Variation in the Detection of Serrated Polyps in an Average Risk Colorectal Cancer Screening Cohort
Variation in the Detection of Serrated Polyps in an Average Risk Colorectal Cancer Screening Cohort
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DOI：
10.1038/ajg.2010.315
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发表时间：
2010-12-01
影响因子：
9.8
通讯作者：
Farraye, Francis A.
中科院分区：
文献类型：
--
作者：
Hetzel, Jeremy T.;Huang, Christopher S.;Farraye, Francis A.
提示：锯齿状息肉是结肠癌替代途径的前体。这些息肉通常是无蒂或扁平的，位于近端结肠，在结肠镜检查时可能被忽略。分类这些息肉的组织学标准最近才被描述。本研究评估锯齿状息肉检测内镜医师和病理学家之间的变化，在平均风险筛查队列和趋势检测随time.METHODS：内镜检查和病理报告进行了审查，从2006年至2008年在城市学术医疗中心的所有平均风险筛查结肠镜检查。息肉分为腺瘤（管状、管状绒毛状或绒毛状）、锯齿状息肉（增生性息肉（HP）、无蒂锯齿状腺瘤（SSA）或发育不良锯齿状息肉（DSP））、腺癌或其他。内镜医师和病理医师之间息肉检测的差异用卡方检验进行检验。息肉检测的潜在预测因素采用Poisson回归建模。结果：研究包括7,192例结肠镜检查的4,335例息肉。腺瘤的检出率（每100次结肠镜检查至少有1例息肉的患者）为22.2，HP为11.7，SSA为0.6，DSP为0.2。近端SSA的检出率从2006年的0.2增加到2008年的4.4（P < 0.001）。腺瘤、HP和SSA在内镜医师中的检出率差异显著。病理学家对HP和SSA的分类率有显著差异，但对腺瘤或DSP无显著差异。在多变量分析中，内镜医师是腺瘤、HP和SSA的重要预测因素。病理学家是一个显着的预测HP，SSA和DSP，但不是adenocal.CONCLUSIONS：本研究描述了检测结直肠息肉的平均风险筛查队列在城市学术医疗中心。在研究期间，近端SSA的检测增加。内镜医师对腺瘤、HP和SSA的检测存在显著差异。病理学家对HP和SSA的分类有显著差异。内窥镜检查和病理学实践应考虑教育干预，以提高锯齿状息肉的检测和标准化分类。
OBJECTIVES: Serrated polyps are precursors in an alternative pathway to colon cancer. These polyps are frequently sessile or flat, located in the proximal colon, and may be overlooked during colonoscopy. Histological criteria to classify these polyps have only recently been described. This study assessed the variation of serrated polyp detection among endoscopists and pathologists in an average risk-screening cohort and trends in detection over time.METHODS: Endoscopy and pathology reports were reviewed from all average risk-screening colonoscopies at an urban academic medical center from 2006 through 2008. Polyps were classified as adenoma (tubular, tubulovillous, or villous), serrated polyp (hyperplastic polyp (HP), sessile serrated adenoma (SSA), or dysplastic serrated polyp (DSP)), adenocarcinoma, or other. Differences in polyp detection among endoscopists and pathologists were tested with chi(2)-tests. Potential predictors of polyp detection were modeled with Poisson regression.RESULTS: Included in the study were 4,335 polyps from 7,192 colonoscopies. Detection prevalence (patients with at least one polyp per 100 colonoscopies) was 22.2 for adenomas, 11.7 for HP, 0.6 for SSA, and 0.2 for DSP. Detection prevalence of proximal SSAs increased from 0.2 in 2006 to 4.4 in 2008 (P < 0.001). Detection prevalences among endoscopists differed significantly for adenomas, HP, and SSA. Classification rates among pathologists differed significantly for HP and SSA, but not for adenoma or DSP. On multivariate analysis, endoscopist was a significant predictor of adenoma, HP, and SSA. Pathologist was a significant predictor of HP, SSA, and DSP, but not adenoma.CONCLUSIONS: This study describes the detection of colorectal polyps in an average risk-screening cohort at an urban academic medical center. Detection of proximal SSAs increased during the study period. Detection of adenoma, HP, and SSA differed significantly by endoscopist. Classification of HP and SSA differed significantly by pathologist. Endoscopy and pathology practices should consider educational interventions to improve serrated polyp detection and standardize classification.