Forceps Biopsy under Direct Vision for Diagnosis of Early Cancer of the Colon and Rectum

Abstract

When early cancer of the colon and rectum is defined as in early gastric cancer, i, e., invasion is limited to the mucosa and submucosa, biopsy specimens of 45 lesions from 44 patients with early cancer of the colon and rectum were obtained by forceps during the last 22 years. Positive findings for cancer were found in 31 of 45 lesions (69%). Most of the lesions without positive findings were small polyps 9 mm or less in diameter and Ip with cancer limited to the mucosa. Seven percent of neoplastic polyps 9 mm or less in diameter, polypectomized endoscopically, were detected as early cancer and they constituted about a third of all early cancers diagnosed by endoscopic polypectomy.
Consequently, this study suggests that forceps biopsy is an incomplete method for the diagnosis of early cancer and endoscopic polypectomy is necessary to detect early cancer, even if polyps are 9 mm or less in diameter. We think that the value of forceps biopsy for the diagnosis of early cancer is limited with regard to both making a definitive diagnosis of Ila+Ilc and decisions on whether flat polyps, which cannot be polypectomized endoscopically, are neoplastic or not.