Kishida Yoshihiro, Shimoda Tadakazu, Hotta Kinichi, Imai Kenichiro, Ito Sayo, Takada Kazunori, Sato Junya, Minamide Tatsunori, Yamamoto Yoichi, Yoshida Masao, Maeda Yuki, Kawata Noboru, Ishiwatari Hirotoshi, Matsubayashi Hiroyuki, Ono Hiroyuki
Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan.
Division of Pathology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan.
Dig Liver Dis. 2025 Nov;57(11):2180-2186. doi: 10.1016/j.dld.2025.09.009. Epub 2025 Sep 22.
Accurate differentiation of sessile serrated lesion with dysplasia (SSLD) or with carcinoma (SSL+Ca) from hyperplastic polyp (HP) and sessile serrated lesion (SSL) is crucial for appropriate endoscopic management.
This single-center retrospective study included colorectal serrated lesions (≥10 mm) resected between 2017 and 2020 and pathologically diagnosed as HP, SSL, SSLD, or SSL+Ca based on the WHO 5th edition criteria. Characteristic factors associated with SSLD/SSL+Ca and their diagnostic performance were analyzed. Additionally, features of submucosal invasive (pT1) SSL+Ca were examined.
Among 498 lesions, 23 (4.6 %) were diagnosed as SSLD/SSL+Ca, with prevalence increasing by size (10-14 mm: 1.2 %, 15-19 mm: 9.2 %, ≥20 mm: 14.3 %). Multivariate analysis identified lesion size ≥15 mm, double elevation, and neoplastic JNET type (2A/2B/3) as significant predictors. A prediction model using these factors demonstrated high diagnostic accuracy (sensitivity 91.3 %, specificity 91.8 %, accuracy 91.8 %, PPV 35.0 %, NPV 99.5 %). In pT1 SSL+Ca, JNET Type 3, Kudo's type V pit pattern, and non-lifting sign were significantly associated.
Among HP and SSL ≥10 mm, the prevalence of SSLD/SSL+Ca increased with lesion size. Double elevation and neoplastic JNET type were valuable for diagnosis, aiding appropriate management.
准确区分伴有发育异常的无蒂锯齿状病变（SSLD）或伴有癌的无蒂锯齿状病变（SSL+Ca）与增生性息肉（HP）和无蒂锯齿状病变（SSL）对于恰当的内镜处理至关重要。
这项单中心回顾性研究纳入了2017年至2020年间切除的结直肠锯齿状病变（≥10毫米），并根据世界卫生组织第5版标准进行病理诊断为HP、SSL、SSLD或SSL+Ca。分析了与SSLD/SSL+Ca相关的特征因素及其诊断性能。此外，还检查了黏膜下浸润性（pT1）SSL+Ca的特征。
在498个病变中，23个（4.6%）被诊断为SSLD/SSL+Ca，其患病率随病变大小增加（10 - 14毫米：1.2%，15 - 19毫米：9.2%，≥20毫米：14.3%）。多变量分析确定病变大小≥15毫米、双重隆起和肿瘤性JNET类型（2A/2B/3）为显著预测因素。使用这些因素的预测模型显示出较高的诊断准确性（敏感性91.3%，特异性91.8%，准确性91.8%，阳性预测值35.0%，阴性预测值99.5%）。在pT1 SSL+Ca中，JNET 3型、工藤分型V型凹陷模式和非抬举征显著相关。
在≥10毫米的HP和SSL中，SSLD/SSL+Ca的患病率随病变大小增加。双重隆起和肿瘤性JNET类型对诊断有价值，有助于进行恰当的处理。
