IS SUPERFICIAL COLORECTAL LESIONS WITH LOW AND HIGH GRADES INTRAEPITHELIAL NEOPLASMS MORE PREVALENT IN OLDER ABOVE 65 YEARS?

ABSTRACT Background: Colorectal cancer has a higher incidence in the rectum and sigmoid. However, with the expansion of the diagnosis of superficial lesions interest in the diagnosis and in the role they play in colorectal carcinogenesis has increased. Aim: To verify the behavior of superficial lesions of the colon and rectum, comparing the pathological and endoscopic findings, below and above 65 years. Methods: Cross-sectional study with prospective evaluation of standard protocol, where 200 patients with colorectal superficial lesions were evaluated; they were submitted to colonoscopy and mucosectomy of these lesions. They were divided in two age groups, below and above 65 years. Results: One hundred-and-eight were women (54%) and 92 men (46%). Most colon lesions were localized in the right colon (95%) and the remaining (5%) in the rectum. In endoscopy, 77.20% were granular lesions in patients under 65 years and 77.90% above. Colon histology showed low grade intraepithelial neoplasia, being 69.79% in patients under and 73.70% in above 65 years. In rectum, above 65 years the incidence of high-grade intraepithelial neoplasia was higher (66.70%). Conclusion: The superficial colorectal lesions have been more endoscopically diagnosed today, and the highest incidence is the granular type, both in the colon and rectum, regardless of age. Regardless the age, histologically colon lesions were more as low grade intraepithelial neoplasia. In rectum, there was distinction for both age groups, being more frequent high grade intraepithelial neoplasia in patients over 65 years.

摘要 背景：结直肠癌（colorectal cancer）在直肠与乙状结肠的发病率更高。然而随着浅表病变诊断范畴的拓展，学界对这类病变的诊断价值及其在结直肠癌癌变进程中所发挥作用的研究兴趣日益高涨。目的：明确结直肠浅表病变的临床特征，并对比65岁以上与65岁以下患者的病理及内镜检查结果。方法：本研究为横断面研究，采用前瞻性标准化方案开展评估，共纳入200例结直肠浅表病变患者，所有患者均接受结肠镜检查（colonoscopy）及病变黏膜切除术（mucosectomy）；按年龄分为65岁以下、65岁以上两组。结果：本研究纳入的患者中，女性108例（54%），男性92例（46%）。多数结肠病变位于右半结肠，剩余5%位于直肠。内镜检查结果显示，65岁以下患者中77.20%为颗粒型病变，65岁以上组该占比为77.90%。结肠组织病理学检查提示以低级别上皮内瘤变（low grade intraepithelial neoplasia）为主，65岁以下患者占比69.79%，65岁以上组占比73.70%。直肠病变方面，65岁以上患者的高级别上皮内瘤变（high grade intraepithelial neoplasia）发生率更高（66.70%）。结论：当前结直肠浅表病变的内镜诊断率有所提升，无论结肠还是直肠，最常见的病变类型均为颗粒型，且该特征与患者年龄无关。无论患者年龄如何，结肠病变的组织病理学表现多为低级别上皮内瘤变。直肠病变则存在年龄差异：65岁以上患者的高级别上皮内瘤变更为常见。