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在全市的病理学实践中对增生性结肠息肉进行病理学重新评估:息肉监测建议的含义

发布日期:2014-1-29 12:40:56 文章来源:GIE 作者次数:3441
    在全市的病理学实践中对增生性结肠息肉进行病理学重新评估:息肉监测建议的含义

    背景

    无柄锯齿状腺瘤(SSAs) 和增生性息肉(HP) 是两种最常见的锯齿状结肠息肉(SCPs)SSAs可能是许多结直肠癌的癌前病变,因此,人们很重视它们的检测和清除另一方面最近有一些如那些来自欧盟的指南认为增生性息肉其临床意义有限。

    目的

    最近诊断HPsSSAs的重新分类率和该重新分类的预测因子进行评估

    设计、环境、干预和主要测量指标

    省级病理学数据库中2009年温尼伯市6家病理学实验室报道的所有结肠息肉进行了检索。两位对消化道病理学特别有兴趣的病理学家重新评价了所有检索到的之前所报道的右侧HPs20%的左侧HPs的随机样本。对被作为潜在的重新分类预测因子如息肉大小、结肠位置、研究参与者的年龄和性别进行了评估。

    结果

    25位不同的病理学家4096个病理学报告进行了审核。20%的息肉被报道为SCPs。之前报道的70%的右侧HPs20%>5 mm的右侧HPs重新分类为SSAs>5mm比值比[OR]4.295%可信区间[CI]1.5-11.4和结肠右侧位置4.795% CI1.4-15.4是独立的重新分类预测因子。

    局限性

    回顾性分析

    结论

    最近报道的很多右侧HPs可能是SSAs。因此建议,监测SCPs时,应该考虑SCPs的大小和位置,而不仅仅是所报道的类型。

    缩写词:CRC,结肠直肠癌;DSM,马尼托巴省的诊断服务;HP,增生性息肉;SCP锯齿状的结肠息肉;SSA,无柄锯齿状腺瘤;TSA,传统型锯齿状腺瘤

     


     

    Pathological reassessment of hyperplastic colon polyps in a city-wide pathology practice: implications for polyp surveillance recommendations

    Background

    Sessile serrated adenomas (SSAs) and hyperplastic polyps (HP) are the two most common types of serrated colon polyps (SCPs). SSAs are suspected to be the precursor lesions for many colorectal cancers, and hence there is an emphasis on their detection and removal. On the other hand, recent guidelines such as those from the European Union consider HPs of limited clinical significance.

    Objective

    Evaluate the reclassification rate of recently diagnosed HPs to SSAs and the predictors of such reclassification.

    Design, Setting, Intervention, Main Outcome Measurements

    The provincial pathology database was searched for all colon polyps reported in the 6 pathology laboratories in the city of Winnipegin 2009. All retrieved pathology slides for previously reported right-sided HPs and a 20% random sample of left-sided HPs were reassessed by two pathologists with a special interest in GI pathology. Polyp size, colon location, and age and sex of the study participants were evaluated as potential predictors of reclassification.

    Results

    A total of 4096 pathology reports by 25 different pathologists were reviewed. Twenty percent of the polyps were reported as SCPs. Seventeen percent of right-sided previously reported HPs and 20% of those >5 mmwere reclassified as SSAs. Size >5 mm(odds ratio [OR] 4.2; 95% confidence interval [CI], 1.5-11.4) and location in the right side of the colon (OR 4.7; 95% CI, 1.4-15.4) were independent predictors of reclassification.

    Limitations

    Retrospective review.

    Conclusion

    A significant proportion of recently reported right-sided HPs may be SSAs. Surveillance recommendations for SCPs should consider the size and location of SCPs and not just the reported type.

    Abbreviations:  CRC, colorectal cancer, DSM, Diagnostic Services of Manitoba, HP, hyperplastic polyp, SCP, serrated colon polyp, SSA, sessile serrated adenoma, TSA, traditional serrated adenoma

     

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