Screening Relevance of Sessile Serrated Polyps
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Conventional adenomas have historically been considered to be the only screening-relevant colorectal cancer (CRC) precursorlesion. The prevailing paradigm was that most CRCs arise along the chromosomal instability pathway, where adenomas accumulateincremental genetic alterations over time, leading eventually to malignancy. However, it is now recognized that this “conventional”pathway accounts for only about two-thirds of CRCs. The serrated pathway is responsible for most of the remainder, and is adisproportionate contributor to postcolonoscopy CRC. Hallmarks of the serrated pathway are mutations in the BRAF gene, high levelsof methylation of promoter CpG islands, and the sessile serrated polyp (SSP). Accumulating evidence shows that SSPs can be consideredadenoma-equivalent from the standpoint of CRC screening. SSPs have a higher prevalence than previously thought, and appear tohave a relatively long dwell time similar to that of conventional adenomas. In addition, SSPs, whether sporadic or as part of the serratedpolyposis syndrome, are associated with increased risk of synchronous and metachronous neoplasia. These features collectively supportthat SSPs are highly relevant to CRC prevention.
Abstract
Conventional adenomas have historically been considered to be the only screening-relevant colorectal cancer (CRC) precursorlesion. The prevailing paradigm was that most CRCs arise along the chromosomal instability pathway, where adenomas accumulateincremental genetic alterations over time, leading eventually to malignancy. However, it is now recognized that this “conventional”pathway accounts for only about two-thirds of CRCs. The serrated pathway is responsible for most of the remainder, and is adisproportionate contributor to postcolonoscopy CRC. Hallmarks of the serrated pathway are mutations in the BRAF gene, high levelsof methylation of promoter CpG islands, and the sessile serrated polyp (SSP). Accumulating evidence shows that SSPs can be consideredadenoma-equivalent from the standpoint of CRC screening. SSPs have a higher prevalence than previously thought, and appear tohave a relatively long dwell time similar to that of conventional adenomas. In addition, SSPs, whether sporadic or as part of the serratedpolyposis syndrome, are associated with increased risk of synchronous and metachronous neoplasia. These features collectively supportthat SSPs are highly relevant to CRC prevention.
참고문헌 (26)
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