de Sene Portel Oliveira Priscilla, Aparecida da Silva Trevisan Miriam, Barbosa de Carvalho Rita, de Cássia Perina Martins Rita, José Fagundes João, Saddy Rodrigues Coy Claudio
Department of Surgery, School of Medical Sciences, Campinas State University, São Paulo, Brazil, unicamp.br.
Department of Pathological Anatomy, School of Medical Sciences, Campinas State University, São Paulo, Brazil, unicamp.br.
Gastroenterol Res Pract. 2025 Dec 19;2025:5970839. doi: 10.1155/grp/5970839. eCollection 2025.
Changes in nomenclature and in the criteria for histological diagnosis of the serrated lesions have occurred over the years. Some of these lesions, the sessile serrated lesions (SSLs), progress to adenocarcinoma via suppression of the gene, an important carcinogenic pathway.
Evaluate the frequency of reclassification in histological diagnosis from hyperplastic polyps (HPs) to SSL after reappraisal using the 2019 World Health Organization (WHO) classification, to determine the occurrence of previously undiagnosed dysplasia and to study the expression of the protein in SSLs and SSLDs.
Lesions with histological diagnosis of HP, SSL, and SSLD resected by colonoscopies performed between 2005 and 2015 located in the proximal colon were studied. All HPs were submitted for histological review by two pathologists (Examiners 1 and 2), and a third experienced pathologist (Examiner 3) made the final decision when the other examiners did not agree. Interobserver agreement was analyzed. protein expression was assessed by immunohistochemistry in lesions diagnosed as SSL and SSLD before and after reappraisal. These lesions were reviewed again for missed dysplasia.
A total of 308 lesions were assessed being 287 with the initial diagnosis of HP and 21 SSL. Thirty-eight (13.3%) lesions with an initial diagnosis of HP had their diagnosis reclassified to SSL. No dysplasia was found. There was a moderate agreement (Kappa 0.52) between Examiners 1 and 2 regarding the diagnosis of SSL. Between Examiners 1 and 3, there was no agreement (Kappa -0.19), and between Examiners 3 and 2, the agreement was poor (Kappa 0.13). All 38 lesions analyzed by immunohistochemistry had expression.
Changes in diagnosis from HP to SSL occurred in 13.3%. No dysplasia or lack of MLH1 expression was observed.
多年来，锯齿状病变的命名和组织学诊断标准发生了变化。其中一些病变，即无蒂锯齿状病变（SSLs），通过某种基因的抑制作用发展为腺癌，这是一条重要的致癌途径。
使用2019年世界卫生组织（WHO）分类重新评估后，评估组织学诊断从增生性息肉（HPs）重新分类为SSL的频率，以确定先前未诊断出的发育异常的发生率，并研究SSL和SSL-D中该蛋白的表达。
研究2005年至2015年间在近端结肠进行结肠镜切除的组织学诊断为HP、SSL和SSL-D的病变。所有HP均由两名病理学家（检查者1和2）进行组织学复查，当其他检查者意见不一致时，由第三名经验丰富的病理学家（检查者3）做出最终决定。分析观察者间的一致性。通过免疫组织化学评估重新评估前后诊断为SSL和SSL-D的病变中的蛋白表达。再次检查这些病变是否存在漏诊的发育异常。
共评估了308个病变，其中287个最初诊断为HP，21个为SSL。最初诊断为HP的病变中有38个（13.3%）诊断重新分类为SSL。未发现发育异常。检查者1和2之间关于SSL诊断的一致性为中等（Kappa 0.52）。检查者1和3之间无一致性（Kappa -0.19），检查者3和2之间一致性较差（Kappa 0.13）。通过免疫组织化学分析的所有38个病变均有蛋白表达。
从HP到SSL的诊断变化发生率为13.3%。未观察到发育异常或MLH1表达缺失。
