Value of macrobiopsies and transanal endoscopic microsurgery in the histological work-up of rectal neoplasms: A retrospective study

Guus M J Bökkerink et al. World J Gastrointest Oncol. .

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: Biopsy; Histology; Macrobiopsy; Rectal cancer; Sampling error; Transanal endoscopic microsurgery.

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Conflict of interest statement

Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.

Figures

Figure 1
Figure 1
Biopsy focepses and histological slides. A: Biopsy forceps used with the flexible endoscope: Representative slide of a malignant tumor, HE × 20; B: Biopsy forceps used with the rigid endoscope, representative slide of the same tumor, HE × 20.
Figure 2
Figure 2
Diagnostic and therapeutic algorithm. TEM: Transanal endoscopic microsurgery.
Figure 3
Figure 3
Yield of macrobiopsies en excision biopsies. 1Fourteen not earlier detected carcinomas; 2Eleven not earlier detected carcinomas.
See this image and copyright information in PMC

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