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1、结直肠锯齿状息肉最新报道Updateonserratedpolypsofthecolorectum2014-03-191简要介绍锯齿状病变专家共识推荐规范增生性息肉(MVHP)与SSA/P的新认知传统型锯齿状腺瘤(TSA)伴异型增生2简要介绍锯齿状病变专家共识推荐规范2010年在Cleveland举行,由美国胃肠病学会(ACG)支持、美国国立卫生研究院(NIH)赞助专家组成员:endoscopy,surgery,pathology,epidemiology,and/ormolecularaspectsofserratedlesions
2、and/orserratedpolyposis.3经与会专家组讨论15年MEDLIAN文献,形成共识报告,目的是总结锯齿状息肉病理、分子病理和内镜特征,提高这种疾病威胁的意识,描述内镜特征,强调该疾病精确探查和完全切除的重要性,提供有关该病切除后处理的推荐规范。4KeyconclusionsandrecommendationsoftheconsensusgroupPathology1Serratedlesionsofthecolorectumshouldbeclassifiedhistologicallyashyperplasticp
3、olyp(HP),sessileserratedadenoma/polyp(SSA/P)withorwithoutcytologicdysplasia,ortraditionalserratedadenoma(TSA).Exceptionsandsubcategoriesarediscussedinthetext.Cliniciansandpathologistswithininstitutionsshouldworkcollaborativelytoachieveacommonusageandunderstandingoftermi
4、nologyofserratedlesions.2SSA/PandTSAarepre-cancerouslesions.SSA/Pistheprincipalprecursorofhypermethylatedcolorectalcancers(cancerswiththeCpGIslandMethylatorPhenotype–CIMP).Thispathwayoccursprimarilyintheproximalcolon.53SSA/PisdistinguishedfromHPpathologicallybyfindingso
5、fcryptdistortion,particularlyinthecryptbase,inSSA/P.Werecommendthatasingleunequivocalarchitecturallydistorted,dilated,and/orhorizontallybranchedcrypt,particularlyifitisassociatedwithinvertedmaturation,issufficientforadiagnosisofSSA/P.Mostlargeserratedlesionsintheproxima
6、lcolonareSSA/Ps.4SSA/PwithcytologicaldysplasiaisamoreadvancedlesionintheprogressiontocancercomparedtoSSA/Pwithoutcytologicaldysplasia.6Endoscopy5SSA/Pandhyperplasticpolypsintheproximalcolonhaveadistinctendoscopicappearance,whichincludesa“mucuscap”,colorusuallysimilarton
7、ormalmucosa,andindistinctedges.Allcolonoscopistsshouldbeabletorecognizeserratedlesions.6Detectionofproximalcolonserratedlesionsbyindividualendoscopistsishighlycorrelatedwithadenomadetection.Pendingdevelopmentofspecificdetectiontargetsforproximalcolonserratedlesions,endo
8、scopistsshouldmeasuretheiradenomadetectionratesasacheckonadequatedetectionofserratedlesions.7Allserratedlesion