Diagnostic value, safety, and histopathologic discrepancy risk factors for endoscopic forceps biopsy and transrectal ultrasound-guided core needle biopsy in rectum lesions

Colorectal cancer is one of the most common malignancies worldwide, and its morbidity and mortality have been increasing over time in China (1,2). Accurate diagnosis of protruding lesions, especially in cancer in the rectum, is crucial for preoperative clinical staging and decision making for initial treatment; concerns and decisions include the extent of surgical resection (radical or palliative), surgical methods (such as transanal endoscopic microsurgery (3), endoscopic submucosal dissection, endoscopic mucosal resection or total mesorectal excision (4), and the use of preoperative chemotherapy/radiotherapy. The most common pathologic types of protruding lesions in the rectum include adenocarcinoma and adenoma, but other pathologic types [such as squamous cell carcinoma, mucinous adenocarcinoma, neuroendocrine cancer (5), and inflammatory polyps, etc.] have also been observed in patients. Although these other pathologic types have a low incidence, their treatments and prognosis are significantly different. Thus, preoperative pathologic diagnosis is very important