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1、结直肠锯齿状息肉最新报道Updateonserratedpolypsofthecolorectum姜惠峰山东大学齐鲁医院（青岛）2014-03-191简要介绍锯齿状病变专家共识推荐规范增生性息肉(MVHP)与SSA/P的新认知传统型锯齿状腺瘤(TSA)伴异型增生2简要介绍锯齿状病变专家共识推荐规范2010年在Cleveland举行，由美国胃肠病学会(ACG)支持、美国国立卫生研究院(NIH)赞助专家组成员：endoscopy,surgery,pathology,epidemiology,and/o
2、rmolecularaspectsofserratedlesionsand/orserratedpolyposis.3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。4KeyconclusionsandrecommendationsoftheconsensusgroupPathology1Serratedlesionsofthecolo
3、rectumshouldbeclassifiedhistologicallyashyperplasticpolyp(HP),sessileserratedadenoma/polyp(SSA/P)withorwithoutcytologicdysplasia,ortraditionalserratedadenoma(TSA).Exceptionsandsubcategoriesarediscussedinthetext.Cliniciansandpathologistswithininstituti
4、onsshouldworkcollaborativelytoachieveacommonusageandunderstandingofterminologyofserratedlesions.2SSA/PandTSAarepre-cancerouslesions.SSA/Pistheprincipalprecursorofhypermethylatedcolorectalcancers(cancerswiththeCpGIslandMethylatorPhenotype–CIMP).Thispat
5、hwayoccursprimarilyintheproximalcolon.53SSA/PisdistinguishedfromHPpathologicallybyfindingsofcryptdistortion,particularlyinthecryptbase,inSSA/P.Werecommendthatasingleunequivocalarchitecturallydistorted,dilated,and/orhorizontallybranchedcrypt,particular
6、lyifitisassociatedwithinvertedmaturation,issufficientforadiagnosisofSSA/P.MostlargeserratedlesionsintheproximalcolonareSSA/Ps.4SSA/PwithcytologicaldysplasiaisamoreadvancedlesionintheprogressiontocancercomparedtoSSA/Pwithoutcytologicaldysplasia.6Endosc
7、opy5SSA/Pandhyperplasticpolypsintheproximalcolonhaveadistinctendoscopicappearance,whichincludesa“mucuscap”,colorusuallysimilartonormalmucosa,andindistinctedges.Allcolonoscopistsshouldbeabletorecognizeserratedlesions.6Detectionofproximalcolonserratedle
8、sionsbyindividualendoscopistsishighlycorrelatedwithadenomadetection.Pendingdevelopmentofspecificdetectiontargetsforproximalcolonserratedlesions,endoscopistsshouldmeasuretheiradenomadetectionratesasacheckonadequatedetectionofserratedlesions.7Al
