Department of Pathology and Laboratory Medicine, Vancouver General Hospital.
BC Cancer.
J Clin Gastroenterol. 2022 Mar 1;56(3):243-248. doi: 10.1097/MCG.0000000000001519.
Serrated lesions give rise to 15% to 30% of all colorectal cancers, driven predominantly by the sessile serrated polyp (SSP). Fecal immunochemical test (FIT), has low sensitivity for SSPs. SSP detection rate (SSPDR) is influenced by performance of both endoscopists and pathologists, as diagnosis can be subtle both on endoscopy and histology.
To evaluate the SSPDR in a population-based screening program, and the influence of subspecialty trained pathologists on provincial reporting practices.
The colon screening program database was used to identify all FIT-positive patients that received colonoscopy between January 2014 and June 2017. Patient demographics, colonoscopy quality indicators, pathologic diagnoses, and FIT values were collected. This study received IRB approval.
A total of 74,605 colonoscopies were included and 26.6% had at least 1 serrated polyp removed. The SSPDR was 7.0%, with 59% of the SSPs detected having a concurrent conventional adenoma. The mean FIT value for colonoscopies with only serrated lesions was less than that for colonoscopies with a conventional adenoma or colorectal cancer (P<0.0001). Centers with a gastrointestinal subspecialty pathologist diagnosed proportionally more SSPs (P<0.0001), and right-sided SSPs than centers without subspecialists.
Serrated lesions often occur in conjunction with conventional adenomas and are associated with lower FIT values. Knowledge of the characteristics of SSPs is essential for pathologists to ensure accurate diagnosis of SSPs.
锯齿状病变占所有结直肠癌的 15%至 30%，主要由无蒂锯齿状息肉（SSP）驱动。粪便免疫化学试验（FIT）对 SSP 的敏感性较低。SSP 检出率（SSPDR）受到内镜医生和病理医生表现的影响，因为内镜和组织学上的诊断都可能很微妙。
在基于人群的筛查计划中评估 SSPDR，并评估专门培训的病理学家对省级报告实践的影响。
使用结肠筛查计划数据库来确定所有在 2014 年 1 月至 2017 年 6 月期间接受结肠镜检查的 FIT 阳性患者。收集了患者人口统计学数据、结肠镜检查质量指标、病理诊断和 FIT 值。本研究获得了 IRB 批准。
共纳入 74605 例结肠镜检查，其中 26.6%至少切除了 1 个锯齿状息肉。SSPDR 为 7.0%，59%的 SSP 伴有同时存在的传统腺瘤。仅存在锯齿状病变的结肠镜检查的平均 FIT 值小于存在传统腺瘤或结直肠癌的结肠镜检查（P<0.0001）。具有胃肠道专科病理学家的中心诊断的 SSP 比例（P<0.0001）和右侧 SSP 比例高于没有专科医生的中心。
锯齿状病变常与传统腺瘤同时发生，与较低的 FIT 值相关。病理学家了解 SSP 的特征对于确保 SSP 的准确诊断至关重要。
