Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK

Citation
Bj. Rembacken et al., Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK, LANCET, 355(9211), 2000, pp. 1211-1214
Citations number
30
Language
INGLESE
art.tipo
Article
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Journal title
LANCET
ISSN journal
0140-6736 → ACNP
Volume
355
Issue
9211
Year of publication
2000
Pages
1211 - 1214
Database
ISI
SICI code
0140-6736(20000408)355:9211<1211:FADCNA>2.0.ZU;2-A
Abstract
Background Flat and depressed colorectal tumours were originally thought to be unique to the Japanese population. Recently there have been reports of flat and depressed lesions in western countries but they have been thought to be uncommon. Methods In this prospective study, 1000 consecutive patients attending for routine colonoscopy were examined for flat or depressed lesions. The examin ations were done by one European colonoscopist using methods developed in J apan. Finding 321 adenomas were found: 202 (63%) were polypoid, 36% (117) were fl at and 2 (0.6%) appeared depressed. Most adenomas contained areas of mild o r moderate dysplasia but 10% (31) were severely dysplastic. Six Dukes' A ad enocarcinomas were identified together with 25 more advanced adenocarcinoma s. The likelihood of Dukes' A cancer or severe dysplasia increased from 4% (3/70) in small flat lesions, to 6% (9/154) in small polyps, 16% (8/50) in larger polyps, 29% (14/49) in large flat lesions, and 75% (3/4) in depresse d lesions. 54% (20/37) lesions containing severe dysplasia or Dukes' A carc inoma were flat or depressed. Interpretation The polyp-carcinoma hypothesis prompts colonoscopists to sea rch only for polypoid lesions when screening for cancer, and many early col orectal neoplasms may therefore be missed. Colonoscopists require training in the recognition of flat and depressed lesions to detect colorectal tumou rs in the early stages.