Clinical Research Papers:
The value of forceps biopsy and core needle biopsy in prediction of pathologic complete remission in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy
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Jing-Hua Tang1,2,*, Xin An1,3,*, Xi Lin1,4,*, Yuan-Hong Gao1,5, Guo-Chen Liu1,2, Ling-Heng Kong1,2, Zhi-Zhong Pan1,2, Pei-Rong Ding1,2
1State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
2Departments of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
3Departments of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
4Departments of Ultrasound, Sun Yat-sen University Cancer Center, Guangzhou, China
5Departments of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
*These authors have contributed equally to this work
Pei-Rong Ding, e-mail: [email protected]
Zhi-Zhong Pan, e-mail: [email protected]
Keywords: forceps biopsy, core needle biopsy, locally advanced rectal cancer, neoadjuvant chemoradiotherapy
Received: June 22, 2015 Accepted: September 08, 2015 Published: September 18, 2015
Patients with pathological complete remission (pCR) after treated with neoadjuvant chemoradiotherapy (nCRT) have better long-term outcome and may receive conservative treatments in locally advanced rectal cancer (LARC). The study aimed to evaluate the value of forceps biopsy and core needle biopsy in prediction of pCR in LARC treated with nCRT. In total, 120patients entered this study. Sixty-one consecutive patients received preoperative forceps biopsy during endoscopic examination. Ex vivo core needle biopsy was performed in resected specimens of another 43 consecutive patients. The accuracy for ex vivo core needle biopsy was significantly higher than forceps biopsy (76.7% vs. 36.1%; p < 0.001). The sensitivity for ex vivo core needle biopsy was significantly lower in good responder (TRG 3) than poor responder (TRG ≤ 2) (52.9% vs. 94.1%; p = 0.017). In vivo core needle biopsy was further performed in 16 patients with good response. Eleven patients had residual cancer cells in final resected specimens, among whom 4 (36.4%) patients were biopsy positive. In conclusion, routine forceps biopsy was of limited value in identifying pCR after nCRT. Although core needle biopsy might further identify a subset of patients with residual cancer cells, the accuracy was not substantially increased in good responders.
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