Japanese
English
- 有料閲覧
- Abstract 文献概要
- 1ページ目 Look Inside
- 参考文献 Reference
- サイト内被引用 Cited by
要旨●近年,通常の大腸腺腫からの発癌とは異なる大腸鋸歯状病変,特にSSA/Pからの発癌経路が報告され,摘除対象として他のポリープとの鑑別が重要となってきている.筆者らの施設ではSSA/Pからの発癌予防,および正確なSSA/Pの組織学的診断に基づく大腸癌発癌のリスク層別化のために,SSA/Pが疑わしい病変を積極的に摘除している.そこでSSA/Pを放置することなく摘除するために感度の高いNBI併用拡大観察所見を前向きに検討した.NICE Type 1と分類された大腸ポリープにおいて腺窩開口部の開大所見(ECO),拡張分岐した血管所見(TBV)のSSA/Pに対する診断能(感度,特異度,正診率)はそれぞれ98%,60%,75%と良好であった.NBI併用拡大観察を用いてSSA/Pが疑わしい病変を拾い上げることにより,大腸癌の前癌病変,および併発する大腸癌発癌リスクの層別化因子と考えられるSSA/Pを効率的に鑑別し摘除できる可能性が示された.
NICE〔the NBI(narrow band imaging)International Colorectal Endoscopic〕, classification accurately classifies colorectal polyps. However, SSA/Ps(sessile serrated adenoma/polyps)pathologically resemble a hyperplastic polyp and can be misclassified as in situ using the NICE classification. Although we think SSA/Ps should be excised, our study aimed to evaluate and establish new and simple diagnostic criteria for SSA/Ps using M-NBI(magnifying NBI).
We performed a single-arm observational study to measure diagnostic accuracy for SSA/Ps. We identified brownish, oval ECOs(expanded crypt openings)and TBVs(thick-branched vessels)on the surfaces of SSA/Ps. We included 796 polyps from 261 patients and classified 126 polyps as NICE type 1; all of these lesions were endoscopically excised and assessed histopathologically. M-NBI showed a sensitivity of 98%, specificity of 60%, and accuracy of 75% in differentiating SSA/Ps from other lesions classified as NICE type 1. Identification of ECOs with TBVs has high sensitivity for the diagnosis of SSA/P. These findings suggest the importance of M-NBI as a diagnostic tool to identify ECO and TBV for selective endoscopic excision of SSA/Ps for risk reduction and stratification for colorectal cancer.
Copyright © 2015, Igaku-Shoin Ltd. All rights reserved.