Endoscopic diagnosis for colorectal sessile serrated lesions

作     者：Toshihiro Nishizawa Shuntaro Yoshida Akira Toyoshima Tomoharu Yamada Yoshiki Sakaguchi Taiga Irako Hirotoshi Ebinuma Takanori Kanai Kazuhiko Koike Osamu Toyoshima 

作者机构：Department of Gastroenterology and HepatologyInternational University of Health and Welfare Narita HospitalNarita 2868520Japan Department of GastroenterologyToyoshima Endoscopy ClinicTokyo 1570066Japan Department of Colorectal SurgeryJapanese Red Cross Medical CenterTokyo 1508935Japan Department of GastroenterologyThe University of TokyoTokyo 1138655Japan Department of GastroenterologyGraduate School of MedicineThe University of TokyoTokyo 1138655Japan Department of Internal MedicineIrako ClinicTokyo 1560052Japan Division of Gastroenterology and HepatologyDepartment of Internal MedicineKeio University School of MedicineShinjuku-ku 1608582TokyoJapan 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2021年第27卷第13期

页      面：1321-1329页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Sessile serrated lesion Mucus cap Indistinct borders Hyperplastic polyp Endoscopic features Size 

摘      要：BACKGROUND Hyperplastic polyps are considered non-neoplastic, whereas sessile serrated lesions(SSLs) are precursors of cancer via the ‘‘serrated neoplastic pathway’’. The clinical features of SSLs are tumor size( 5 mm), location in the proximal colon, coverage with abundant mucus called the ‘‘mucus cap’’, indistinct borders, and a cloud-like surface. The features in magnifying narrow-band imaging are varicose microvascular vessels and expanded crypt openings. However, accurate diagnosis is often difficult.AIM To develop a diagnostic score system for SSLs.METHODS We retrospectively reviewed consecutive patients who underwent endoscopic resection during colonoscopy at the Toyoshima endoscopy clinic. We collected data on serrated polyps diagnosed by endoscopic or pathological examination. The significant factors for the diagnosis of SSLs were assessed using logistic regression analysis. Each item that was significant in multivariate analysis was assigned 1 point, with the sum of these points defined as the endoscopic SSL diagnosis score. The optimal cut-off value of the endoscopic SSL diagnosis score was determined by receiver-operating characteristic curve analysis.RESULTS Among 1288 polyps that were endoscopically removed, we analyzed 232 diagnosed as serrated polyps by endoscopic or pathological examination. In the univariate analysis, the location(proximal colon), size( 5 mm), mucus cap, indistinct borders, cloud-like surface, and varicose microvascular vessels were significantly associated with the diagnosis of SSLs. In the multivariate analysis, size( 5 mm;P = 0.033), mucus cap(P = 0.005), and indistinct borders(P = 0.033) were independently associated with the diagnosis of SSLs. Size 5 mm, mucus cap, and indistinct borders were assigned 1 point each and the sum of these points was defined as the endoscopic SSL diagnosis score. The receiver-operating characteristic curve analysis showed an optimal cut-off score of 3, which predicted pathological SSLs with 75% sensitivity, 80% specificity, and 78.4% accuracy. The pathological SSL rate for an endoscopic SSL diagnosis score of 3 was significantly higher than that for an endoscopic SSL diagnosis score of 0, 1, or 2(P 5 mm, mucus cap, and indistinct borders were significant endoscopic features for the diagnosis of SSLs. Serrated polyps with these three features should be removed during colonoscopy.