在纵向 CT 结肠成像中观察到的无蒂锯齿状腺瘤/息肉的体积增长率。
Volumetric growth rates of sessile serrated adenomas/polyps observed in situ at longitudinal CT colonography.
机构信息
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Department of Radiology, University of Wisconsin School of Medicine and E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA.
出版信息
Eur Radiol. 2019 Sep;29(9):5093-5100. doi: 10.1007/s00330-019-5999-0. Epub 2019 Feb 11.
OBJECTIVE
Sessile serrated adenomas/polyps (SSA/Ps) are now recognized as potential cancer precursors, but little is known about their natural history. We assessed the in vivo growth rates of histologically proven SSA/Ps at longitudinal CT colonography (CTC) and compared results with non-advanced tubular adenomas (TAs).
METHODS
We identified a cohort of 53 patients (mean age, 54.8 ± 5.5 years; M:F, 26:27) from one center with a total of 58 SSA/Ps followed longitudinally at CTC (mean follow-up interval, 5.3 ± 1.9 years). Initial and final size measurements were determined using dedicated CTC software. Findings were compared with 141 non-advanced TAs followed at CTC (mean, 4.1 ± 2.3 years) in 113 patients (mean age, 56.8 ± 6.9 years).
RESULTS
SSA/Ps were more often flat (62% [36/58] vs. 14% [20/141], p < 0.0001) and right-sided (98% [57/58] vs. 46% [65/141], p < 0.0001) compared with TAs. Initial average diameter was greater for SSA/Ps (9.3 mm vs. 6.3 mm; p < 0.0001). Mean annual volumetric growth was + 12.7%/year for SSA/Ps vs. + 36.4%/year for TAs (p = 0.028). Using a previously defined threshold of + 20% increase in volume/year to define progression, 22% (13/58) of SSA/Ps and 41% (58/141) of TAs progressed (p = 0.014). None of the SSA/Ps had dysplasia or invasive cancer at histopathology.
CONCLUSIONS
Sessile serrated adenoma/polyps demonstrate slower growth compared with conventional non-advanced tubular adenomas, despite larger initial linear size. This less aggressive behavior may help explain the more advanced patient age for serrated pathway cancers. Furthermore, these findings could help inform future colonoscopic surveillance strategies, as current guidelines are largely restricted to expert opinion related to the absence of natural history data.
KEY POINTS
• Sessile serrated adenoma/polyps (SSA/Ps) tend to be flat, right-sided, and demonstrate slower growth compared with conventional non-advanced tubular adenomas. • This less aggressive behavior of SSA/Ps may help explain the more advanced patient age for serrated pathway cancers.
目的
目前已认识到无蒂锯齿状腺瘤/息肉（SSA/Ps）是潜在的癌前病变，但对其自然史知之甚少。我们通过纵向 CT 结肠成像（CTC）评估了经组织学证实的 SSA/Ps 的体内生长速度，并与非进展性管状腺瘤（TAs）进行了比较。
方法
我们从一个中心确定了一个 53 例患者（平均年龄 54.8±5.5 岁；M:F=26:27）的队列，这些患者总共存在 58 个 SSA/Ps，在 CTC 中进行了纵向随访（平均随访间隔 5.3±1.9 年）。使用专用 CTC 软件确定初始和最终大小测量值。将这些发现与在 113 例患者（平均年龄 56.8±6.9 岁）中 141 个非进展性 TAs 在 CTC 中的随访情况进行比较（平均随访时间 4.1±2.3 年）。
结果
与 TAs 相比，SSA/Ps 更常为平坦型（62%[36/58]与 14%[20/141]，p<0.0001）和右侧（98%[57/58]与 46%[65/141]，p<0.0001）。SSA/Ps 的初始平均直径更大（9.3mm 与 6.3mm；p<0.0001）。SSA/Ps 的平均每年体积增长率为+12.7%/年，而 TAs 为+36.4%/年（p=0.028）。使用之前定义的每年体积增加 20%来定义进展，22%（13/58）的 SSA/Ps 和 41%（58/141）的 TAs 进展（p=0.014）。在组织病理学检查中，没有 SSA/Ps 出现异型增生或浸润性癌。
结论
尽管初始线性尺寸较大，但无蒂锯齿状腺瘤/息肉的生长速度比传统的非进展性管状腺瘤慢。这种侵袭性较低的行为可能有助于解释锯齿状通路癌症患者年龄较大的原因。此外，这些发现可以帮助为未来的结肠镜监测策略提供信息，因为目前的指南主要局限于与缺乏自然史数据相关的专家意见。
关键点
• 与传统的非进展性管状腺瘤相比，无蒂锯齿状腺瘤/息肉（SSA/Ps）往往呈平坦状，位于右侧，生长速度较慢。• SSA/Ps 这种侵袭性较低的行为可能有助于解释锯齿状通路癌症患者年龄较大的原因。
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