Volumetric growth rates of sessile serrated adenomas/polyps observed in situ at longitudinal CT colonography.

Autor: Pickhardt PJ; University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. ppickhardt2@uwhealth.org.; Department of Radiology, University of Wisconsin School of Medicine and E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA. ppickhardt2@uwhealth.org., Pooler BD; University of Wisconsin School of Medicine and Public Health, Madison, WI, USA., Matkowskyj KA; University of Wisconsin School of Medicine and Public Health, Madison, WI, USA., Kim DH; University of Wisconsin School of Medicine and Public Health, Madison, WI, USA., Grady WM; Fred Hutchinson Cancer, University of Washington, Seattle, WA, USA., Halberg RB; University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2019 Sep; Vol. 29 (9), pp. 5093-5100. Date of Electronic Publication: 2019 Feb 11.
DOI: 10.1007/s00330-019-5999-0
Abstrakt: Objective: Sessile serrated adenomas/polyps (SSA/Ps) are now recognized as potential cancer precursors, but little is known about their natural history. We assessed the in vivo growth rates of histologically proven SSA/Ps at longitudinal CT colonography (CTC) and compared results with non-advanced tubular adenomas (TAs).
Methods: We identified a cohort of 53 patients (mean age, 54.8 ± 5.5 years; M:F, 26:27) from one center with a total of 58 SSA/Ps followed longitudinally at CTC (mean follow-up interval, 5.3 ± 1.9 years). Initial and final size measurements were determined using dedicated CTC software. Findings were compared with 141 non-advanced TAs followed at CTC (mean, 4.1 ± 2.3 years) in 113 patients (mean age, 56.8 ± 6.9 years).
Results: SSA/Ps were more often flat (62% [36/58] vs. 14% [20/141], p < 0.0001) and right-sided (98% [57/58] vs. 46% [65/141], p < 0.0001) compared with TAs. Initial average diameter was greater for SSA/Ps (9.3 mm vs. 6.3 mm; p < 0.0001). Mean annual volumetric growth was + 12.7%/year for SSA/Ps vs. + 36.4%/year for TAs (p = 0.028). Using a previously defined threshold of + 20% increase in volume/year to define progression, 22% (13/58) of SSA/Ps and 41% (58/141) of TAs progressed (p = 0.014). None of the SSA/Ps had dysplasia or invasive cancer at histopathology.
Conclusions: Sessile serrated adenoma/polyps demonstrate slower growth compared with conventional non-advanced tubular adenomas, despite larger initial linear size. This less aggressive behavior may help explain the more advanced patient age for serrated pathway cancers. Furthermore, these findings could help inform future colonoscopic surveillance strategies, as current guidelines are largely restricted to expert opinion related to the absence of natural history data.
Key Points: • Sessile serrated adenoma/polyps (SSA/Ps) tend to be flat, right-sided, and demonstrate slower growth compared with conventional non-advanced tubular adenomas. • This less aggressive behavior of SSA/Ps may help explain the more advanced patient age for serrated pathway cancers.
Databáze: MEDLINE
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