含进展组织腺瘤在结直肠微小息肉中的检出率

Prevalence of Adenoma with Advanced Histology in Diminutive Colorectal Polyps

背景:新近,美国消化内镜学会提出了PIVI策略,建议对结直肠微小息肉(≤5 mm)采取'预测、切除、丢弃'策略。该策略能否实施取决于微小息肉中含进展组织腺瘤(指含≥25%的绒毛成分或高级别上皮内瘤变或黏膜下浸润癌的腺瘤)的检出率。目的:调查含进展组织腺瘤在结直肠微小息肉中的检出率。方法:纳入2013年1~6月在上海仁济医院消化内镜中心行结肠镜检查并检出息肉的患者。记录息肉大小、部位、形态等信息,切除后置于独立标本瓶中,送病理检查。结果:共1 986枚结直肠息肉纳入研究,其中≤5 mm的微小息肉900枚(45.3%),6~9 mm的小息肉521枚(26.2%),≥10 mm的大息肉565枚(28.4%)。微小息肉组含进展组织腺瘤的检出率显著低于小息肉组和大息肉组(1.1%对8.4%和43.7%,P<0.05),且与微小息肉的检出部位和形态无关。所有微小息肉中均未检出黏膜下浸润癌,小息肉组和大息肉组黏膜下浸润癌检出率分别为0.4%和4.6%。结论:在本组研究对象中,含进展组织腺瘤在结直肠微小息肉中的检出率极低且未发现黏膜下浸润癌,适合采取'预测、切除、丢弃'策略。

Background:Recently,the American Society for Gastrointestinal Endoscopy published the PIVI( Preservation and Incorporation of Valuable Endoscopic Innovations)initiative regarding to the“predict,resect,and discard”strategy on diminutive(≤5 mm)colorectal polyps. The low prevalence of adenoma with advanced histology( containing ≥25%villous component,or high-grade intraepithelial neoplasia,or submucosal invasive carcinoma)in diminutive polyps would provide high confidence for endoscopists to adopt the strategy. Aims:To investigate the prevalence of adenoma with advanced histology in diminutive colorectal polyps. Methods:Data of diameter,location and morphology of colorectal polyps were collected prospectively from patients undergoing colonoscopy at Digestive Endoscopy Centre,Shanghai Ren Ji Hospital from Jan. 2013 to Jun. 2013. The polyps were resected,placed in a unique specimen vial,and sent for histological evaluation. Results:A total of 1 986 colorectal polyps were enrolled in the study,including 900(45. 3%) diminutive polyps(≤5 mm),521(26. 2%)small polyps(6-9 mm)and 565(28. 4%)large polyps(≥10 mm). Prevalence of adenoma with advanced histology in diminutive polyps was significantly lower than those in small and large polyps(1. 1% vs. 8. 4% and 43. 7%,P<0. 05),and was not correlated with the location and morphology of diminutive polyps. Submucosal invasive carcinoma was found in 4. 6% of large polyps,0. 4% of small polyps,and 0% of diminutive polyps. Conclusions:The very low prevalence of adenoma with advanced histology and absence of submucosal invasive carcinoma in diminutive colorectal polyps favours the potential practice of“predict,resect,and discard”strategy in the patient population studied.