Department of Gastroenterology and Hepatology, International University of Health and Welfare Narita Hospital, Narita 2868520, Japan.
Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 1570066, Japan.
World J Gastroenterol. 2021 Apr 7;27(13):1321-1329. doi: 10.3748/wjg.v27.i13.1321.
Hyperplastic polyps are considered non-neoplastic, whereas sessile serrated lesions (SSLs) are precursors of cancer the ''serrated neoplastic pathway''. The clinical features of SSLs are tumor size (> 5 mm), location in the proximal colon, coverage with abundant mucus called the ''mucus cap'', indistinct borders, and a cloud-like surface. The features in magnifying narrow-band imaging are varicose microvascular vessels and expanded crypt openings. However, accurate diagnosis is often difficult.
To develop a diagnostic score system for SSLs.
We retrospectively reviewed consecutive patients who underwent endoscopic resection during colonoscopy at the Toyoshima endoscopy clinic. We collected data on serrated polyps diagnosed by endoscopic or pathological examination. The significant factors for the diagnosis of SSLs were assessed using logistic regression analysis. Each item that was significant in multivariate analysis was assigned 1 point, with the sum of these points defined as the endoscopic SSL diagnosis score. The optimal cut-off value of the endoscopic SSL diagnosis score was determined by receiver-operating characteristic curve analysis.
Among 1288 polyps that were endoscopically removed, we analyzed 232 diagnosed as serrated polyps by endoscopic or pathological examination. In the univariate analysis, the location (proximal colon), size (> 5 mm), mucus cap, indistinct borders, cloud-like surface, and varicose microvascular vessels were significantly associated with the diagnosis of SSLs. In the multivariate analysis, size (> 5 mm; = 0.033), mucus cap ( = 0.005), and indistinct borders ( = 0.033) were independently associated with the diagnosis of SSLs. Size > 5 mm, mucus cap, and indistinct borders were assigned 1 point each and the sum of these points was defined as the endoscopic SSL diagnosis score. The receiver-operating characteristic curve analysis showed an optimal cut-off score of 3, which predicted pathological SSLs with 75% sensitivity, 80% specificity, and 78.4% accuracy. The pathological SSL rate for an endoscopic SSL diagnosis score of 3 was significantly higher than that for an endoscopic SSL diagnosis score of 0, 1, or 2 ( < 0.001).
Size > 5 mm, mucus cap, and indistinct borders were significant endoscopic features for the diagnosis of SSLs. Serrated polyps with these three features should be removed during colonoscopy.
增生性息肉被认为是非肿瘤性的，而无蒂锯齿状病变（SSLs）则是癌症的前体——“锯齿状肿瘤途径”。SSLs 的临床特征是肿瘤大小（> 5 毫米）、位于近端结肠、大量称为“粘液帽”的粘液覆盖、边界不清晰和云状表面。放大窄带成像的特征是静脉曲张的微血管和扩张的隐窝开口。然而，准确的诊断往往很困难。
开发一种用于 SSLs 的诊断评分系统。
我们回顾性分析了在 Toyoshima 内窥镜诊所接受内窥镜切除的连续患者的资料。我们收集了经内镜或病理检查诊断为锯齿状息肉的患者的数据。使用逻辑回归分析评估诊断 SSLs 的显著因素。多变量分析中具有统计学意义的每个项目均赋值 1 分，这些分数的总和定义为内镜 SSL 诊断评分。通过接收者操作特征曲线分析确定内镜 SSL 诊断评分的最佳截断值。
在 1288 个经内镜切除的息肉中，我们分析了 232 个经内镜或病理检查诊断为锯齿状息肉的患者。单因素分析中，位置（近端结肠）、大小（> 5 毫米）、粘液帽、边界不清晰、云状表面和静脉曲张的微血管与 SSLs 的诊断显著相关。多变量分析中，大小（> 5 毫米； = 0.033）、粘液帽（ = 0.005）和边界不清晰（ = 0.033）与 SSLs 的诊断独立相关。大小> 5 毫米、粘液帽和边界不清晰各赋值 1 分，这些分数的总和定义为内镜 SSL 诊断评分。接收者操作特征曲线分析显示，最佳截断评分 3 分预测病理 SSLs 的灵敏度为 75%、特异性为 80%、准确率为 78.4%。内镜 SSL 诊断评分 3 分的病理 SSL 发生率明显高于内镜 SSL 诊断评分 0、1 或 2 分（< 0.001）。
大小> 5 毫米、粘液帽和边界不清晰是诊断 SSLs 的重要内镜特征。具有这三个特征的锯齿状息肉应在结肠镜检查中切除。
