Background and Aims

Carcinogenesis in Lynch syndrome involves fast progression of adenomas to colorectal cancer (CRC) because of microsatellite instability. The role of sessile serrated lesions (SSLs) and the serrated neoplasia pathway in these patients is unknown. The aim of this matched case-control study was to compare endoscopic detection rates and distribution of SSLs in Lynch syndrome patients with a matched control population.

Methods

We collected data of Lynch syndrome patients with a proven germline mutation who underwent colonoscopy between January 2011 and April 2016 in 2 tertiary referral hospitals. Control subjects undergoing elective colonoscopy from 2011 and onward for symptoms or surveillance were selected from a prospectively collected database. Patients were matched 1:1 for age, gender, and index versus surveillance colonoscopy. An expert pathology review of serrated polyps was performed. The primary outcomes included the detection rates and distribution of SSLs.

Results

We identified 321 patients with Lynch syndrome who underwent at least 1 colonoscopy. Of these, 223 Lynch syndrome patients (mean age, 49.3; 59% women; index colonoscopy, 56%) were matched to 223 control subjects. SSLs were detected in 7.6% (95% confidence interval, 4.8-11.9) of colonoscopies performed in Lynch syndrome patients and in 6.7% (95% confidence interval, 4.1-10.8) of control subjects (P = .86). None of the detected SSLs in Lynch syndrome patients contained dysplasia.

Conclusions

The detection rate of SSLs in Lynch syndrome patients undergoing colonoscopy is comparable with a matched population. These findings suggest that the role of the serrated neoplasia pathway in CRC development in Lynch syndrome seems to be comparable with that in the general population.

中文翻译：

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Lynch综合征患者的无梗锯齿状病变的内窥镜检出率可与年龄和性别相匹配的对照人群相媲美：病例对照研究与专家病理学审查

背景和目标

Lynch综合征的致癌作用涉及腺瘤因微卫星不稳定性而快速发展为结直肠癌（CRC）。在这些患者中，无柄锯齿状病变（SSL）和锯齿状瘤形成途径的作用尚不清楚。这项匹配的病例对照研究的目的是比较对照人群匹配的Lynch综合征患者的内窥镜检出率和SSLs分布。

方法

我们收集了2011年1月至2016年4月之间在两家三级转诊医院接受结肠镜检查的，已证明具有种系突变的林奇综合征患者的数据。从前瞻性收集的数据库中选择从2011年及以后接受症状或监测的择期结肠镜检查的对照对象。患者的年龄，性别和指数与结肠镜检查按1：1匹配。进行了锯齿状息肉的专家病理检查。主要结果包括SSL的检测率和分布。

结果

我们确定了321例Lynch综合征患者，他们接受了至少1次结肠镜检查。在这些患者中，有223名林奇综合征患者（平均年龄49.3；女性59％；结肠镜检查指数56％）与223名对照对象匹配。在Lynch综合征患者中进行结肠镜检查的7.6％（95％置信区间，4.8-11.9）和对照组的6.7％（95％置信区间，4.1-10.8）中检测到SSL（P  = .86）。在Lynch综合征患者中未检测到SSLs含有异型增生。

结论

在接受结肠镜检查的林奇综合征患者中，SSL的检出率与匹配人群相当。这些发现表明，锯齿状瘤形成途径在Lynch综合征的CRC发生中的作用似乎与普通人群相当。