Stomach and Intestine(Tokyo) Volume 54, Issue 1 (January 2019)

Magnifying Endoscopic Observation and Diagnosis for Colorectal Serrated Lesions Hiro-o Yamano 1 , Hiro-o Matsushita 2 , Yoshihito Tanaka 2,3 , Kenjiro Yoshikawa 2 , Eiji Harada 2 , Yuko Yoshida 2 , Bunichiro Kato 2 , Toshiyuki Kubo 1 , Tamotsu Sugai 3 , Hiroshi Nakase 1 1Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan 2Department of Digestive Disease Center, Akita Red Cross Hospital, Akita, Japan 3Department of Molecular Diagnostic Pathology, Iwate Medical University, School of Medicine, Morioka, Japan Keyword: 大腸鋸歯状病変 , 拡大内視鏡診断 , SSA/P , TSA , 早期大腸癌 pp.48-56
Published Date 2019/1/25
  • Abstract
  • Look Inside
  • Reference

 Magnifying endoscopic diagnosis for colon neoplastic lesions has become an indispensable diagnostic method for qualitative and quantitative diagnoses. However, due to the emergence of a new disease concept called SSA/P(sessile serrated adenoma/polyp), endoscopic diagnosis for serrated lesion is entering a new stage. In this study, we classified the conventional pit pattern classification by adding II and IV subclasses(type II-O, type II-L, and type IV serration). For 180 lesions of colorectal serrated lesions excluding HP(hyperplastic polyp), we examined separately homogenous and heterogenous pit groups from the viewpoint of uniformity of the entire lesion. As a result, in the homogenous pit group, SSA/P showed type II-O at a high rate of 85.2% of the 69 lesions in 81 lesions, and TSA(traditional serrated adenoma)showed type IV serration as high as 83.3% of the 10 lesions in 12 lesions. High sensitivity, specificity and positive predictive value were reported. Conversely, in heterogenous pit group, SSA/P with cytological dysplasia showed type II-O+type IV serration at a high rate. In this category, type II-O+α showed high sensitivity and negative predictive value. TSA also had a similar tendency in α+type IV serration, but in both groups the specificity and positive predictive value were inferior. In cancer in SSA/P, type II-O+type VI was observed at a high rate, but no characteristic could be found with cancer in TSA. This might be explained by the involvement of TSA in pathological diagnostic problems. Therefore, we conclude that confirmation of homogeneity is important for magnifying endoscopic observation for colorectal serrated lesions, and careful correspondence is desirable for lesions with heterogenous pits.

Copyright © 2019, Igaku-Shoin Ltd. All rights reserved.


54巻1号 (2019年1月)
電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院