Flat adenomas in the United Kingdom: Are treatable cancers being missed?
Flat adenomas in the United Kingdom: Are treatable cancers being missed?
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DOI：
10.1055/s-2007-1001304
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发表时间：
1998-06-01
期刊：
影响因子：
9.3
通讯作者：
Axon, ATR
中科院分区：
文献类型：
--
作者：
Fujii, T;Rembacken, BJ;Axon, ATR
背景和研究目的：公认的结直肠恶性肿瘤途径是腺瘤-癌序列。据估计，多达三分之二的结直肠癌源自腺瘤性息肉。近年来，日本研究人员提出，早期结直肠恶性肿瘤可能表现为“扁平”或“凹陷”，而不是息肉样病变。这种扁平或凹陷的腺瘤和腺癌在西方尚未得到广泛认识。一项前瞻性研究采用日本结肠镜技术在英国人群中寻找扁平和凹陷的腺瘤。患者和方法：在英国一家中心的这项前瞻性研究中，连续 210 名参加常规结肠镜检查的患者接受了扁平或凹陷的病变检查。检查由经验丰富的日本内窥镜医师（T.F.）使用日本技术进行。结果：总共发现 68 个腺瘤，其中 40 个（59%）为息肉状，26 个（38%）为扁平状，2 个（3%）为凹陷状。大多数腺瘤包含轻度或中度不典型增生区域，但有四个是严重不典型增生。其中两个是大息肉状管状绒毛状腺瘤，第三个是7毫米突出的息肉，第四个是直径6毫米的凹陷腺瘤。还发现了三名 Dukes 的 A 期腺癌。其中，一个是 20 毫米的息肉，一个是 15 毫米的粘膜平坦隆起，中央凹陷，第三个是 6 毫米的粘膜凹陷。最后，发现了 4 例 Dukes B 级或更晚期的腺癌。结论：息肉癌假说提示结肠镜医生在筛查恶性肿瘤时仅寻找息肉样病变。因此，很大一部分早期结直肠肿瘤可能会被遗漏。欧洲结肠镜医生需要接受识别平坦隆起和凹陷病变的培训，以便在早期发现结直肠恶性肿瘤。
Background and Study Aims: The recognized pathway for colorectal malignancies is the adenoma-carcinoma sequence. It is estimated that up to two-thirds of colorectal carcinomas arise from adenomatous polyps. In recent years, Japanese workers have suggested that early colorectal malignancies may arise as "flat" or "depressed" rather than as polypoid lesions. Such flat or depressed adenomas and adenocarcinomas have not been widely recognized in the West. A prospective study was carried out to search for flat and depressed adenomas in a British population, using Japanese colonoscopic techniques.Patients and Methods: In this prospective study at a British centre, 210 consecutive patients attending for routine colonoscopy were examined for flat or depressed lesions. The examinations were carried out using Japanese techniques by an experienced Japanese endoscopist (T.F.).Results: Overall, 68 adenomas were found, of which 40 (59%) were polypoid, 26 (38%) were flat, and two (3%) appeared depressed. The majority of the adenomas contained areas of mild or moderate dysplasia, but four were severely dysplastic. Two of these were large polypoid tubulovillous adenomas, the third was a 7-mm protruding polyp, and the fourth was a depressed adenoma 6 mm in diameter. Three Dukes' stage A adenocarcinomas were also found. Of these, one was a 20-mm polyp, one a 15-mm flat elevation of the mucosa with a central depression, and the third a 6-mm depression of the mucosa. Finally, four Dukes' B or more advanced adenocarcinomas were found.Conclusions: The polyp-carcinoma hypothesis prompts colonoscopists to search only for polypoid lesions when screening for malignancy. A significant proportion of early colorectal neoplasms may therefore be missed. European colonoscopists require training in the recognition of flat elevated and depressed lesions in order to detect colorectal malignancies in their early stages.