The serrated pathway and colorectal cancer: what the gastroenterologist should know.

IF 3.8 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Rachael Hagen, Amitabh Srivastava, Joseph C Anderson
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引用次数: 0

Abstract

Introduction: Serrated polyps can progress to colorectal cancer (CRC), through a pathway that is distinct from the conventional adenoma-carcinoma sequence. This pathway includes hyperplastic polyps (HPs), sessile serrated polyps (SSPs), and traditional serrated adenomas (TSAs).

Areas covered: Our review includes the histology and pathological challenges, carcinogenesis, risk factors, detection, emerging technologies, resection, and surveillance.

Expert opinion: Serrated polyp management presents many detection, diagnosis, resection, and surveillance challenges. Missed serrated polyps contribute to preventable CRCs. A new SSP detection rate benchmark will guide endoscopists with a goal when improving detection. Furthermore, new SSP-specific surveillance strategies may also aid in reducing CRC burden. Histologic differentiation remains a challenge, underscoring the need for standardized pathology practices and exploring novel ways to stratify risk independent of histology, given interobserver variation. Moreover, the clinical significance of proximal HPs requires further clarification. Which HPs < 1 cm require closer surveillance intervals? Molecular profiling may help identify markers that separate proximal low risk from high-risk HP. The best approach for resection of serrated polyps also needs to be clarified. There is also a lack of robust longitudinal outcome data to guide surveillance recommendations since current guidelines are based on low quality of evidence.

锯齿状通路与结直肠癌:胃肠病学家应该知道的。
导读:锯齿状息肉可发展为结直肠癌(CRC),其发展途径不同于传统的腺瘤-癌序列。该途径包括增生性息肉(hp)、无柄锯齿状息肉(ssp)和传统锯齿状腺瘤(TSAs)。涵盖领域:我们的综述包括组织学和病理学挑战、致癌、危险因素、检测、新兴技术、切除和监测。专家意见:锯齿状息肉的治疗提出了许多检测、诊断、切除和监测方面的挑战。漏诊的锯齿状息肉可导致可预防的crc。一个新的SSP检出率基准将指导内镜医师有目标地提高检出率。此外,新的ssp特异性监测策略也可能有助于减轻结直肠癌负担。组织学分化仍然是一个挑战,强调需要标准化的病理实践和探索新的方法来区分独立于组织学的风险,考虑到观察者之间的差异。此外,近端hp的临床意义需要进一步明确。这HPs
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来源期刊
Expert Review of Gastroenterology & Hepatology
Expert Review of Gastroenterology & Hepatology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
6.80
自引率
2.60%
发文量
86
审稿时长
6-12 weeks
期刊介绍: The enormous health and economic burden of gastrointestinal disease worldwide warrants a sharp focus on the etiology, epidemiology, prevention, diagnosis, treatment and development of new therapies. By the end of the last century we had seen enormous advances, both in technologies to visualize disease and in curative therapies in areas such as gastric ulcer, with the advent first of the H2-antagonists and then the proton pump inhibitors - clear examples of how advances in medicine can massively benefit the patient. Nevertheless, specialists face ongoing challenges from a wide array of diseases of diverse etiology.
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