Eisele R, Vogelsang E, Kraft K, Baumgarten U, Schick R R
Department of Internal Medicine, Federal Armed Forces Hospital Ulm, Ulm, Germany.
Z Gastroenterol. 2007 Sep;45(9):952-7. doi: 10.1055/s-2007-963477.
Prevalence data for colorectal neoplastic lesions obtained from screening colonoscopies have recently been reported for a U. S. American and a Polish average-risk population. However, prevalence data for a German average-risk population have not been published.
From 1998 until 2003 a screening colonoscopy was offered to all male participants of a health assessment program. In a total of 618 volunteers with an average risk for colorectal cancer, polypoid lesions were identified and removed using high-resolution video colonoscopes. The histological features of the lesions were categorised according to those of the most advanced one. An advanced lesion was defined as an adenoma of at least 1 cm in diameter, a polyp with villous histological features or high-grade intraepithelial neoplasms or a cancer. Data were analysed in two groups: age 40 - 49 years (group A) and age 50 - 59 years (group B).
In group A (age 40 - 49 years, n = 285), 133 subjects (47 %) had polypoid lesions. Histological findings revealed that 57 subjects (20 %) had non-neoplastic and 76 subjects (27 %) had neoplastic lesions. In nine cases (3.2 %) polyps were classified as advanced lesions with a maximal diameter of 35 mm. In group B (age 50 - 59, n = 333), 183 subjects (55 %) had polypoid lesions. Histological findings revealed that 64 subjects (19 %) had non-neoplastic and 119 subjects (36 %) had neoplastic lesions. Among those, 34 (10.2 %) had advanced lesions with a maximal diameter of 55 mm. In neither group was an invasive cancer detected. The difference in the prevalence of neoplastic lesions between the two age groups was statistically significant (chi (2) = 5.85). An exceptionally high rate of 27 % neoplastic lesions was detected in subjects at 40 to 49 years of age. The rate of detected lesions in the group of older subjects was 36 %.
By using high-resolution endoscopes we found an unexpectedly large number of neoplastic lesions in the colon even in a relatively young average-risk population. The question whether screening colonoscopy should therefore not only aim at detecting early colorectal cancer but also at identifying and removing precursor adenomas at younger ages clearly deserves further attention.
最近已报道了来自美国和波兰平均风险人群的结肠镜筛查中结直肠肿瘤性病变的患病率数据。然而，德国平均风险人群的患病率数据尚未公布。
从1998年至2003年，对一项健康评估计划的所有男性参与者进行了结肠镜筛查。在总共618名患结直肠癌平均风险的志愿者中，使用高分辨率视频结肠镜识别并切除了息肉样病变。根据最晚期病变的组织学特征对病变进行分类。晚期病变定义为直径至少1厘米的腺瘤、具有绒毛组织学特征的息肉或高级别上皮内瘤变或癌症。数据分为两组进行分析：40 - 49岁组（A组）和50 - 59岁组（B组）。
在A组（40 - 49岁，n = 285）中，133名受试者（47%）有息肉样病变。组织学检查结果显示，57名受试者（20%）有非肿瘤性病变，76名受试者（27%）有肿瘤性病变。9例（3.2%）息肉被分类为晚期病变，最大直径为35毫米。在B组（50 - 59岁，n = 333）中，183名受试者（55%）有息肉样病变。组织学检查结果显示，64名受试者（19%）有非肿瘤性病变，119名受试者（36%）有肿瘤性病变。其中，34例（10.2%）有晚期病变，最大直径为55毫米。两组均未检测到浸润性癌。两个年龄组之间肿瘤性病变患病率的差异具有统计学意义（χ² = 5.85）。在40至49岁的受试者中检测到异常高的27%的肿瘤性病变率。老年受试者组中检测到的病变率为36%。
通过使用高分辨率内窥镜，我们发现即使在相对年轻的平均风险人群中，结肠内的肿瘤性病变数量也出乎意料地多。因此，结肠镜筛查是否不仅应旨在检测早期结直肠癌，还应在较年轻的年龄段识别并切除前期腺瘤，这一问题显然值得进一步关注。
