Screening Group, International Agency for Research on Cancer, Lyon, France.
Eur J Gastroenterol Hepatol. 2012 Oct;24(10):1123-34. doi: 10.1097/MEG.0b013e328355e2d9.
The large and relatively flat colorectal neoplastic lesions called laterally spreading tumors are classified as nonpolypoid despite some mixed patterns with protruding nodules. Large hyperplastic polyps and sessile serrated lesions are non-neoplastic lesions that also have this morphology and may potentially progress to neoplasia. All these large and relatively flat lesions are more frequent in the proximal colon and less conspicuous than polypoid lesions. Their underdiagnosis is a major factor in the failure of colonoscopy to prevent cancer in the proximal colon. The treatment of laterally spreading tumors by endoscopic resection (endoscopic mucosal resection, piecemeal endoscopic mucosal resection, endoscopic submucosal dissection), or by surgery is based on a careful morphologic analysis, taking into account the size and surface with nodules or depression. The technique of endoscopic submucosal dissection should be diffused because it reduces the number of surgical indications.
被称为侧向伸展肿瘤的大型且相对平坦的结直肠肿瘤病变尽管存在一些与凸起结节混合的模式，但仍被归类为非息肉样。大型增生性息肉和无蒂锯齿状病变是非肿瘤性病变，也具有这种形态，可能会进展为肿瘤。所有这些大型且相对平坦的病变在近端结肠中更为常见，并且不如息肉样病变明显。它们的漏诊是结肠镜检查未能预防近端结肠癌的一个主要因素。侧向伸展肿瘤的治疗方法是通过内镜切除（内镜黏膜切除术、分片式内镜黏膜切除术、内镜黏膜下剥离术）或手术进行，这取决于仔细的形态学分析，考虑到大小和表面是否有结节或凹陷。内镜黏膜下剥离术技术应该得到推广，因为它减少了手术适应证的数量。
