区分结肠息肉中的高级别异型增生（HGD）和T1结直肠癌（T1CRC）与低级别异型增生（LGD）可能会具有挑战性。对HGD或T1CRC聚焦的错误识别可能导致需要额外的治疗，在局部切除后这可能是不必要的，如果正确识别就不会出现这种情况。肿瘤靶向荧光引导内窥镜可能有助于改善识别。从一系列已建立的生物标志物中选择最适合HGD和T1CRC特异成像靶点：癌胚抗原（CEA），c-介导上皮细胞转化因子（c-MET），上皮细胞黏附分子（EpCAM），叶酸受体阿尔法（FRα）和整合素αvβ6（αvβ6）。选择携带HGD或T1CRC的结肠息肉的整块切除标本。对蜡片进行免疫组织化学染色以确定正常上皮，LGD，HGD和T1CRC（得分为0-12）的生物标志物表达。评估HGD-T1CRC组分与周围LGD和正常组分的差异表达，以及每个标记的灵敏度和特异性。包括60个标本（21 HGD，39 T1CRC）。发现在CEA，c-MET和EpCAM中的HGD-T1CRC组分中有73.3％，78.3％和100％的阳性表达（得分> 1），而在FRα和αvβ6中则少于40％。对于CEA（66.1％）而不是c-MET（31.6％）和EpCAM（0％），LGD组分的阴性表达（分数0-1）更为常见。在HGD-T1CRC组分与周围LGD组分的差异表达中，对于CEA，在66.7％，对于c-MET，在43.1％，对于EpCAM，在17.2％，对于FRα，在22.4％，对于αvβ6，在15.5％的情况下发现。此外，CEA在检测结肠息肉中的HGD-T1CRC组分方面显示出最高的联合敏感性（65.0％）和特异性（75.0％）。在测试的靶点中，CEA似乎是最适合在结肠息肉中特异地检测HGD和T1癌症聚焦的。一项使用肿瘤靶向荧光引导内窥镜的体内研究应证实这些发现。 ©2023年作者。由Wiley Periodicals LLC代表United European Gastroenterology发表的United European Gastroenterology Journal。

Differentiating high-grade dysplasia (HGD) and T1 colorectal cancer (T1CRC) from low-grade dysplasia (LGD) in colorectal polyps can be challenging. Incorrect recognition of HGD or T1CRC foci can lead to a need for additional treatment after local resection, which might not have been necessary if it was recognized correctly. Tumor-targeted fluorescence-guided endoscopy might help to improve recognition.Selecting the most suitable HGD and T1CRC-specific imaging target from a panel of well-established biomarkers: carcinoembryonic antigen (CEA), c-mesenchymal-epithelial transition factor (c-MET), epithelial cell adhesion molecule (EpCAM), folate receptor alpha (FRα), and integrin alpha-v beta-6 (αvβ6).En bloc resection specimens of colorectal polyps harboring HGD or T1CRC were selected. Immunohistochemistry on paraffin sections was used to determine the biomarker expression in normal epithelium, LGD, HGD, and T1CRC (scores of 0-12). The differential expression in HGD-T1CRC components compared to surrounding LGD and normal components was assessed, just as the sensitivity and specificity of each marker.60 specimens were included (21 HGD, 39 T1CRC). Positive expression (score >1) of HGD-T1CRC components was found in 73.3%, 78.3%, and 100% of cases for CEA, c-MET, and EpCAM, respectively, and in <40% for FRα and αvβ6. Negative expression (score 0-1) of the LGD component occurred more frequently for CEA (66.1%) than c-MET (31.6%) and EpCAM (0%). The differential expression in the HGD-T1CRC component compared to the surrounding LGD component was found for CEA in 66.7%, for c-MET in 43.1%, for EpCAM in 17.2%, for FRα in 22.4%, and for αvβ6 in 15.5% of the cases. Moreover, CEA showed the highest combined sensitivity (65.0%) and specificity (75.0%) for the detection of an HGD-T1CRC component in colorectal polyps.Of the tested targets, CEA appears the most suitable to specifically detect HGD and T1 cancer foci in colorectal polyps. An in vivo study using tumor-targeted fluorescence-guided endoscopy should confirm these findings.© 2023 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.