Critical Appraisal of the Diagnosis of the Sessile Serrated Adenoma
Critical Appraisal of the Diagnosis of the Sessile Serrated Adenoma
复制标题
DOI：
10.1097/pas.0000000000000103
复制
发表时间：
2014-02-01
影响因子：
5.6
通讯作者：
Leggett, Barbara
中科院分区：
文献类型：
--
作者：
Bettington, Mark;Walker, Neal;Leggett, Barbara
无蒂锯齿状腺瘤 (SSA) 是一种相对较新的息肉，可能给执业病理学家带来诊断困难。文献报道中 SSA 诊断的频率差异很大。此外，微泡增生性息肉 (MVHP) 和 SSA 之间的组织学界面仍然是一个诊断问题。近年来的趋势是降低 SSA 诊断的门槛。在此，我们对 3 个月内在大规模社区病理学实践中收到的 6340 例结直肠息肉进行了横断面研究。经过集中审查，严格应用2010年版世界卫生组织消化道肿瘤分类中概述的诊断标准，我们发现SSA占所有息肉的12.1%。此外，我们开发了新的诊断子类别，试图确定 MVHP 和 SSA 之间接口的最合适的截止值。我们发现，具有任何 SSA 样隐窝的锯齿状息肉（MVHP 或 SSA）与 SSA 的临床特征比 MVHP 更相似，并且这种诊断界限在病理学家之间显示出良好的可重复性。这支持了最近一份共识出版物的立场，即只要有 1 个 SSA 型隐窝的息肉就应诊断为 SSA。将这些标准应用到我们的队列中，总体 SSA 率为 14.7%。总之，我们认为 SSA 在病理实践中仍然未被充分诊断，这可能导致监测不足，从而导致间期结直肠癌。
The sessile serrated adenoma (SSA) is a relatively recently described polyp that can present diagnostic difficulties for the practicing pathologist. The frequency of SSA diagnoses varies dramatically in the reported literature. In addition, the histologic interface between the microvesicular hyperplastic polyp (MVHP) and the SSA continues to be a diagnostic problem. The trend in recent years has been toward a lower threshold for SSA diagnosis. Herein, we have performed a cross-sectional study of 6340 colorectal polyps received at a high-volume community-based pathology practice over a 3-month period. After central review, with strict application of the diagnostic criteria outlined in the 2010 edition of the World Health Organization Classification of Tumours of the Digestive Tract, we found that SSAs represented 12.1% of all polyps. In addition, we developed novel diagnostic subcategories in an attempt to determine the most appropriate cutoff for the interface between the MVHP and the SSA. We found that serrated polyps (MVHPs or SSAs) with any SSA-like crypts had clinical features more in common with the SSA than the MVHP and that this diagnostic cutoff showed good reproducibility between pathologists. This supports the position of a recent consensus publication proposing that polyps with as few as 1 SSA-type crypt should be diagnosed as an SSA. Applying these criteria to our cohort yields an overall SSA rate of 14.7%. In summary, we believe that SSAs continue to be underdiagnosed in pathologic practice and that this may result in inadequate surveillance and thus contribute to interval colorectal carcinomas.