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Importance of the surrounding colonic mucosa in distinguishing between hyperplastic and adenomatous polyps during acetic acid chromoendoscopy

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World Journal of Gastroenterology 2008年第12期14卷 1903-1907页

作者： Jeong Hwan Kim Sun-Young Lee Byung Kook Kim won hyeok choe So Young Kwon In-Kyung Sung Hyung-Seok Park Choon-Jo Jin Department of Internal Medicine Konkuk University School of Medicine Seoul 143-729 Korea

AIM: To examine the characteristics of colonic polyps, where it is difficult to distinguish adenomatous polyps from hyperplastic polyps, with the aid of acetic acid chromoendoscopy. METHODS: Acetic acid spray was applied to colonic polyps smaller than 10 mm before complete excision. Endoscopic images were taken before and 15-30 s after the acetic acid spray. Both pre-and post-sprayed images were shown to 16 examiners, who were asked to interpret the lesions as either hyperplastic or adenomatous polyps. Regression analysis was performed to determine which factors were most likely related to diagnostic accuracy. RESULTS: In 50 cases tested by the 16 examiners, the overall accuracy was 62.4% (499/800). Regression analysis demonstrated that surrounding colonic mucosa was the only factor that was significantly related to accuracy in discriminating adenomatous from hyperplastic polyps (P < 0.001). Accuracy was higher for polyps with linear surrounding colonic mucosa than for those with nodular surrounding colonic mucosa (P < 0.001), but was not related to the shape, location, or size of the polyp. CONCLUSION: The accuracy of predicting histology is significantly related to the pattern of colonic mucosa surrounding the polyp. Making a histological diagnosis of colon polyps merely by acetic acid spray is helpful for colon polyps with linear, regularly patterned surrounding colonic mucosa, and less so for those with nodular, irregularly patterned surrounding colonic mucosa.

关键词： Colon polyp Chromoendoscopy Acetic acid

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Treatment for gastric ‘indefinite for neoplasm/dysplasia' lesions based on predictive factors

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World Journal of Gastroenterology 2019年第4期25卷 469-484页

作者： Mi Jung Kwon Ho Suk Kang Hyeon Tae Kim Jin Woo Choo Bo Hyun Lee Sung Eun Hong Kun Ha Park Dong Min Jung Hyun Lim Jae Seung Soh Sung Hoon Moon Jong hyeok Kim Hye-Rim Park Soo Kee Min Jin won Seo Ji-Young choe Department of Pathology Hallym University Sacred Heart Hospital Hallym University College of Medicine Department of Internal Medicine Hallym University Sacred Heart Hospital

BACKGROUND Gastric ‘indefinite for neoplasm/dysplasia'(IFND) is a borderline lesion that is difficult to diagnose as either regenerative or neoplastic. There is a need for guidance in the identification of a subset of patients, who have an IFND lesion with a higher risk of malignant potential, to enable risk stratification and optimal *** To determine the clinical and pathologic factors for the accurate diagnosis of gastric IFND *** In total, 461 gastric lesions diagnosed via biopsy as IFND lesions were retrospectively evaluated. Endoscopic resection(n = 134), surgery(n = 22), and follow-up endoscopic biopsy(n = 305) were performed to confirm the *** time interval from initial biopsy to cancer diagnosis was measured, and diagnostic delays were categorized as > 2 wk, > 2 mo, > 6 mo, and > 1 year. The IFND lesions presenting as regenerating atypia(60%) or atypical epithelia(40%)at initial biopsy were adenocarcinomas in 22.6%, adenomas in 8.9%, and gastritis in 68.5% of the *** Four clinical factors [age ≥ 60 years(2.445, 95%CI: 1.305-4.580, P = 0.005),endoscopic size ≥ 10 mm(3.519, 95%CI: 1.891-6.548, P < 0.001), single lesion(5.702, 95%CI: 2.212-14.696, P < 0.001), and spontaneous bleeding(4.056, 95%CI:1.792-9.180, P = 0.001)], and two pathologic factors [atypical epithelium(25.575,95%CI: 11.537-56.695, P < 0.001], and repeated IFND diagnosis [6.022, 95%CI:1.822-19.909, P = 0.003)] were independent risk factors for gastric cancer. With two or more clinical factors, the sensitivity and specificity for carcinoma were91.3% and 54.9%, respectively. Ten undifferentiated carcinomas were initially diagnosed as IFND. In the subgroup analysis, fold change(5.594, 95%CI: 1.458-21.462, P = 0.012) predicted undifferentiated or invasive carcinoma in the submucosal layers or deeper. Diagnostic delays shorter than 1 year were not associated with worse prognoses. Extremely well-differentiated adenocarcinomas accounted for half of the repeate

关键词： Gastric cancer Biopsy Endoscopic surgical procedure Diagnostic delay Prognosis

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