Fidalgo Catarina, Santos Liliana, Rosa Isadora, Fonseca Ricardo, Lage Pedro, Claro Isabel, Chaves Paula, Dias Pereira António
Serviço de Gastrenterologia. Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E. Lisboa. Portugal.
Serviço de Anatomia Patológica. Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E. Lisboa. Portugal.
Acta Med Port. 2014 May-Jun;27(3):304-8. doi: 10.20344/amp.4725. Epub 2014 Jun 30.
The World Health Organization reviewed the classification for serrated colonic polyps in 2010. A new entity, sessile serrated adenoma, was included with two variants: with and without cytological dysplasia. This lesion's malignant potential has been recognized and according to the new classification, many polyps may be reclassified. The impact of this change is yet to be assessed.
Analyze the proportion of lesions that were reclassified according to the new World Health Organization classification and the variables that influenced it.
Every patient with at least one sessile serrated adenoma diagnosed in a 5 year period was included. All polyps (regardless of type) resected during the study period were reviewed. Data concerning polyp's characteristics and patient variables were collected. Forty consecutive patients were included [13 female, mean age at 1st sessile serrated adenoma -59 yrs (34-80)].
Were reviewed 247 polyps: hyperplastic--42%; conventional adenomas--29%; sessile serrated adenoma--24%; serrated adenomas--5%. Sixty-three polyps were reclassified: 43 hyperplastic, 12 serrated adenomas, 7 sessile serrated adenoma and 1 conventional adenoma with low grade dysplasia. Reclassification was significantly greater for hyperplastic polyps when compared with the other subtypes. Forty-three of one hundred and four (41%) hyperplastic polyps were reclassified all as sessile serrated adenoma. In these polyps the probability of reclassification was independent from polyp location but was greater if polyp size ≥ 5 mm.
This is a single center, rectrospective study. The fact that it was done in an Oncology Referral Institution with a Family Risk Clinic may have influenced the results. Nevertheless the impressive reclassification rate for Hyperplastic Polyps and the fact that they were reclassified mainly as Serrated Adenomas makes these results relevant to daily practice.
Our results suggest that, according to the new World Health Organization classification for serrated colonic polyps, a considerable proportion of hyperplastic polyps will be reclassified. The serrated pathway of colorectal carcinogenesis has probably been underestimated and at-risk patients may have been under inappropriate surveillance.
世界卫生组织于2010年对锯齿状结肠息肉的分类进行了修订。新增了一种病变，即无蒂锯齿状腺瘤，它有两种变体：伴有和不伴有细胞学异型增生。这种病变的恶性潜能已得到认可，根据新的分类，许多息肉可能需要重新分类。这一变化的影响尚待评估。
分析根据世界卫生组织新分类重新分类的病变比例以及影响重新分类的变量。
纳入在5年期间诊断出至少有一个无蒂锯齿状腺瘤的每位患者。对研究期间切除的所有息肉（无论类型）进行复查。收集有关息肉特征和患者变量的数据。纳入了连续的40例患者[13例女性，首次诊断无蒂锯齿状腺瘤时的平均年龄为59岁（34 - 80岁）]。
共复查了247个息肉：增生性息肉占42%；传统腺瘤占29%；无蒂锯齿状腺瘤占24%；锯齿状腺瘤占5%。63个息肉被重新分类：43个增生性息肉、12个锯齿状腺瘤、7个无蒂锯齿状腺瘤和1个伴有低级别异型增生的传统腺瘤。与其他亚型相比，增生性息肉的重新分类明显更多。104个增生性息肉中有43个（41%）被重新分类为无蒂锯齿状腺瘤。在这些息肉中，重新分类的可能性与息肉位置无关，但如果息肉大小≥5mm则可能性更大。
这是一项单中心回顾性研究。该研究在一家设有家庭风险诊所的肿瘤转诊机构进行这一事实可能影响了结果。然而，增生性息肉令人印象深刻的重新分类率以及它们主要被重新分类为锯齿状腺瘤这一事实使得这些结果与日常实践相关。
我们的结果表明，根据世界卫生组织对锯齿状结肠息肉的新分类，相当一部分增生性息肉将被重新分类。结直肠癌发生的锯齿状途径可能被低估了，高危患者可能一直处于不适当的监测之下。
