Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, New South Wales, Australia; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, New South Wales, Australia.
Gastrointest Endosc. 2018 Jan;87(1):222-231.e2. doi: 10.1016/j.gie.2017.06.031. Epub 2017 Jul 13.
Dysplasia within sessile serrated polyps (SSPs) is difficult to detect and may be mistaken for an adenoma, risking incomplete resection of the background serrated tissue, and is strongly implicated in interval cancer after colonoscopy. The use of endoscopic imaging to detect dysplasia within SSPs has not been systematically studied.
Consecutively detected SSPs ≥8 mm in size were evaluated by using a standardized imaging protocol at a tertiary-care endoscopy center over 3 years. Lesions suspected as SSPs were analyzed with high-definition white light then narrow-band imaging. A demarcated area with a neoplastic pit pattern (Kudo type III/IV, NICE type II) was sought among the serrated tissue. If this was detected, the lesion was labeled dysplastic (sessile serrated polyp with dysplasia); if not, it was labeled non-dysplastic (sessile serrated polyp without dysplasia). Histopathology was reviewed by 2 blinded specialist GI pathologists.
A total of 141 SSPs were assessed in 83 patients. Median lesion size was 15.0 mm (interquartile range 10-20), and 54.6% were in the right side of the colon. Endoscopic evidence of dysplasia was detected in 36 of 141 (25.5%) SSPs; of these, 5 of 36 (13.9%) lacked dysplasia at histopathology. Two of 105 (1.9%) endoscopically designated non-dysplastic SSPs had dysplasia at histopathology. Endoscopic imaging, therefore, had an accuracy of 95.0% (95% confidence interval [CI], 90.1%-97.6%) and a negative predictive value of 98.1% (95% CI, 92.6%-99.7%) for detection of dysplasia within SSPs.
Dysplasia within SSPs can be detected accurately by using a simple, broadly applicable endoscopic imaging protocol that allows complete resection. Independent validation of this protocol and its dissemination to the wider endoscopic community may have a significant impact on rates of interval cancer. (Clinical trial registration number: NCT03100552.).
在无蒂锯齿状息肉（SSP）中发现异型增生较为困难，并且可能被误诊为腺瘤，从而导致锯齿状背景组织切除不完全，并且强烈提示在结肠镜检查后存在间期癌症。尚未对使用内镜成像来检测 SSP 中的异型增生进行系统研究。
在 3 年的时间里，在一家三级护理内镜中心，使用标准化成像方案评估大小≥8mm 的连续检测到的 SSP。使用高清白光和窄带成像分析疑似 SSP 的病变。在锯齿状组织中寻找具有肿瘤性凹陷模式（Kudo 型 III/IV，NICE 型 II）的划定区域。如果检测到该区域，则将病变标记为异型增生（具有异型增生的无蒂锯齿状息肉）；如果未检测到，则将其标记为非异型增生（无异型增生的无蒂锯齿状息肉）。由 2 名盲法胃肠病学专家病理学家对组织病理学进行了审查。
共评估了 83 例患者的 141 个 SSP。中位病变大小为 15.0mm（四分位间距 10-20），54.6%位于结肠右侧。在 141 个 SSP 中，有 36 个（25.5%）内镜下有异型增生的证据；其中，5 个（13.9%）在组织病理学上没有异型增生。105 个内镜指定的非异型增生 SSP 中有 2 个（1.9%）在组织病理学上有异型增生。因此，内镜成像的准确性为 95.0%（95%置信区间 [CI]，90.1%-97.6%），对 SSP 内异型增生的阴性预测值为 98.1%（95%CI，92.6%-99.7%）。
使用简单、广泛适用的内镜成像方案可以准确检测 SSP 中的异型增生，从而可以进行完全切除。对该方案的独立验证及其向更广泛的内镜界传播可能会对间期癌症的发生率产生重大影响。（临床试验注册号：NCT03100552.）。
