Sacco Michele, De Palma Fatima Domenica Elisa, Guadagno Elia, Giglio Mariano Cesare, Peltrini Roberto, Marra Ester, Manfreda Andrea, Amendola Alfonso, Cassese Gianluca, Dinuzzi Vincenza Paola, Pegoraro Francesca, Tropeano Francesca Paola, Luglio Gaetano, De Palma Giovanni Domenico
Department of Clinical Medicine and Surgery, University of Naples Federico II via Sergio Pansini, 5 - 80131, Naples, Italy.
CEINGE Biotecnologie Avanzate s.c.ar.l., Via Comunale Margherita, 80131, Naples, Italy.
Open Med (Wars). 2020 Nov 9;15(1):1087-1095. doi: 10.1515/med-2020-0226. eCollection 2020.
In 2010, serrated polyps (SP) of the colon have been included in the WHO classification of digestive tumors. Since then a large corpus of evidence focusing on these lesions are available in the literature. This review aims to analyze the present data on the epidemiological and molecular aspects of SP. Hyperplastic polyps (HPs) are the most common subtype of SP (70-90%), with a minimal or null risk of malignant transformation, contrarily to sessile serrated lesions (SSLs) and traditional serrated adenomas (TSAs), which represent 10-20% and 1% of adenomas, respectively. The malignant transformation, when occurs, is supported by a specific genetic pathway, known as the serrated-neoplasia pathway. The time needed for malignant transformation is not known, but it may occur rapidly in some lesions. Current evidence suggests that a detection rate of SP ≥15% should be expected in a population undergoing screening colonoscopy. There are no differences between primary colonoscopies and those carried out after positive occult fecal blood tests, as this screening test fails to identify SP, which rarely bleed. Genetic similarities between SP and interval cancers suggest that these cancers could arise from missed SP. Hence, the detection rate of serrated-lesions should be evaluated as a quality indicator of colonoscopy. There is a lack of high-quality longitudinal studies analyzing the long-term risk of developing colorectal cancer (CRC), as well as the cancer risk factors and molecular tissue biomarkers. Further studies are needed to define an evidence-based surveillance program after the removal of SP, which is currently suggested based on experts' opinions.
2010年，结肠锯齿状息肉（SP）被纳入世界卫生组织消化系统肿瘤分类。自那时起，文献中已有大量聚焦于这些病变的证据。本综述旨在分析目前关于SP流行病学和分子方面的数据。增生性息肉（HP）是SP最常见的亚型（70 - 90%），恶性转化风险极小或为零，与之相反，无蒂锯齿状病变（SSL）和传统锯齿状腺瘤（TSA）分别占腺瘤的10 - 20%和1%。恶性转化一旦发生，由一种特定的遗传途径支持，即锯齿状肿瘤形成途径。恶性转化所需时间尚不清楚，但在某些病变中可能迅速发生。目前的证据表明，在接受筛查结肠镜检查的人群中，SP的检出率应预期≥15%。初次结肠镜检查与潜血试验阳性后进行的结肠镜检查之间没有差异，因为这种筛查试验无法识别很少出血的SP。SP与间期癌之间的遗传相似性表明，这些癌症可能源于漏诊的SP。因此，锯齿状病变的检出率应作为结肠镜检查质量指标进行评估。缺乏高质量的纵向研究来分析结直肠癌（CRC）发生的长期风险、癌症危险因素和分子组织生物标志物。需要进一步研究来确定切除SP后的循证监测方案，目前该方案是基于专家意见提出的。
