| 特集名 | 小さな(大きさ10mm以下)ポリープの取扱い --処置すべきか，フォローアップか | |
|---|---|---|
| 題名 | どう扱うか，小さなポリープ (2) 小さな(10mm以下)大腸上皮性腫瘍の取扱い --X線の立場から | |
| 発刊年月 | 2000年 05月 | |
| 著者 | 小林 広幸 | 松山赤十字病院消化器科 |
| 【 要旨 】 | 要旨はありません。 | |
| Theme | Strategy of managing small colorectal polyps | |
|---|---|---|
| Title | Management of colorectal tumors less than 10mm in diameter, from a radiologic viewpoint | |
| Author | Hiroyuki Kobayashi | Institute of Gastroenterology, Matuyama Red Cross Hospital |
| [ Summary ] | Endoscopic or surgically resected colorectal tumors less than 10mm in diameter were analyzed for their macroscopic appearance and histology (adenoma, intramucosal carcinoma, submucosal invasive carcinoma), and discussed from a radiologic viewpoint, concerning their initial management and follow up, based on the analysis. In the small lesions(6-10mm in diameter), the incidence of carcinoma was 7.0% in protruding types of Ip, Isp and Is, and 19.4% in the flat elevated type(IIa), whereas the incidence of submucosal invasive carcinoma(sm-ca) was detected 1.4%, 6.0%, in each macroscopic type. However, in the minute lesions(less than 5 mm), the incidence of carcinoma markedly decreased to 0.9% in the former types and in 5.7% in the latter type. There were no cases of sm-ca in either type. On the contrary, flat depressed types IIa + IIc, IIc (+ IIa), had higher incidences of carcinoma(55.0%) and of sm-ca(30.0%) in the small lesions but sm-ca was not detected in minute lesions. We recommend as an initial management to follow up for protruding and flat elevated types, except for the lesions suspected of sm-ca by radiologic findings of barium enama ; more than 70% in the ratio of the size of the stalk/head in pedunculated type(Ip), the gross nodular surface structure in sessile polypoid types(Isp, Is, IIa), deformities of the lateral view of the lesion, etc. The reasons are follows ; the lesions are too numerous for treatment of all lesions. Those macroscopic types had a lower incidence of carcinoma than the flat depressed types. Furthermore, it was reported that most of them showed no change in size and remained in the mucosa for several years or more. On the other hand, flat depressed lesions should be treated after the first examination, whether the findings of sm-ca by x-ray show them or not, because of the higher incidence of carcinoma and difficulties in distinguishing intramucosal carcinoma and adenoma through radiologic, endoscopic and pathologic findings. |
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