结直肠广基锯齿状腺瘤/息肉与增生性息肉的内镜及病理学特征分析

Endoscopic and hispathological features of sessile serrated adenoma/polyp and hyperplastic polyp

目的 分析比较结直肠广基锯齿状腺瘤/息肉(SSA/P)与增生性息肉(HP)的内镜及组织病理学特征.方法 回顾性分析本院消化内镜中心2015年5月至2018年12月检出的151例(179枚)SSA/P、200例(200枚)HP的内镜及病理学资料.结果 SSA/P更多位于近端结肠(52.5%),而HP大部分(72.5%)位于远端结肠,两者比较P<0.05;82.7%的SSA/P直径大于5 mm,而95%的HP直径小于5 mm.69.8%的SSA/P和97%的HP形态均为浅表型,但SSA/P中隆起型息肉所占比例(30.2%)明显高于HP (3%);HP中,日本NBI专家组(Japan NBI Expert Team,JNET)允型均为1型,无异型增生病例.42.5%的SSA/P伴低级别上皮内瘤变,5.5%伴高级别上皮内瘤变,位于远端结肠、形态呈隆起型或侧向发育型、直径>10 mm、窄带内镜成像(NBI)放大下呈JNET 2A或2B型的病变中,异型增生发生率显著增高(58.8%~81.3%)(P<0.05).≤5 mm的SSA/P有67.7%位于远端结肠,93.5%呈0-Ⅱa型,93.5%呈JNET 1型,在分布部位、形态、JNET分型方面,与HP内镜下特点相似(P>0.05).结论 SSA/P具有恶变潜能,但SSA/P和HP在内镜下表现有相似之处,其诊断及鉴别诊断仍存在难点,值得进一步研究.

Objective To investigate the endoscopic and hispathological features of sessile serrated adenoma/polyp(SSA/P)and hyperplastic polyp(HP). Methods The data of patients with SSA/P or HP diagnosed in the Digestive Endoscopy Center at Fujian Provincial JinShan Hospital from May 2015 to Dec. 2018 were reviewed,and the endoscopic and hispathological features of 179 SSA/Ps and 200 HPs were analyzed. Result 52.5% of SSA/Ps were located in the proximal colon, while most HPs(72.5%)were located in the distal colon. 82.7% of SSA/Ps were larger than 5 mm,with a proportion much higher than HPs(5%).Most SSA/Ps and HPs had a type 0-IIa morphology,but SSA/Ps displayed protrude type morphology more frequently than HPs(30.2% VS 3%). All HPs showed type JNET 1 in NBI magnifying endoscopy and without dysplasia. 42.5% of SSA/Ps had low-grade intraepithelial neoplasia(LGIN),and 5.5% had high-grade intraepithelial neoplasia(HGIN).The incidence of dysplasia was significantly increased(58.8%-81.3%) in SSA/Ps with one of the following characteristics:located in the distal colon, displayed protrude type or LST morphology,larger than 10 mm,JNET 2 A or 2 B at NBI magnification(P<0.05). Among the SSA/P≤5 mm, 67.7% were located in the distal colon, 93.5% were 0-IIa type, and 93.5% were JNET 1 type. In terms of location, morphology, and JNET classification, the characteristics were similar to HP(P>0.05). Conclusion SSA/Ps have malignant potential, but SSA/P and HPs still have difficulties in endoscopic diagnosis, which deserve further attention and study.