Flat adenomas exist in asymptomatic people: important implications for colorectal cancer screening programmes
Flat adenomas exist in asymptomatic people: important implications for colorectal cancer screening programmes
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DOI：
10.1136/gut.43.2.229
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发表时间：
1998-08-01
期刊：
影响因子：
24.5
通讯作者：
Atkin, WS
中科院分区：
文献类型：
--
作者：
Hart, AR;Kudo, S;Atkin, WS
背景-扁平腺瘤是非外生性的，具有平坦的顶部或中央凹陷，并且在组织学上，发育不良组织的深度绝不会超过粘膜厚度的两倍。扁平腺瘤通常含有严重发育异常的组织，并且可能通过腺瘤-癌序列迅速进展。在英国无症状人群中从未描述过扁平病变。目的 - 参与一项可弯曲乙状结肠镜筛查的大型随机对照试验，确定无症状人群中是否存在扁平腺瘤。患者 - 总共 3000 名受试者（年龄 55-64 岁）接受了可弯曲乙状结肠镜筛查。方法 - 所有息肉均被切除并送去组织学检查。记录具有内镜和组织学特征的扁平腺瘤息肉的数量。结果——3名受试者总共有4个扁平病变——即每1000名筛查者中有1个。其中三个包含严重发育异常的组织，其中一个是腺癌的焦点。 4个病灶中，3个病灶直径小于5mm，第4个病灶直径15mm。结论：无症状人群中存在严重不典型增生的扁平病灶。这对于胃肠病学家来说具有重大意义，他们应该接受培训来识别它们。它们的存在对于研究结直肠癌病因的分子生物学家和流行病学家来说非常重要。
Background-Flat adenomas are non-exophytic with a flat top or central depression and histologically the depth of dysplastic tissue is never more than twice the mucosal thickness. Flat adenomas frequently contain severely dysplastic tissue, and may progress rapidly through the adenoma-carcinoma sequence. Flat lesions have never been described in a British asymptomatic population.Aims-To determine whether flat adenomas exist in an asymptomatic population participating in a large randomised controlled trial of flexible sigmoidoscopy screening.Patients-A total of 3000 subjects (aged 55-64 years) underwent screening by flexible sigmoidoscopy.Methods-All polyps were removed and sent for histology. The number of polyps with endoscopic and histological features of flat adenomas was recorded.Results-Three subjects had a total of four flat lesions-that is, one per 1000 people screened. Three contained severely dysplastic tissue, one a focus of adenocarcinoma. Three of the four lesions were less than 5 mm in size and the fourth was 15 mm in diameter.Conclusions-Flat lesions with severe dysplasia exist in the asymptomatic population. This has major implications for gastroenterologists who should be trained to identify them. Their existence is of importance to molecular biologists and epidemiologists investigating the aetiology of colorectal cancer.