Gastrointestinal Center, Sano Hospital, Kobe, Hyogo, Japan.
Department of Pathology, Shinko Hospital, Kobe, Hyogo, Japan.
J Gastroenterol Hepatol. 2018 Aug;33(8):1454-1460. doi: 10.1111/jgh.14099. Epub 2018 Mar 25.
Although sessile serrated adenoma/polyps (SSA/Ps) are considered to be premalignant lesions and rapidly progress to carcinomas after they develop cytological dysplasia (CD), a treatment strategy for SSA/Ps in Asian countries is still being debated and has not yet been established. The present study aimed to propose a treatment strategy for SSA/Ps.
Histopathological data of patients, who underwent colonoscopy at our center between January 2011 and December 2016, were reviewed. Data of patients with ≥ 1 SSA/P were retrieved, and clinicopathological characteristics were retrospectively analyzed.
A total of 281 patients with 326 SSA/Ps, including 258 patients who had 300 SSA/Ps without CD (SSA/Ps-CD[-]) and 23 patients who had 26 SSA/Ps with CD (SSA/Ps-CD[+]), were evaluated in this study. Although SSA/Ps-CD(+) were often found in older female patients and in the proximal colon, there were no significant differences between SSA/Ps-CD(-) and SSA/Ps-CD(+). Endoscopic morphological findings, such as large or small nodules on the surface and partial protrusion of the lesions, were significantly more common in SSA/Ps-CD(+) than in SSA/Ps-CD(-). Although the diagnostic ability of nodule/protrusion in lesions to predict CD within SSA/Ps was very high with an accuracy of 93.9% and a negative predictive value of 95.4%, sensitivity was low at 46.2%. SSA/Ps-CD(+) were significantly larger than SSA/Ps-CD(-), and the rate of CD within SSA/Ps significantly increased with lesion size (≤ 5 mm, 0%; 6-9 mm, 6.0%; ≥ 10 mm, 13.6%).
The study proposes removing all SSA/Ps ≥ 6 mm in order to remove high-risk SSA/Ps-CD(+), with high sensitivity.
尽管无蒂锯齿状腺瘤/息肉（SSA/Ps）被认为是癌前病变，并且在发生细胞学异型增生（CD）后会迅速进展为癌，但亚洲国家的 SSA/Ps 治疗策略仍存在争议，尚未确定。本研究旨在提出一种治疗 SSA/Ps 的策略。
回顾了 2011 年 1 月至 2016 年 12 月在我院行结肠镜检查的患者的组织病理学数据。检索了≥ 1 个 SSA/P 的患者数据，并对其临床病理特征进行了回顾性分析。
共评估了 281 例 326 个 SSA/Ps 的患者，包括 258 例 300 个无 CD 的 SSA/Ps（SSA/Ps-CD[-]）和 23 例 26 个有 CD 的 SSA/Ps（SSA/Ps-CD[+]）。虽然 SSA/Ps-CD（+）常发生于老年女性和近端结肠，但 SSA/Ps-CD（-）与 SSA/Ps-CD（+）之间无显著差异。内镜下形态学表现，如病变表面的大或小结节和部分隆起，在 SSA/Ps-CD（+）中明显比在 SSA/Ps-CD（-）中更常见。尽管病变中结节/隆起对 SSA/Ps 内 CD 的诊断能力非常高，准确性为 93.9%，阴性预测值为 95.4%，但敏感性仅为 46.2%。SSA/Ps-CD（+）明显大于 SSA/Ps-CD（-），且随着病变大小的增加，SSA/Ps 内 CD 的发生率显著增加（≤ 5mm，0%；6-9mm，6.0%；≥ 10mm，13.6%）。
该研究提出切除所有≥ 6mm 的 SSA/Ps，以去除高风险的 SSA/Ps-CD（+），敏感性高。
