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. 2024 Apr 3;14(4):2762-2773.
doi: 10.21037/qims-23-1451. Epub 2024 Mar 15.

Transrectal contrast-enhanced ultrasound-guided transperineal core-needle biopsy versus endoscopic forceps biopsy in the diagnosis of complex rectal lesions

Qiong Zhang  1 , Tingting Qiu  1 , Hua Zhuang  1 , Youxiang Ren  1 , Wenwu Ling  1 , Yan Luo  1
Affiliations

Transrectal contrast-enhanced ultrasound-guided transperineal core-needle biopsy versus endoscopic forceps biopsy in the diagnosis of complex rectal lesions

Qiong Zhang et al. Quant Imaging Med Surg. .

Abstract

Background: The preoperative pathological diagnosis of rectal lesions is crucial for formulating treatment plans. For subepithelial lesions (SELs) and larger lesions with necrosis of the rectum, endoscopic forceps biopsy (EFB) cannot provide an accurate pathological diagnosis in most cases. By comparing the efficacy and safety of transrectal contrast-enhanced ultrasound-guided transperineal core-needle biopsy (TRCEUS-TP-CNB) and EFB, this study explored the value of TRCEUS-TP-CNB in the diagnosis of complex rectal lesions, such as SELs.

Methods: A retrospective, cross-sectional study was conducted with 32 consecutive patients with complex rectal lesions admitted to our hospital from May 2016 to June 2022. Clinical, ultrasound, and pathological data were collected from these patients who underwent EFB followed by TRCEUS-TP-CNB.

Results: The success rate of EFB was 21.88% (7/32) and that of TRCEUS-TP-CNB was 93.75% (30/32). No significant complications were observed for either biopsy method. Factors affecting the success rate of EFB included the lesion width (cm) (1.90±0.62 vs. 4.26±2.40, P<0.001) and lesion thickness (cm) (1.29±0.51 vs. 2.96±1.75, P<0.001). The success rate of TRCEUS-TP-CNB was not affected by these factors. In the paired study of TRCEUS-TP-CNB and EFB, the times of samples per person (1 vs. 2.14±0.90, P=0.015), number of specimens per sample (8.27±1.93 vs. 3.31±1.67, P<0.001), lesion width (cm) (3.79±2.42 vs. 1.90±0.62, P=0.001), and lesion thickness (cm) (2.64±1.75 vs. 1.29±0.51, P=0.001) were the factors affecting the difference of the sampling success rate. In the SELs, the success rate of EFB was 10% (1/10) and that of TRCEUS-TP-CNB was 100% (10/10), and the difference between the two groups was statistically significant (P=0.004).

Conclusions: TRCEUS-TP-CNB is an effective biopsy method for complex rectal lesions. The success rate of EFB is lower in the larger lesions. Compared with EFB, TRCEUS-TP-CNB required fewer times of samples be taken and obtained more specimens. For larger lesions and SELs of the rectum, TRCEUS-TP-CNB is expected to become one of the preferred biopsy methods.

Keywords: Transperineal core-needle biopsy (TP-CNB); biplane transrectal ultrasonography; contrast-enhanced ultrasound (CEUS); endoscopic forceps biopsy (EFB); rectal lesions.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-23-1451/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart displaying the number of patients enrolled in the study. TRCEUS-TP-CNB, transrectal contrast-enhanced ultrasound-guided transperineal core-needle biopsy; EFB, endoscopic forceps biopsy.
Figure 2
Figure 2
Ultrasound manifestations and pathological results of rectal GIST with extensive necrosis. (A) Transrectal CEUS: a large area of no enhancement can be observed near the rectal wall in the mass. (B) TRCEUS-TP-CNB: under the guidance of CEUS, the puncture needle was inserted into the enhanced area of the mass for biopsy. (C) The pathological result of endoscopic forceps biopsy: inflammation (H&E stain, ×40 magnification). (D) The pathological result of TRCEUS-TP-CNB: GIST (H&E stain, ×200 magnification). Diagnosis after resection of the mass: GIST. GIST, gastrointestinal stromal tumor; CEUS, contrast-enhanced ultrasound; TRCEUS-TP-CNB, transrectal contrast-enhanced ultrasound-guided transperineal core-needle biopsy; H, hematoxylin; E, eosin.
Figure 3
Figure 3
Ultrasound manifestations and pathological results of rectal subepithelial lesion. (A) Transrectal ultrasound: the mass was located in the submucosa of the rectum. (B) TRCEUS-TP-CNB of the mass. (C) The pathological result of endoscopic forceps biopsy: inflammation with lymphoid hyperplasia (H&E stain, ×40 magnification). (D) The pathological result of TRCEUS-TP-CNB: sarcoma (H&E stain, ×200 magnification). The patient was treated with drugs due to coronary heart disease and its complications. Final clinical diagnosis: sarcoma. TRCEUS-TP-CNB, transrectal contrast-enhanced ultrasound-guided transperineal core-needle biopsy; H, hematoxylin; E, eosin.
Figure 4
Figure 4
Suggested algorithm for selecting biopsy methods for complex rectal lesions. EFB, endoscopic forceps biopsy; TRCEUS, transrectal contrast-enhanced ultrasound; TRCEUS-TP-CNB, transrectal contrast-enhanced ultrasound-guided transperineal core-needle biopsy; SELs, subepithelial lesions.
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