Adenoma miss rate of polypectomy-referring hospitals is high in Korea

Ju Hyun Seo,이보인,Kyung-Jin Lee,박재명,Jin Soo Kim,조영석,이강문,Sang Woo Kim,최황,최명규 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.4

Background/Aims: We evaluated the miss rates of polyps, adenomas, and advanced neoplasia of polypectomy-referring hospitals and risk factors for missed adenomas. Methods: We compared medical records and electronic images of initial colonoscopies from polypectomy-referring hospitals with those of corresponding therapeutic colonoscopies from Seoul St. Mary’s Hospital obtained from May 2014 to February 2016. Results: A total of 147 patients (56.6 ± 12.1 years, 37 females) were included. The mean number of polyps and adenomas detected on initial colonoscopy was 2.4 ± 1.7 and 1.7 ± 1.4, respectively. The mean number of additionally detected polyps and adenomas per patient during therapeutic colonoscopy was 1.4 ± 1.8 and 1.0 ± 1.5, respectively. Pooled miss rate for polyps, adenomas, and advanced neoplasia was 36%, 37%, and 11%, respectively. Pooled miss rate for adenomas was significantly higher for right-sided, non-pedunculated, and small (< 1 cm) adenomas (p = 0.031, p = 0.000, and p = 0.000, respectively). The miss rate of polyps, adenomas, and advanced neoplasia per patient was 60%, 49%, and 7%, respectively. Multivariate analysis revealed age and number of adenoma on initial colonoscopy were significantly related with risk for adenoma-missing (p = 0.005 and p = 0.023, respectively). Conclusions: Among patients referred for polypectomy, adenoma is missed in one of two patients and advanced neoplasm is missed in one of 13. Patients with advanced age or multiple adenoma on initial colonoscopy have a higher possibility of missed adenoma. Total colon exploration should be performed carefully during therapeutic colonoscopy.

Comparison of malignant potential between serrated adenomas and traditional adenomas

Song, Sang Yong,Kim, Young-Ho,Yu, Min Kyu,Kim, Jeong Hwan,Lee, Ji Min,Son, Hee Jung,Rhee, Poong-Lyul,Kim, Jae J,Paik, Seung Woon,Rhee, Jong Chul Blackwell Publishing Asia 2007 Journal of gastroenterology and hepatology Vol.22 No.11

<P>Abstract</P><P>Background: </P><P>Serrated adenoma is a discrete colorectal epithelial neoplastic lesion that can evolve into colorectal cancer. However, the degree of malignant potential has not been firmly established as yet. The purpose of the present paper was to compare the malignant potential and clinicopathological features between serrated and traditional adenomas.</P><P>Methods: </P><P>A total of 124 serrated adenomas from 116 patients were assessed, and 419 traditional adenomas from 200 were randomly selected. The combination of nuclear dysplasia and serration of ≥20% of crypts was regarded as serrated adenoma. The clinicopathological features of serrated and traditional adenomas were compared, and multivariate analysis performed to confirm whether the malignant potential of serrated adenoma was similar to that of traditional adenoma.</P><P>Results: </P><P>The differences in age, sex, total number of adenomas, and synchronous lesions including adenoma with high-grade dysplasia and carcinoma between subjects with and without serrated adenoma were not significant. Serrated adenomas were more frequently located in the rectum and sigmoid colon (<I>P</I> < 0.001), and the average size of serrated adenomas was greater than that of traditional adenomas (<I>P</I> < 0.05). The incidence of malignant lesions including high-grade dysplasia and carcinoma in serrated adenomas was found to be lower than in traditional adenomas (3.2% vs 9.3%, <I>P</I> < 0.05). In the multivariate analysis, adenoma type and polyp size constituted the risk factors for the incidence of high-grade dysplasia and carcinoma.</P><P>Conclusions: </P><P>Serrated adenoma is a premalignant lesion, but it has a lower potential for the development of malignancy than traditional adenomas.</P>

국내에서 보고된 간세포 선종에 대한 임상적 고찰

최남수(Nam Soo Choi),김병호(Byung Ho Kim),이성배(Sung Bae Lee),정일우(Il Woo Jung),동석호(Seok Ho Dong),김효종(Hyo Jong Kim),장영운(Young Woon Jang),이정일(Joung Il Lee),장린(Rin Chang),홍성화(Sung Hwa Hong) 대한내과학회 1998 대한내과학회지 Vol.54 No.5

N/A Objectives: Hepatic adenoma is a rare benign tumor, occuring in women of child-bearing age and it is known that hepatic adenoma is associated with history of oral contraceptive use in about 90% of cases, rarely with type I glycogen storage disease or anabolic steroids. There have been five cases of hepatic adenoma reported in Korea and three cases have been confirmed in our hospital. We examined the clinical findings of these eight cases and compare them with those of hepatic adenoma reported in western countries. Methods: We reviewed five cases published in medical literature of Korea and three cases confirmed in our hospital, The clinical, laboratory, and radiological features of the eight cases were examined and all were pathologically proven cases as hepatic adenoma. Results: Six cases were male and two cases were female. Mean age of them were 37±6 years old which ranged from 24 to 45 years old. Two cases of female did not have history of ingestion of oral contraceptives and six cases of male did not have history of having anabolic steroids. The associated diseases were chronic hepatitis B in two cases, glycogen storage disease type I in one case, and ovarian mucinous cystadenoma in one case. The presenting symptoms we upper abdominal discomfort in five cases, chronic fatigue in one case and two cases had no symptom Hepatic adenomas were single mass in seven cases and only one case suspected of having glycogen storage disease showed six nodules. The mean diameter of the eight hepatic adenoma was 7.7±3.7cm which range from 2.0cm to 15cm 5even of the eight cases were larger than 5cm in diameter. but there was no case of intraperitoneal bleeding. In laboratory studies, AST/ALT was elevated (81/84IU/L, normal range less than 40lU/L) in one case which was suspected of glycogen storage disease. Alkaline phosphatase were elevated in four cases and elevated α-FP was not found in any case. Hepatic adenoma was shown as hyperechoic mass with indistinct margin by ultrasonography and hypodense mass with contrast enhancement by computed tomography. Hepatic adenoma showed isodense or low signal intensity in T1WI, and low or high signal intensity in T2WI. Hepatic angiography showed hypervascular mass in six cases but avascular mass in two cases. Conclusion: The reported cases of hepatic adenoma were predominant in men, associated with chronic hepatitis B in two cases, and females with hepatic adenoma had no history of having oral contraceptive. Despite the large size of hepatic adenoma, there was no case accompanied by peritoneal bleeding. These findings contrasts with these of hepatic adenoma reported in western countries. Therefore the pathogenesis and clinical course of hepatic adenoma in Korea may be different with those of hepatic adenoma occurring in western countries and further studies are needed,

뇌하수체 선종의 면역조직화학 검색

이용희,김태승 대한병리학회 1994 Journal of Pathology and Translational Medicine Vol.28 No.6

Endoscopic and Histopathologic Predictors of Recurrence of Colorectal Adenoma on Lowering the Miss Rate

( Jeong Seon Ji ),( Kyu Yong Choi ),( Won Chul Lee ),( Bo In Lee ),( Soo Heon Park ),( Hwang Choi ),( Byung Wook Kim ),( Hiun Suk Chae ),( Yong Moon Park ),( Young Jun Park ) 대한내과학회 2009 The Korean Journal of Internal Medicine Vol.24 No.3

Background/Aims: Although colorectal adenoma is reported to recur frequently, this may result from missing it at baseline. However, few studies of recurrence have considered the miss rate. This study evaluated the recurrence rate prospectively and clinical predictors of recurrence in colorectal adenoma after lowering the miss rate. Methods: The study population comprised 128 patients who underwent baseline colonoscopy with resection of colorectal adenomas. Re-examination to lower the miss rate was performed within 2 months. Follow-up colonoscopy to detect recurrence was done more than 1 year after removal. Results: The mean follow-up period was 35.1 months (range, 12 to 84 months). Thirty patients had a recurrent adenoma, for a recurrence rate of 23.4%. Older patients (over 60 years) had a two-fold greater risk of recurrence than younger patients (hazard ratio, 2.39; 95% confidence interval [CI], 1.16-4.90). Patients with three or four adenomas at baseline colonoscopy had a two-fold greater risk than those with one adenoma (hazard ratio, 2.44; 95% CI, 1.11-5.35). Patients with advanced adenoma had a two-fold greater risk than those with no advanced adenoma (hazard ratio, 2.88; 95% CI, 1.40-5.95). In multivariate analysis, only the presence of three or four adenomas independently predicted the recurrence of adenoma (hazard ratio, 3.19; 95% CI, 1.04-9.79). Conclusions: The recurrence rate of colorectal adenoma corrected by lowering the miss rate was lower than reported rates. The presence of multiple adenomas on initial colonoscopy was an important predictor of recurrence. (Korean J Intern Med 2009;24:196-202)

면역세포화학 염색법과 전자 현미경검사를 통한 뇌하수체 선종의 특징

이은직(Eun Jig Lee),이현철(Hyun Chul Lee),양우익(Woo Ik Yang),김경래(Kyung Rai Kim),김현만(Hyun Man Kim),안광진(Kwang Jin Ahn),정윤석(Yoon Sok Chung),임승길(Sung Kil Lim),김태승(Tae Seung Kim),박찬일(Chan Il Park),최인준(In Joon choi 대한내과학회 1992 대한내과학회지 Vol.43 No.2

N/A Background: The development of immunocytochemistry and the application of electron microscopy improved the knowledge of the pathology and classification of the pitutiary adenomas. We investigated the characteristics of the pituitary adenomas examined by the immunocytochemistry and electron microscopy. Methods: 44 patients with the pituitary adenomas were investigated, using immunocytochemical techniques in paraffin-embedded tissue, and electron microscopy in fresh tissue. Results: The mean age was 38±13 years, and the ratio of male to female was 1: 2.4 and 18 were prolactinomas, 8 acromegalies, 3 acromegalies with hyperprolactinemia, 3 Cushing`s diaseases, 3 FSH secreting adenomas, 1 TSH secreting adenomas, and 6 nonfunctioning adenomas among 44 patients. The agreement between serum prolactin and prolactin immunocytochemistry was 77.3% if the serum prolaetin level to predict lactotrope adenoma was above 50ng/ml; however, the agreement was 93,2% if the serum prolatin level above 100ng/ml. The serum levels of prolactin and growth hormone in sparsely granulated lactotrope and somatotrope adenomas were 1149.6, 109.5ng/ml, respectively, which were higher than those (129.6, 35.9ng/ml) of densely granulated ones. Immunocytochemical and electron microscopic analysis revealed that thirteen were lactotrope adenomas (12 sparsely granulated, and 1 densely granulated), 9 somatotrope adenomas (6 sparsely granulated and 3 densely granulated), 6 gonadotrope, 4 corticotrope (3 symtomatic and 1 silent), 1 mixed somatotrope and lactotrope, 1 mammosomatotrope, 1 thyrotrope, and 9 null cell (6 nononcocytic, and 3 oncocytic) adenomas. Conclusion: The immunocytochemistry, permitting the visualization of intracellular hormones in the tissue of the pituitary adenoma, made exact histologic diagnosis. So, we have known whether the cause of hyperprolactinemia was lactotrope adenoma or functional hyperprolactinemia due to PIF inhibiton. And it was also possible to diagnose silent corticotrope adenoma and gonadotrope adenoma which had no apparent clinical manifestation. Electron microscopic examination of the pituitary adenoma diagnosed by immunocytchemistry showed ultrastructrural characteristics of the adenoma cells containing each hormones, Accordingly, we could subclassify the pituitary adenoma. However, the identification of the adenomas with somewhat similar ultrastrutural features such as null cell, gonadotrope, and thyrotrope adenoma, may be facilitated by immunocytochemistry. Accordingly, both immunocytochemistry and electron microscopy are necessary for the identification and characterization of the pituitary adenomas.

위선종 환자에서 대장내시경 선별 검사가 필요한가?

박선영 ( Seon Young Park ),김현수 ( Hyun Soo Kim ),윤경원 ( Kyung Won Yoon ),조성범 ( Sung Bum Cho ),이완식 ( Wan Sik Lee ),박창환 ( Chang Hwan Park ),주영은 ( Young Eun Joo ),최성규 ( Sung Kyu Choi ),류종선 ( Jong Sun Rew ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.4

Background/Aims: It has been reported that patients with gastric cancer may be at increased risk of synchronous or metachronous colorectal cancer. However, the incidence of colorectal adenoma in patients with gastric adenoma has not been discussed earlier. The aims of this study were to investigate the incidence of colorectal adenoma and to evaluate the necessity of colonoscopic surveillance in patients with gastric adenoma. Methods: We performed colonoscopy in 221 patients with gastric adenoma between January 2002 and June 2008. As a control group, 387 consecutive patients without gastric adenoma on gastroscopy who underwent colonoscopy were included. We retrospectively examined the endoscopic and colonoscopic findings as well as the clinicopathologic features. Results: Colorectal adenoma were diagnosed in 57.5% (127/221) of the gastric adenoma group and 38.0% (147/387) of the control group (p<0.001). Univariate analysis demonstrated that gender, age, past history of diabetes, and past history of gastric adenoma were associated with the risk of colorectal adenoma. Multivariate analysis demonstrated that gender (male, aOR 2.31, 95% CI 1.61-3.31), age (≥50 years, aOR 2.47, 95% CI 1.53-4.01), past history of diabetes (aOR 2.35, 95% CI 1.32-4.20), and presence of gastric adenoma (aOR 1.63, 95% CI 1.13-2.36) appeared to be independent risk factors for colorectal adenoma. Conclusions: The risk of colorectal adenoma increases significantly in patients with gastric adenoma. We suggest that colonoscopic surveillance may be necessary in patients with gastric adenoma. (Korean J Gastroenterol 2009;54:220-226)

심장발목혈관지수와 발목상완지수를 기반으로 한 죽상경화증과 고위험 대장 샘종의 연관성

이정호,조현석,이상훈,이성준,강창돈,최대희,박진명,남승주,김태석,김지현,박성철 대한소화기학회 2024 대한소화기학회지 Vol.83 No.4

Background/Aims: Colorectal adenomas are precancerous lesions that may lead to colorectal cancer. Recent studies have shown that colorectal adenomas are associated with atherosclerosis. The cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) are noninvasive methods for evaluating atherosclerosis. This study examined the association between atherosclerosis and high-risk colorectal adenomas based on the CAVI and ABI. Methods: The data of patients aged ≥50 years who had a colonoscopy and CAVI and ABI measurements from August 2015 to December 2021 at the Kangwon National University Hospital were analyzed retrospectively. After the colonoscopy, subjects were divided into no, overall, and high-risk (size ≥1 cm, high-grade dysplasia or villous adenoma, three or more adenomas) adenoma groups based on the pathology findings. The data were subjected to univariate and multivariate logistic regression analyses. Results: Among the 1,164 subjects, adenomas and high-risk adenomas were found in 613 (52.6%) and 118 (10.1%) patients, respectively. The rate of positive ABI (<0.9) and positive CAVI (≥9.0) were significantly higher in the high-risk adenoma group (22.0% and 55.9%) than in the no adenoma (12.3% and 39.6%) and the overall adenoma group (15.7% and 44.0%) (p=0.008 and p=0.006, respectively). Multivariate analysis revealed a positive CAVI and smoking status to be significantly associated with high-risk adenoma with an odds ratio of 1.595 (95% confidence interval 1.055–2.410, p=0.027) and 1.579 (1.072–2.324, p=0.021), respectively. Conclusions: In this study, a significant correlation between positive CAVI and high-risk adenomas was observed. Therefore, CAVI may be a significant predictor for high-risk colorectal adenoma.

대장편평선종의 임상적 고찰

박용순(Yong Soon Park),최우봉(Woo Bong Choi),함정식(Jung Sik Ham),장재영(Jae Young Jang),이영홍(Young Hong Lee),김진오(Jin Oh Kim),조영덕(Young Deok Cho),봉형근(Hyung Keun Bong),김연수(Yun Soo Kim),조주영(Joo Young Cho),이준성(Joon S 대한내과학회 1997 대한내과학회지 Vol.53 No.2

N/A Objectives: To determine accurate diagnosis and proper treatment, we reviewed colonoscopic and histologic findings of flat adenoma of colon, Methods: We studied retrospectively 2148 cases of colonoscopic findings performed in our hospital from March of 1993 to September of 1995. Results: 1) The incidence of adenoma is 9.5%(203 cases), and that of flat adenoma is 1.6%(34 cases). 2) The location of flat adenoma is 3 cases in rectum(8.8%), 15 cases in sigmoid colon(44.1%), 9 cases in descending colon(26.5%), 3 cases in transverse colon(8.8%) and 4 cases in ascending colon and cecum(11.8%). 3) The diameter of flat adenoma was smaller than 5mm in 17 cases(50.0%), between 5-10mm in 8 cases(23.5%) and larger than 10mm in 9 cases (26.5%). Mean size was 9.2mm. 4) In colonoscopic features, type IIa was 25 cases (73.5%), type IIa + IIc was 5 cases(14.7%) and lateral spreading tumor was 4 cases(11.8%). 5) In histologic findings, tubular adenoma was 26 cases(76.5%), tubulovillous adenoma was 6 cases (17.6%) and serrated adenoma was 2 cases(5.9%). 6) The incidence of severe dysplasia or carcinoma was zero in smaller than 5mm, 25.0%(2 case) in 5-10mm and 55.6%(5 cases) in larger than 10mm. 7) The incidence of severe dysplasia or carcinoma was 11.5%(3 cases) in tubular adenoma and 66.7%(6 cases) in tubulovillous adenoma. 8) It was confirmed by abdominal CT scan or operation that lesions were limited to intraepithelium in 4 cases, mucosa in 2 cases submucosa in 1 case and no lymph node metastasis in any case. Conclusion: Even though flat adenoma of colon was smaller than polypoid adenoma, the incidence of malignant change was higher. When it was smaller than 10mm, the incidence of submucosal invasion or lymph node invasion was rare. Therefore endoscopic mucosal resection(EMR) can be the treatment of choice in flat adenoma smaller than 10mm, and after EMR, it is desirable to decide the treatment modality depending on the histologic findings.

에스 결장경, 선별검사로서 충분한가? 에스 결장경으로 발견할 수 없는 대장 선종

정승용,강윤식,김도선,이두한,조항준,김태수 대한대장항문학회 1998 Annals of Coloproctolgy Vol.14 No.1