To the Editor:Colorectal cancer(CRC)remains a leading cause of cancer-related death worldwide.[1]In addition to the classical adenoma-to-carcinoma model of colorectal carcinogenesis,the serrated neoplastic pathway acc...To the Editor:Colorectal cancer(CRC)remains a leading cause of cancer-related death worldwide.[1]In addition to the classical adenoma-to-carcinoma model of colorectal carcinogenesis,the serrated neoplastic pathway accounts for 20%–30%of CRCs.Sessile serrated lesions(SSLs),the most common premalignant serrated polyp subtype,share many of the genomic characteristics of post-colonoscopy CRCs and are thus recognized as their precursor lesions.However,SSLs can be easily missed due to their flat shape and subtle endoscopic features.Sometimes they can also be difficult to distinguish from other types of polyps,especially hyperplastic polyps(HPs),which are believed to have no malignant potential.[2]Approximately 10%of polyps initially diagnosed as HPs endoscopically are reclassified as SSLs after histopathological examination,reflecting diagnostic difficulties in colonoscopy.[3,4]Current guidelines recommend“diagnose-and-leave”and“resect-and-discard”strategies for diminutive polyps,which might lead to SSLs being left in situ or diagnoses being missed,[5]raising the risk of recurrence and post-colonoscopy cancers.Furthermore,it remains debatable in the gastrointestinal community whether the risks of resecting SSLs outweigh the reduction in cancer risk.Any strategy that improves the diagnostic accuracy of SSLs could have a meaningful clinical impact.展开更多
基金CAMS Innovation Fund for Medical Sciences(CIFMSNo.2022-I2M-1-003)Peking Union Medical College(No.2019zlgc0503)
文摘To the Editor:Colorectal cancer(CRC)remains a leading cause of cancer-related death worldwide.[1]In addition to the classical adenoma-to-carcinoma model of colorectal carcinogenesis,the serrated neoplastic pathway accounts for 20%–30%of CRCs.Sessile serrated lesions(SSLs),the most common premalignant serrated polyp subtype,share many of the genomic characteristics of post-colonoscopy CRCs and are thus recognized as their precursor lesions.However,SSLs can be easily missed due to their flat shape and subtle endoscopic features.Sometimes they can also be difficult to distinguish from other types of polyps,especially hyperplastic polyps(HPs),which are believed to have no malignant potential.[2]Approximately 10%of polyps initially diagnosed as HPs endoscopically are reclassified as SSLs after histopathological examination,reflecting diagnostic difficulties in colonoscopy.[3,4]Current guidelines recommend“diagnose-and-leave”and“resect-and-discard”strategies for diminutive polyps,which might lead to SSLs being left in situ or diagnoses being missed,[5]raising the risk of recurrence and post-colonoscopy cancers.Furthermore,it remains debatable in the gastrointestinal community whether the risks of resecting SSLs outweigh the reduction in cancer risk.Any strategy that improves the diagnostic accuracy of SSLs could have a meaningful clinical impact.
