Sporadic Nonampullary Duodenal Adenoma in the Natural History of Duodenal Cancer: A Study of Follow-up Surveillance
Sporadic Nonampullary Duodenal Adenoma in the Natural History of Duodenal Cancer: A Study of Follow-up Surveillance
复制标题
DOI：
10.1038/ajg.2010.422
复制
发表时间：
2011-02-01
影响因子：
9.8
通讯作者：
Igarashi, Masahiro
中科院分区：
文献类型：
--
作者：
Okada, Kazuhisa;Fujisaki, Junko;Igarashi, Masahiro
目的：虽然散发性非壶腹十二指肠腺瘤（SNDA）被认为是癌前病变，但其自然病程尚不确定。本研究的目的是评估最初诊断为低级别非典型增生（LGD，分类3）或高级别非典型增生（HGD，分类4.1）的SNDA病变发生腺癌的风险。方法：我们分析了66例连续患者的68例snda，这些snda是根据初始和随后的活检诊断的。其中46例（43例LGD， 3例HGD）未治疗随访>= 6个月（平均27.7 +/- 16.9个月，范围6-72个月），其中8例在随访期间最终切除。16个病变（LGD 8个，HGD 8个）立即内镜或手术切除，6个病变因随访时间短（< 6个月）而被排除。评估组织病理学诊断和肉眼变化。结果：43例LGD随访6个月，34例（79.1%）无组织学改变，其余9例（20.9%）进展为HGD，其中2例（4.7%）最终进展为非侵袭性癌（4.2类）。从宏观上看，76.7%（33 / 43）的LGD病变没有明显的大小变化，16.3%（7 / 43）无法检测到，4.7%（2 / 43）的体积变小，2.3%（1 / 43）的体积变大。相比之下，所有三个HGD病变在随访bb0 = 6个月的组织学上保持不变，基于活检，并没有显示明显的宏观变化，尽管其中一个HGD病变在内镜下切除后显示为非侵袭性癌。虽然我们从活检样本中诊断出所有病变为HGD，但很高比例的癌症（54.5%，11例中的6例）是从切除的标本中诊断出来的。一项多变量分析表明，首次活检时诊断出HGD，病变直径为>= 20mm可显著预测腺癌的进展。结论：LGD病变进展为腺癌的风险较低，但有进展为HGD的风险，值得仔细随访活检。然而，HGD病变和大snda >= 20mm直径显示进展为腺癌的高风险。因此，他们应该立即治疗。
OBJECTIVES: Although sporadic nonampullary duodenal adenoma (SNDA) is regarded as a precancerous lesion, its natural course is uncertain. The aim of this study was to evaluate the risk of development of adenocarcinoma in SNDA lesions initially diagnosed as showing low-grade dysplasia (LGD; category 3) or high-grade dysplasia (HGD; category 4.1).METHODS: We analyzed 68 SNDAs, diagnosed based on initial and subsequent biopsies, in 66 consecutive patients. Of these, 46 (43 LGD lesions, 3 HGD lesions) were followed up for >= 6 months without treatment (mean 27.7 +/- 16.9 months; range 6-72 months), including 8 lesions that were eventually resected during follow-up. Sixteen lesions (eight LGD lesions, eight HGD lesions) were resected immediately, either endoscopically or surgically, and six lesions were excluded because of a short follow-up (< 6 months). The histopathological diagnoses and macroscopic changes were evaluated.RESULTS: Among the 43 LGD lesions followed up for >= 6 months, 34 (79.1%) showed no histopathological changes during follow-up, whereas the remaining 9 (20.9%) showed progression to HGD, including 2 (4.7%) that progressed eventually to noninvasive carcinoma (category 4.2). Macroscopically, 76.7% (33 of 43) of the LGD lesions showed no notable changes in size, 16.3% (7 of 43) became undetectable, 4.7% (2 of 43) reduced in size, and 2.3% (1 of 43) became larger in size. In contrast, all the three HGD lesions that were followed up for >= 6 months remained unchanged histologically, based on biopsy, and showed no notable macroscopic changes, although one of these HGD lesions resected endoscopically revealed evidence of noninvasive carcinoma. Although we diagnosed all lesions as HGD from biopsy samples, a high percentage of cancers (54.5%, 6 of 11) were diagnosed from resected specimens. A multivariate analysis identified HGD diagnosed at first biopsy and a lesion diameter of >= 20 mm as being significantly predictive of progression to adenocarcinoma.CONCLUSIONS: LGD lesions show a low risk of progression to adenocarcinoma, but some risk of progression to HGD, which warrants careful follow-up biopsy. However, HGD lesions and large SNDAs >= 20 mm in diameter show a high risk of progression to adenocarcinoma. Therefore, they should be treated immediately.