O'Brien Kevin, Sweeney Brian F, Conger Nicholas, Fischer Joseph R, Lang Kevin A
Division of General Internal Medicine, Wilford Hall Medical Center, San Antonio, TX, USA.
Cancer Detect Prev. 2003;27(4):259-65. doi: 10.1016/s0361-090x(03)00099-0.
Adenomatous polyps are a precursor of colorectal cancer and a frequent finding on screening flexible sigmoidoscopy (FS). Performance of colonoscopy when a diminutive (<6mm) adenoma is found on FS has been the subject of considerable debate.
We retrospectively reviewed the data from our colorectal cancer screening program for patients with adenoma(s) found on FS. Patients were divided into three groups based on FS findings: (1) an adenoma <6mm in size, (2) multiple non-advanced adenomas or an adenoma 6-10mm in size, or (3) advanced adenoma defined as an adenoma >10mm or with villous histology or high-grade dysplasia or cancer. A comparison of the proximal findings was then made.
5291 FS reports were reviewed with 606 (12%) patients having at least one adenoma. Colonoscopy reports were available in 550 patients. Of the 258 patients with a diminutive distal adenoma, 69 (27%) had a proximal adenoma and 13 (5%) had an advanced proximal adenoma on colonoscopy. Of the 164 patients with an adenoma 6-10mm or multiple non-advanced adenomas, 59 (36%) had a proximal adenoma and 13 (8%) had an advanced proximal adenoma. Of the 128 patients with a distal advanced adenoma, 58 (45%) had a proximal adenoma and 15 (12%) had an advanced proximal adenoma. The increase in proximal adenomas across the three groups was significant (P=0.001), and there was a trend for increased prevalence of advanced adenomas (P=0.061).
The prevalence of proximal adenomas increased significantly with more advanced lesions found distally at FS, and there was a trend towards a higher prevalence of advanced proximal adenomas. Based on current guidelines, flexible sigmoidoscopy is a screening option that can be used to identify average-risk patients at increased risk of proximal neoplasia.
腺瘤性息肉是结直肠癌的前驱病变，也是筛查性乙状结肠镜检查（FS）中常见的发现。当在FS中发现微小（<6mm）腺瘤时，结肠镜检查的必要性一直是相当有争议的话题。
我们回顾性分析了在FS中发现腺瘤的患者的结直肠癌筛查项目数据。根据FS检查结果将患者分为三组：（1）大小<6mm的腺瘤，（2）多个非进展性腺瘤或大小为6-10mm的腺瘤，或（3）进展性腺瘤，定义为腺瘤>10mm或具有绒毛状组织学或高级别异型增生或癌症。然后对近端检查结果进行比较。
共审查了5291份FS报告，其中606例（12%）患者至少有一个腺瘤。550例患者有结肠镜检查报告。在258例远端微小腺瘤患者中，69例（27%）结肠镜检查发现近端腺瘤，13例（5%）有进展性近端腺瘤。在164例大小为6-10mm的腺瘤或多个非进展性腺瘤患者中，59例（36%）有近端腺瘤，13例（8%）有进展性近端腺瘤。在128例远端进展性腺瘤患者中，58例（45%）有近端腺瘤，15例（12%）有进展性近端腺瘤。三组近端腺瘤的增加具有显著性（P=0.001），进展性腺瘤的患病率有增加趋势（P=0.061）。
随着FS远端发现更晚期病变，近端腺瘤的患病率显著增加，且进展性近端腺瘤的患病率有升高趋势。根据当前指南，乙状结肠镜检查是一种筛查选择，可用于识别近端肿瘤发生风险增加的平均风险患者。
