Endoskopie heute 2009; 22(1): 22-29
DOI: 10.1055/s-2008-1076948
Originalarbeit

© Georg Thieme Verlag Stuttgart ˙ New York

Die Koloskopiefalle: Intervallkarzinome und übersehene Befunde – Neoplasien mit besonders aggressivem Wachstum

Pitfalls in Colonoscopy: New or Missed Cancers after Colonoscopy – Neoplasia with a More Aggressive BehaviourJ. Munding1 , A. Tannapfel1
  • 1Institut für Pathologie, Ruhr-Universität Bochum
Further Information

Publication History

Publication Date:
13 March 2009 (online)

Zusammenfassung

Immer wieder erkranken Patienten, bei denen zuvor eine unauffällige Koloskopie durchgeführt wurde, an einem sogenannten Intervallkarzinom. Es stellt sich die Frage, wie diese Zahl vermin­dert werden kann, oder ob es sich um ein tumorbio­logisch bedingtes, aggressiveres Wachstum ­bestimmter Subtypen handelt. Das „Über­sehen“ ­eines Karzinom oder einer Vorläuferläsion ist ­unter bestimmten Voraussetzungen sowohl untersucher- als auch patientenbedingt möglich. Verschiedene Tumor-Phäno- und Genotypen müssen jedoch genauso bezüglich ihrer Vorläuferläsionen, Entwicklungsgeschwindigkeit und Aggressivität unterschieden werden, wie auch hinsichtlich ihrer koloskopischen Detektierbarkeit.

Abstract

With a remarkable frequency patients develop a so called interval-carcinoma after a colonoscopy without any relevant findings. Ways to minimize the incidence rate are desirable. Further it is of great interest to show if special tumour entities have a more aggressive growth behaviour. The colonoscopic missing of a carcinoma or a preneoplastic lesion can occur under several conditions which could be attributed to patients as well as to the observer. Despite this, different pheno- or genotypes of carcinoma have to be distinguished in regard to specific preneoplastic lesions, growth-rate, aggressiveness and the colonoscopical detection.

Literatur

  • 1 Ries L AG, Melbert D, Krapcho M et al. SEER Cancer Statistics Review, 1975–2004. Bethesda, MD: National Cancer Institute; 2007
  • 2 Winawer S J, Zauber A G, Ho M N et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup.  N Engl J Med. 1993;  329 1977-1981
  • 3 Bressler B, Paszat L F, Chen Z et al. Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis.  Gastroenterology. 2007;  132 96-102
  • 4 Leaper M, Johnston M J, Barclay M et al. Reasons for failure to diagnose colorectal carcinoma at colonoscopy.  Endoscopy. 2004;  36 499-503
  • 5 Farrar W D, Sawhney M S, Nelson D B et al. Colorectal cancers found after a complete colonoscopy.  Clin Gastroenterol Hepatol. 2006;  4 1259-1264
  • 6 Robertson D J, Greenberg E R, Beach M et al. Colorectal cancer in patients under close colonoscopic surveillance.  Gastroenterology. 2005;  129 34-41
  • 7 Sawhney M S, Farrar W D, Gudiseva S et al. Microsatellite instability in interval colon cancers.  Gastroenterology. 2006;  131 1700-1705
  • 8 Vogelstein B, Fearon E R, Hamilton S R et al. Genetic alterations during colorectal-tumor development.  N Engl J Med. 1988;  319 525-532
  • 9 Torlakovic E, Snover D C. Serrated adenomatous polyposis in humans.  Gastroenterology. 1996;  110 748-755
  • 10 Longacre T A, Fenoglio-Preiser C M. Mixed hyperplastic adenomatous polyps/serrated adenomas. A distinct form of colorectal neoplasia.  Am J Surg Pathol. 1990;  14 524-537
  • 11 Song S Y, Kim Y H, Yu M K et al. Comparison of malignant potential between serrated adenomas and traditional adenomas.  J Gastroenterol Hepatol. 2007;  22 1786-1790
  • 12 Zakinen M J. Colorectal serrated adenocarcinoma.  Histopathology. 2007;  50 131-150
  • 13 Snover D C, Jass J R, Fenoglio-Preiser C et al. Serrated polyps of the large intestine: a morphologic and molecular review of an evolving concept.  Am J Clin Pathol. 2005;  124 380-391
  • 14 Kane M F, Loda M, Gaida G M et al. Methylation of the hMLH1 promoter correlates with lack of expression of hMLH1 in sporadic colon tumors and mismatch repair-defective human tumor cell lines.  Cancer Res. 1997;  57 808-811
  • 15 Cunningham J M, Christensen E R, Tester D J et al. Hypermethylation of the hMLH1 promoter in colon cancer with microsatellite instability.  Cancer Res. 1998;  58 3455-3460
  • 16 Toyota M, Ahuja N, Ohe-Toyota M et al. CpG island methylator phenotype in colorectal cancer.  Proc Natl Acad Sci U S A. 1999;  96 8681-8686
  • 17 Saitoh Y, Waxman I, West A B et al. Prevalence and distinctive biologic features of flat colorectal adenomas in a North American population.  Gastroenterology. 2001;  120 1657-1665
  • 18 Nasir A, Boulware D, Kaiser H E et al. Flat and polypoid adenocarcinomas of the colorectum: A comparative histomorphologic analysis of 47 cases.  Hum Pathol. 2004;  35 604-611
  • 19 Okamoto M, Kawabe T, Yamaji Y et al. Flat-type early colorectal cancer preferentially develops in right-sided colon in older patients.  Dis Colon Rectum. 2005;  48 101-107
  • 20 Lanspa S J, Rouse J, Smyrk T et al. Epidemiologic characteristics of the flat adenoma of Muto. A prospective study.  Dis Colon Rectum. 1992;  35 543-546
  • 21 Takahashi T, Nosho K, Yamamoto H et al. Flat-type colorectal advanced adenomas (laterally spreading tumors) have different genetic and epigenetic alterations from protruded-type advanced adenomas.  Mod ­Pathol. 2007;  20 139-147
  • 22 Hurlstone D P, Sanders D S, Atkinson R et al. Endoscopic mucosal resection for flat neoplasia in chronic ulcerative colitis: can we change the endoscopic management paradigm?.  Gut. 2007;  56 838-846
  • 23 Tweedle E M, Chaudhri S, Azadeh B et al. Small, flat colorectal cancers in the UK population: an analysis of resected specimens.  Colorectal Dis. 2007;  9 641-646
  • 24 Postma C, Hermsen M A, Coffa J et al. Chromosomal instability in flat adenomas and carcinomas of the colon.  J Pathol. 2005;  205 514-521
  • 25 Nosho K, Yamamoto H, Takahashi T et al. Genetic and epigenetic profiling in early colorectal tumors and prediction of invasive potential in pT1 (early invasive) colorectal cancers.  Carcinogenesis. 2007;  28 1364-1370
  • 26 Rembacken B J, Fujii T, Cairns A et al. Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK.  Lancet. 2000;  355 1211-1214
  • 27 Diebold M D, Samalin E, Merle C et al. Colonic flat neoplasia: frequency and concordance between endoscopic appearance and histological diagnosis in a French prospective series.  Am J Gastroenterol. 2004;  99 1795-1800
  • 28 O'Brien M J, Winawer S J, Zauber A G et al. flat adenomas in the National Polyp Study: is there increased risk for high-grade dysplasia initially or during surveillance?.  Clin Gastroenterol Hepatol. 2004;  2 905-911
  • 29 Park D H, Kim H S, Kim W H et al. Clinicopathologic Characteristics and Malignant Potential of Colorectal Flat Neoplasia Compared with that of Polypoid Neoplasia.  Dis Colon Rectum. 2008;  51(1) 43-49
  • 30 Hornick J L, Farraye F A, Odze R D. Clinicopathologic and immunohistochemical study of small apparently “de novo” colorectal adenocarcinomas.  Am J Surg Pathol. 2007;  31 207-215
  • 31 Uronis J M, Herfarth H H, Rubinas T C et al. Flat colorectal cancers are ­genetically determined and progress to invasion without going through a polypoid stage.  Cancer Res. 2007;  67 11594-11600
  • 32 Kiesslich R, Goetz M, Lammersdorf K et al. Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis.  Gastroenterology. 2007;  132 874-882
  • 33 Hurlstone D P, Thomson M, Brown S et al. Confocal endomicroscopy in ulcerative colitis: differentiating dysplasia-associated lesional mass and adenoma-like mass.  Clin Gastroenterol Hepatol. 2007;  5 1235-1241
  • 34 Itzkowitz S H, Yio X. Inflammation and cancer IV. Colorectal cancer in inflammatory bowel disease: the role of inflammation.  Am J Physiol Gastrointest Liver Physiol. 2004;  287 G7-G17
  • 35 Lutgens M W, Vleggaar F P, Schipper M E et al. High Frequency of Early Colorectal Cancer in Inflammatory Bowel Disease.  Gut. 2008;  Mar 12 ,  Epub ahead of print
  • 36 Rex D K. Maximizing detection of adenomas and cancers during colonoscopy.  Am J Gastroenterol. 2006;  101 2866-2877

Dr. J. Munding

Institut für Pathologie · Ruhr-Universität Bochum

Bürkle-de-la-Camp-Platz 1

44789 Bochum

Phone: 02 34 / 3 02 48 00

Fax: 02 34 / 3 02 48 09

Email: Johanna.Munding@ruhr-uni-bochum.de

    >