Service of Digestive Disease Clinical Service, Archive and Documentation Service, University Hospital Virgen del Rocío. Sevilla, Spain.
Rev Esp Enferm Dig. 2009 Dec;101(12):830-6. doi: 10.4321/s1130-01082009001200002.
a) to evaluate the appropriateness of histological criteria as proposed by Morson as indicators for surgery; and b) to compare the adequacy of Morson s criteria with Haggitt s levels as indicators for surgery in the case of malignant sessile lesions.
we carried out a prospective, protocolized study of 42 patients with polyps with invasive carcinoma (IC) who underwent colonoscopic polypectomy from 1979 through 2008. We applied the histological criteria proposed by Morson to all the patients included in the series.
we treated 24 polyps with IC and favorable histological criteria (FC) and 18 polyps showing unfavorable histological criteria (UC). All polyps with FC were treated by means of colonoscopic polypectomy. None of the patients showed signs of disease after a mean follow-up period o f 9.67 yrs. Patients with polyps with UC were recommended to undergo surgery. The presence of unfavorable histological criteria in the polypectomy sample was clearly associated with an unfavorable patient outcome and showed a 100% sensitivity level, a negative prognostic value (NPV) of 100%, and a false negative (FN) percentage of 0% for the prognosis of the disease. We found 12 sessile polyps (Haggitt s level 4). Colonoscopic polypectomy was the treatment employed in 9 out of 12 cases. All patients are free from disease (mean follow-up 7.3 yrs). If Haggitt s level criteria had been applied, all 12 patients would have undergone surgery. This means 58% more patients than following Morson s criteria.
Morson s criteria are considered an adequate diagnostic tool for the indication of surgery in patients with malignant adenomas. Haggitt s invasion levels do not accurately discriminate the necessity for surgery in case of malignant sessile lesions.
a）评估 Morson 提出的组织学标准作为手术指征的适宜性；b）比较 Morson 标准与 Haggitt 分级作为恶性息肉样病变手术指征的充分性。
我们对 1979 年至 2008 年间经结肠镜息肉切除术治疗的 42 例有浸润性癌（IC）的息肉患者进行了一项前瞻性、方案化研究。我们对所有纳入研究的患者均应用 Morson 提出的组织学标准。
我们治疗了 24 例组织学良性且具有有利特征（FC）的 IC 息肉和 18 例组织学表现不佳且具有不利特征（UC）的 IC 息肉。所有 FC 息肉均采用结肠镜息肉切除术治疗。所有患者平均随访 9.67 年后均未见疾病迹象。UC 息肉患者建议手术治疗。息肉切除标本中存在不利组织学特征与患者预后不良明显相关，对疾病预后的敏感性为 100%、阴性预测值为 100%、假阴性率为 0%。我们发现 12 例无蒂息肉（Haggitt 分级 4 级）。12 例中有 9 例采用了结肠镜息肉切除术治疗。所有患者均无疾病（平均随访 7.3 年）。如果应用 Haggitt 分级标准，则所有 12 例患者均需手术治疗。这意味着比遵循 Morson 标准多 58%的患者需要手术。
Morson 标准被认为是恶性腺瘤患者手术指征的一种充分诊断工具。Haggitt 浸润分级不能准确区分恶性无蒂病变是否需要手术。
