20180319结直肠锯齿状息肉最新报道资料教程.pptxVIP

结直肠锯齿状息肉最新报道Update on serrated polyps of the colorectum2014-03-19经与会专家组讨论15年MEDLIAN文献，形成共识报告，目的是总结锯齿状息肉病理、分子病理和内镜特征，提高这种疾病威胁的意识，描述内镜特征，强调该疾病精确探查和完全切除的重要性，提供有关该病切除后处理的推荐规范。Key conclusions and recommendations of the consensus groupPathology1 Serrated lesions of the colorectum should be classified histologically as hyperplastic polyp (HP), sessile serrated adenoma/polyp(SSA/P) with or without cytologic dysplasia, or traditional serrated adenoma (TSA). Exceptions and subcategories are discussed in the text. Clinicians and pathologists within institutions should work collaboratively to achieve a common usage and understanding of terminology of serrated lesions.2 SSA/P and TSA are pre-cancerous lesions. SSA/P is the principal precursor of hypermethylated colorectal cancers (cancers with the CpG Island Methylator Phenotype – CIMP). This pathway occurs primarily in the proximal colon.3 SSA/P is distinguished from HP pathologically by findings of crypt distortion, particularly in the crypt base, in SSA/P. We recommend that a single unequivocal architecturally distorted, dilated, and/or horizontally branched crypt, particularly if it is associated with inverted maturation, is sufficient for a diagnosis of SSA/P. Most large serrated lesions in the proximal colon are SSA/Ps.4 SSA/P with cytological dysplasia is a more advanced lesion in the progression to cancer compared to SSA/P without cytologicaldysplasia.Endoscopy5 SSA/P and hyperplastic polyps in the proximal colon have a distinct endoscopic appearance, which includes a “mucus cap”, color usually similar to normal mucosa, and indistinct edges. All colonoscopists should be able to recognize serrated lesions.6 Detection of proximal colon serrated lesions by individual endoscopists is highly correlated with adenoma detection. Pending development of specific detection targets for proximal colon serrated lesions, endoscopists should measure their adenoma detection rates as a check on adequate detection of serrated lesions.7 All