O'Connell Brendon, Hafiz Nazar, Crockett Seth
Department of Medicine, University of North Carolina School of Medicine, CB 7080, Chapel Hill, NC, 27599, USA.
Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
Curr Gastroenterol Rep. 2017 Aug 29;19(10):52. doi: 10.1007/s11894-017-0588-3.
In this manuscript, we review current surveillance guidelines for serrated polyps (SPs) and discuss how recent studies inform the selection of appropriate surveillance intervals for patients with SPs.
Large and/or proximal SPs, particularly sessile serrated polyps (SSPs), are associated with increased risk of both synchronous and metachronous neoplasia, including advanced adenomas and colorectal cancer (CRC). Persons harboring multiple SSPs or dysplastic SSPs are at the highest risk. Moreover, a high percentage of large and/or proximal SPs are reclassified as SSPs when read by trained gastrointestinal pathologists, even if they were originally reported as hyperplastic polyps. These findings support the adoption of surveillance guidelines that prescribe closer surveillance of large and/or proximal SPs, regardless of subtype. SSPs remain a challenge to reliably identify, resect, and diagnose via histology. The increased risk of future neoplasia in patients with SSPs is likely driven by a combination of underdetection, inadequate removal, misclassification, and biology. Until further evidence emerges, we support guidelines that recommend close surveillance of patients with a history of large and/or proximal SPs and SSPs specifically in order to mitigate the threat of interval CRC.
在本手稿中，我们回顾了锯齿状息肉（SPs）的当前监测指南，并讨论了近期研究如何为SPs患者选择合适的监测间隔提供依据。
大型和/或近端SPs，特别是无蒂锯齿状息肉（SSPs），与同时性和异时性肿瘤形成风险增加相关，包括高级别腺瘤和结直肠癌（CRC）。携带多个SSP或发育异常SSP的人风险最高。此外，即使最初报告为增生性息肉，经训练有素的胃肠病理学家阅片时，很大比例的大型和/或近端SPs会被重新分类为SSPs。这些发现支持采用监测指南，规定对大型和/或近端SPs进行更密切的监测，无论其亚型如何。SSPs在通过组织学进行可靠识别、切除和诊断方面仍然是一个挑战。SSPs患者未来发生肿瘤的风险增加可能是由漏检、切除不充分、错误分类和生物学因素共同驱动的。在有进一步证据之前，我们支持指南建议对有大型和/或近端SPs病史特别是SSPs病史的患者进行密切监测，以减轻间隔期CRC的威胁。
