HÁ DIFERENÇAS ENDOSCÓPICAS E HISTOPATOLÓGICAS ENTRE LESÕES SERRILHADAS SUPERFICIAIS NAS SUAS FASES INICIAIS?

Introduction: Serrated lesions are considered precursors of colorectal adenocarcinomas. Studying them in their initial phases is important when thinking about cancer prevention, when they are hyperplastic lesions, or sessile serrated lesions. Objective: To carry out an integrative review of the literature to compare the endoscopic and histopathological characteristics in the initial phases of the disease, with the intention to help understand colorectal cancer. Methods: Integrative literature review based on existing analysis material on the digital platforms SciELO – Scientific Electronic Library Online, Google Scholar, Pubmed and Scopus. The beginning was the search with the following descriptors: “serrated sessile lesions, colorectal carcinoma, superficial lesions”, with AND or OR search, considering the title and/or abstract , and subsequently including only those with the highest correlation for reading the full texts. Results: 39 articles were included. Conclusion: The majority of superficially elevated serrated lesions measuring more than 5 mm and resected by colonoscopies are hyperplastic. They occur throughout the colon and rectum, while the serrated sessiles are preferentially located in the proximal colon. Hyperplastic ones generally do not present dysplasias and sessile serrated ones can have them intensely.Introdução: Lesões serrilhadas são consideradas precursoras dos adenocarcinomas colorretais. Estudá-las em suas fases iniciais é importante ao pensar na prevenção do câncer, quando, então, são lesões hiperplásicas, ou sésseis serrilhadas Objetivo: Realizar revisão integrativa da literatura para comparar as características endoscópicas e histopatológicas nas fases iniciais da doença, com a intenção de auxiliar no entendimento do câncer colorretal. Métodos: Revisão integrativa da literatura baseada em material de análise existente nas plataformas digitais SciELO – Scientific Electronic Library Online, Google Scholar, Pubmed e Scopus.  O início foi a busca com os seguintes descritores: “lesões sésseis serrilhadas, carcinoma colorretal, lesões superficiais”, e seus equivalentes em inglês “serrated sessile lesions, colorectal carcinoma, superficial lesions” com busca AND ou OR, considerando o título e/ou resumo, e incluindo-se posteriormente somente  aqueles com maior correlação para leitura dos textos completos. Resultados:  Incluíram-se 39 artigos. Conclusão: A maioria das lesões serrilhadas superficialmente elevadas com mais de 5 mm e ressecadas por colonoscopias, são hiperplásicas. Elas ocorrem por todo o cólon e reto, enquanto as sésseis serrilhadas localizam-se preferencialmente no cólon proximal. As hiperplásicas geralmente não apresentam displasias e as sésseis serrilhadas podem tê-las de forma intensa

QUAIS LESÕES APRESENTAM MAIOR RISCO DE EVOLUÇÃO PARA CARCINOMAS COLORRETAIS: AS SERRILHADAS SUPERFICIALMENTE ELEVADAS OU AS DEPRIMIDAS?

Background: There are lesions that are still being missed in colonoscopy. Many of those could be superficially elevated serrated lesions or depressed ones. Aim: Compare the histopathological characteristics of these lesions and their risks for submucosal carcinoma. Methods: Retrospective, cross-sectional and observational study comparing 217 superficially elevated serrated lesions larger than 5 mm resected by colonoscopies (G1) with 558 depressed lesions (G2). Results: In G1, 217 lesions were found in 12653 colonoscopies (1,7%); in G2, 558 lesions in 36174 colonoscopies (1.5%). In G1 there were 63.4% of women and in G2 no gender predominance. Average size was G1 with 16.2 mm and G2 with 9.2 mm (p<0.001). G1 predominated on the proximal colon and G2 on the distal and rectum (p<0.001). In G1 there were 214 low-grade intramucosal neoplasia (98,6%) and three high grade intramucosal neoplasia (1,4%). Excluding 126 hyperplastic polyps and considering 91 sessile serrated adenomas in G1, was observed 88 (96.7%) with low-grade intramucosal neoplasia and three (3.3%) high-grade intramucosal neoplasia; in G2, 417 low-grade intramucosal neoplasia (74,7%), 113 high-grade intramucosal neoplasia (20,3%) and 28 (5,0%) submucosal adenocarcinomas (p<0.001). Conclusion: Depressed lesions significantly had more high-grade intramucosal neoplasia and more invasive carcinomas for the submucosal layer than superficially elevated serrated lesions and more than superficially elevated sessile serrated adenomas.Racional: Há ainda lesões que podem ser perdidas nas colonoscopias. Muitas delas poderiam ser serrilhadas superficialmente elevadas ou deprimidas. Objetivo: Comparar as características histopatológicas destas lesões e seus riscos para carcinoma invasivo para a submucosa. Método: Estudo retrospectivo, transversal, observacional comparando 217 lesões serrilhadas superficialmente elevadas com mais de 5 mm e ressecadas por colonoscopias (G1) com 558 lesões deprimidas (G2). Resultados: As 217 lesões do G1 foram encontradas em 12653 colonoscopias (1,7%) enquanto as 558 do G2 ocorreram dentre 36174 colonoscopias (1,5%). No G1, 63,4% eram mulheres e no G2 não houve predominância de gênero. O tamanho médio foi no G1, 16,2 mm e no G2, 9,2 mm (p<0,001). G1 predominaram no cólon proximal e G2, no distal e reto (p<0,001). No G1, ocorreram 214 (98,6%) neoplasias mucosas de baixo grau e três de alto grau (1,4%). Excluídos 126 pólipos hiperplásicos e considerados os 91 adenomas sésseis serrilhados, no G1 observou- se 88 (96,7%) neoplasias mucosas de baixo grau e três (3,3%) de alto grau, e no G2, 417 (74,7%) neoplasias mucosas de baixo grau 113 (20,3%) de alto grau e 28 (5,0%) adenocarcinomas invadindo a submucosa (p<0,001). Conclusões: As lesões deprimidas apresentaram significativamente mais neoplasias mucosas de alto grau e carcinomas invasivos para a submucosa do que as serrilhadas superficialmente elevadas e mais do que os adenomas sésseis serrilhados superficialmente elevados

WHICH LESIONS ARE AT HIGHER RISK OF DEVELOPING COLORECTAL CARCINOMAS: SUPERFICIALLY ELEVATED SERRATED LESIONS OR DEPRESSED LESIONS?

ABSTRACT BACKGROUND: There are lesions that are still being missed in colonoscopy. Many of those could be superficially elevated serrated lesions or depressed ones. AIMS: The aim of this study was to compare the histopathological characteristics of these lesions and their risks for submucosal carcinoma. METHODS: This is a retrospective, cross-sectional, and observational study comparing 217 superficially elevated serrated lesions larger than 5 mm resected by colonoscopies (G1) with 558 depressed lesions (G2). RESULTS: In G1, 217 lesions were found in 12,653 (1.7%) colonoscopies; in G2, 558 lesions were found in 36,174 (1.5%) colonoscopies. In G1, 63.4% were women and in G2, there was no gender predominance. The average size of G1 was 16.2 mm and G2 was 9.2 mm (p<0.001). G1 predominated on the proximal colon and G2 on the distal and rectum (p<0.001). In G1, there were 214 (98.6%) low-grade intramucosal neoplasia and 3 (1.4%) high-grade intramucosal neoplasia. Excluding 126 hyperplastic polyps and considering 91 sessile serrated adenomas in G1, we observed 88 (96.7%) low-grade intramucosal neoplasia and 3 (3.3%) high-grade intramucosal neoplasia; in G2, we observed 417 (74.7%) low-grade intramucosal neoplasia, 113 (20.3%) high-grade intramucosal neoplasia, and 28 (5.0%) submucosal adenocarcinomas (p<0.001). CONCLUSION: Depressed lesions significantly had more high-grade intramucosal neoplasia and more invasive carcinomas in the submucosal layer than superficially elevated serrated lesions and more than superficially elevated sessile serrated adenomas