Endoscopy 2011; 43(10): 856-861
DOI: 10.1055/s-0030-1256639
Original article
© Georg Thieme Verlag KG Stuttgart · New York

The Cooperative Italian FLIN Study Group: prevalence and clinico-pathological features of colorectal laterally spreading tumors

G. Rotondano
1   Gastroenterology, Hospital Maresca, Torre del Greco, Italy
M. A. Bianco
1   Gastroenterology, Hospital Maresca, Torre del Greco, Italy
F. Buffoli
2   Gastroenterology, Azienda Ospedaliera di Cremona, Cremona, Italy
G. Gizzi
3   Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy
F. Tessari
4   Electronic Data Processing, “Idea 99”, Padua, Italy
L. Cipolletta
1   Gastroenterology, Hospital Maresca, Torre del Greco, Italy
› Author Affiliations
Further Information

Publication History

submitted06 October 2010

accepted after revision 15 May 2011

Publication Date:
08 August 2011 (online)

Background and study aims: Laterally spreading tumors (LSTs) are increasingly recognized as important precursors of colorectal carcinoma. The clinical behavior of these large nonpolypoid lesions is still uncertain. The aim of the present study was to assess prevalence and clinico-pathological features of LSTs in a large Italian cohort of patients.

Methods: The study was a subgroup analysis of a large database of patients undergoing total colonoscopy. The database originated from a multicenter cross-sectional observational study involving 80 centers throughout Italy.

Results: Data from 27 400 total colonoscopies were analyzed. Precancerous lesions were detected in 5609 patients. Of these, LSTs were identified in 254 patients (4.5%; 95% confidence interval [CI] 3.5–6.2). Granular-type LSTs (G-LSTs) accounted for 83% of the cases (211/254). LSTs were predominant in the proximal colon (154, 60.6%). A total 231 lesions were endoscopically removed, with histology being available for 242. Neoplasia was confirmed in 225 lesions (93.4%) (143 low grade adenoma, 76 high grade adenoma, and six submucosal cancer). The six cases of submucosally invasive carcinoma were diagnosed in five G-LST and one nongranular LST (NG-LST). The risk of containing advanced histology was not increased in G-LST compared with NG-LST (odds ratio [OR] 1.55, 95%CI 0.73–3.27); it was significantly higher in lesions with large nodules (OR 3.09, 95%CI 1.05–9.04; P = 0.041) or depressed surface (OR 4.27, 95%CI 1.24–14.61; P = 0.021).

Conclusions: LSTs represent approximately 5% of all precancerous colorectal lesions in the Italian population and are prevalent in the proximal colon. These lesions are no more likely to harbor advanced histology than similar-sized polypoid lesions. Large nodularity or depressed surface are risk factors for advanced histology.

  • References

  • 1 Ferlay J, Parkin DM, Steliarova-Foucher E. Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer 2010; 46: 765-781
  • 2 Jemal A, Siegel R, Ward E et al Cancer statistics, 2008. CA Cancer J Clin 2008; 58: 71-96
  • 3 Kudo S, Kashida H, Tamura T et al Colonoscopic diagnosis and management of nonpolypoid early colorectal cancer. World J Surg 2000; 24: 1081-1090
  • 4 Kudo S, Lambert R, Allen JI et al Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc 2008; 68 (S4): S3-47
  • 5 Soetikno R, Friedland S, Kaltenbach T et al Nonpolypoid (flat and depressed) colorectal neoplasms. Gastroenterology 2006; 130: 566-576
  • 6 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: Novemver 30 to December 1, 2000. Gastrointest Endosc 2003; 58 (S6): S3-43
  • 7 Jaramillo E, Watanabe M, Slezak P et al Flat neoplastic lesions of the colon and rectum detected by high-resolution video endoscopy and chromoscopy. Gastrointest Endosc 1995; 42: 114-122
  • 8 Kudo S, Tamura S, Nakajima T et al Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 1996; 44: 8-14
  • 9 Tamura S, Nakajo K, Yokoyama Y et al Evaluation of endoscopic mucosal resection for laterally spreading rectal tumors. Endoscopy 2004; 36: 306-312
  • 10 Uraoka T, Saito Y, Matsuda T et al Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut 2006; 55: 1592-1597
  • 11 Ross AS, Waxman I. Flat and depressed neoplasms of the colon in Western populations. Am J Gastroenterol 2006; 101: 172-180
  • 12 Soetikno RM, Kaltenbach T, Rouse RV et al Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA 2008; 299: 1027-1035
  • 13 Chiu HM, Lin JT, Chen CC et al Prevalence and characteristics of nonpolypoid colorectal neoplasm in an asymptomatic and average-risk Chinese population. Clin Gastroenterol Hepatol 2009; 7: 463-470
  • 14 Bianco MA, Cipolletta L, Rotondano G et al. Flat Lesions Italian Network (FLIN). Prevalence of nonpolypoid colorectal neoplasia: an Italian multicenter observational study. Endoscopy 2010; 42: 279-285
  • 15 Lambert R, Kudo SE, Vieth M et al Pragmatic classification of superficial neoplastic colorectal lesions. Gastrointest Endosc 2009; 70: 1182-1199
  • 16 Rex DK, Petrini JL, Baron TH et al Quality indicators for colonoscopy. Gastrointest Endosc 2006; 63 (S4): S16-28
  • 17 Dixon MF. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut 2002; 51: 130-131
  • 18 Bianco MA, Rotondano G, Marmo R et al Predictive value of magnification chromoendoscopy for diagnosing invasive neoplasia in nonpolypoid colorectal lesions and stratifying patients for endoscopic resection or surgery. Endoscopy 2006; 38: 470-476
  • 19 Eguchi H, Hasegawa H, Yamada H et al Large granule-aggregating non-polypoid colorectal neoplasm: a clinically-important entity with unique cell loss and proliferation kinetics. Eur J Med Res 2007; 12: 277-283
  • 20 Hiraoka S, Kato J, Tatsukawa M et al Laterally spreading type of colorectal adenoma exhibits a unique methylation phenotype and K-ras mutations. Gastroenterology 2006; 131: 379-389
  • 21 Sugimoto T, Ohta M, Ikenoue T et al Macroscopic morphologic subtypes of laterally spreading colorectal tumors showing distinct molecular alterations. Int J Cancer 2010; 127: 1562-1569
  • 22 Yoshikane H, Hidano H, Sakakibara A et al Endoscopic resection of laterally spreading tumours of the large intestine using a distal attachment. Endoscopy 1999; 31: 426-430
  • 23 Toyonaga T, Man-i M, Fujita T et al Retrospective study of technical aspects and complications of endoscopic submucosal dissection for laterally spreading tumors of the colorectum. Endoscopy 2010; 42: 714-722
  • 24 Tanaka S, Haruma K, Oka S. Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm. Gastrointest Endosc 2001; 54: 62-66
  • 25 Saito Y, Fujii T, Kondo H et al Endoscopic treatment for laterally spreading tumors in the colon. Endoscopy 2001; 33: 682-686
  • 26 Tamegai Y, Saito Y, Masaki N et al Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy 2007; 39: 418-422
  • 27 Fujishiro M, Yahagi N, Kakushima N et al Successful endoscopic en bloc resection of a large laterally spreading tumor in the rectosigmoid junction by endoscopic submucosal dissection. Gastrointest Endosc 2006; 63: 178-183
  • 28 Cipolletta L, Rotondano G, Bianco MA et al Self-assembled hydro-jet system for submucosal elevation before endoscopic resection of nonpolypoid colorectal lesions. Gastrointest Endosc 2009; 70: 1018-1022
  • 29 Huang Y, Liu S, Gong W et al Clinicopathologic features and endoscopic mucosal resection of laterally spreading tumors: experience from China. Int J Colorectal Dis 2009; 24: 1441-1450