Faculdade Evangélica Mackenzie do Paraná, Postgraduate Program in Principles of Surgery - Curitiba (PR), Brazil.
Nove de Julho Hospital, Center for Endoscopic Diagnosis and Therapeutics of São Paulo - São Paulo (SP), Brazil.
Arq Bras Cir Dig. 2023 Jan 9;35:e1716. doi: 10.1590/0102-672020220002e1716. eCollection 2023.
There are lesions that are still being missed in colonoscopy. Many of those could be superficially elevated serrated lesions or depressed ones.
The aim of this study was to compare the histopathological characteristics of these lesions and their risks for submucosal carcinoma.
This is a retrospective, cross-sectional, and observational study comparing 217 superficially elevated serrated lesions larger than 5 mm resected by colonoscopies (G1) with 558 depressed lesions (G2).
In G1, 217 lesions were found in 12,653 (1.7%) colonoscopies; in G2, 558 lesions were found in 36,174 (1.5%) colonoscopies. In G1, 63.4% were women and in G2, there was no gender predominance. The average size of G1 was 16.2 mm and G2 was 9.2 mm (p<0.001). G1 predominated on the proximal colon and G2 on the distal and rectum (p<0.001). In G1, there were 214 (98.6%) low-grade intramucosal neoplasia and 3 (1.4%) high-grade intramucosal neoplasia. Excluding 126 hyperplastic polyps and considering 91 sessile serrated adenomas in G1, we observed 88 (96.7%) low-grade intramucosal neoplasia and 3 (3.3%) high-grade intramucosal neoplasia; in G2, we observed 417 (74.7%) low-grade intramucosal neoplasia, 113 (20.3%) high-grade intramucosal neoplasia, and 28 (5.0%) submucosal adenocarcinomas (p<0.001).
Depressed lesions significantly had more high-grade intramucosal neoplasia and more invasive carcinomas in the submucosal layer than superficially elevated serrated lesions and more than superficially elevated sessile serrated adenomas.
结肠镜检查仍有遗漏的病变。其中许多可能是表面隆起的锯齿状病变或凹陷性病变。
本研究旨在比较这些病变的组织病理学特征及其黏膜下癌的风险。
这是一项回顾性、横断面和观察性研究，比较了 217 个大于 5 毫米的表面隆起锯齿状病变（G1）和 558 个凹陷病变（G2）。
G1 中，在 12653 次结肠镜检查（1.7%）中发现 217 个病变；G2 中，在 36174 次结肠镜检查（1.5%）中发现 558 个病变。G1 中，63.4%为女性，G2 中无性别优势。G1 的平均大小为 16.2 毫米，G2 为 9.2 毫米（p<0.001）。G1 主要位于近端结肠，G2 主要位于远端和直肠（p<0.001）。G1 中，214 个（98.6%）为低级别黏膜内肿瘤，3 个（1.4%）为高级别黏膜内肿瘤。排除 G1 中的 126 个增生性息肉，并考虑 G1 中的 91 个无蒂锯齿状腺瘤，我们观察到 88 个（96.7%）低级别黏膜内肿瘤和 3 个（3.3%）高级别黏膜内肿瘤；G2 中，我们观察到 417 个（74.7%）低级别黏膜内肿瘤，113 个（20.3%）高级别黏膜内肿瘤和 28 个（5.0%）黏膜下腺癌（p<0.001）。
凹陷性病变的高级别黏膜内肿瘤和黏膜下浸润性癌明显多于表面隆起的锯齿状病变，也多于表面隆起的无蒂锯齿状腺瘤。
