Chino A, Yamamoto N, Kato Y, Morishige K, Ishikawa H, Kishihara T, Fujisaki J, Ishikawa Y, Tamegai Y, Igarashi M
Department Digestive Endoscopy, The Cancer Institution Hospital, Japanese Foundation of Cancer Research, Tokyo, Japan.
Division of Pathology, The Cancer Institute of Japanese Foundation of Cancer Research, Tokyo, Japan.
Int J Colorectal Dis. 2016 Feb;31(2):343-9. doi: 10.1007/s00384-015-2416-2. Epub 2015 Oct 29.
Sessile serrated adenoma/polyps (SSAPs) are suspected to have a high malignant potential, although few reports have evaluated the incidence of carcinomas derived from SSAPs using the new classification for serrated polyps (SPs). The aim of study was to compare the frequency of cancer coexisting with the various SP subtypes including mixed polyps (MIXs) and conventional adenomas (CADs).
A total of 18,667 CADs were identified between April 2005 and December 2011, and 1858 SPs (re-classified as SSAP, hyperplastic polyp (HP), traditional serrated adenoma (TSA), or MIX) were removed via snare polypectomy, endoscopic mucosal resection, or endoscopic sub-mucosal dissection.
Among 1160 HP lesions, 1 (0.1%) coexisting sub-mucosal invasive carcinoma (T1) was detected. Among 430 SSAP lesions, 3 (0.7%) high-grade dysplasia (HGD/Tis) and 1 (0.2%) T1 were detected. All of the lesions were detected in the proximal colon, with a mean tumor diameter of 18 mm (SD 9 mm). Among 212 TSA lesions, 3 (1%) HGD/Tis were detected but no T1 cancer. Among 56 MIX lesions, 9 (16%) HGD/Tis and 1 (2%) T1 cancers were detected, and among 18,677 CAD lesions, 964 (5%) HGD/Tis and 166 (1%) T1 cancers were identified.
Among the resected lesions that were detected during endoscopic examination, a smaller proportion (1%) of SSAPs harbored HGD or coexisting cancer, compared to CAD or MIX lesions. Therefore, more attention should be paid to accurately identifying lesions endoscopically for intentional resection and the surveillance of each SP subtype.
无蒂锯齿状腺瘤/息肉（SSAPs）被怀疑具有较高的恶性潜能，尽管很少有报告使用锯齿状息肉（SPs）的新分类来评估源自SSAPs的癌的发生率。本研究的目的是比较与包括混合性息肉（MIXs）和传统腺瘤（CADs）在内的各种SP亚型共存的癌症的频率。
在2005年4月至2011年12月期间共识别出18667个CADs，并通过圈套息肉切除术、内镜黏膜切除术或内镜黏膜下剥离术切除了1858个SPs（重新分类为SSAP、增生性息肉（HP）、传统锯齿状腺瘤（TSA）或MIX）。
在1160个HP病变中，检测到1个（0.1%）共存的黏膜下浸润癌（T1）。在430个SSAP病变中，检测到3个（0.7%）高级别异型增生（HGD/Tis）和1个（0.2%）T1。所有病变均在近端结肠中检测到，平均肿瘤直径为18mm（标准差9mm）。在212个TSA病变中，检测到3个（1%）HGD/Tis，但未检测到T1癌。在56个MIX病变中，检测到9个（16%）HGD/Tis和1个（2%）T1癌，在18677个CAD病变中，识别出964个（5%）HGD/Tis和166个（1%）T1癌。
在内镜检查期间检测到的切除病变中，与CAD或MIX病变相比，SSAPs中携带HGD或共存癌症的比例较小（1%）。因此，应更加注意在内镜下准确识别病变以便进行意向性切除和对每种SP亚型进行监测。
