Tiivistelmä

Paksusuolen paikalliset adenoomat ja sahalaitapolyypit ovat yleisiä. Niiden esiintyvyys ­aikuisväestössä on 10–40 %.

Paksusuolisyövän esiastemuutosten diagnostiikka perustuu histologiseen tutkimukseen. Endoskopiassa havaitut muutokset poistetaan patologis-anatomista diagnoosia varten seurantatarpeen määrittämiseksi.

Ruoansulatuskanavan kasvainten päivitetty luokitus WHO 2019 sisältää merkittäviä muutoksia esiasteiden terminologiaan ja diagnostisiin kriteereihin.

Abstract

Precursors of large bowel cancer are common, and their estimated prevalence in the average-risk adult population is around 10–40%. Conventional adenomas and serrated lesions account for the majority of precursors. While the technical development of endoscopy equipment has been rapid during the last years, histopathological diagnosis is still required for the follow-up decision.

The role of the pathologist in the estimation of the costs of the follow-up is evident. Correct and up to date diagnosis that meets the needs of a clinician is a prerequisite for the optimal follow-up strategy.

The World Health Organization has recently published the fifth edition of Tumours of the Digestive Tract in the WHO Classification of Tumours series. This classification includes several refinements of the polyp terminology and diagnostic criteria. The current recommendations for polypectomy and follow-up are based on the previous WHO classification (WHO 2010). Therefore, the follow-up for some new polyp types featured in the new classification (WHO 2019) is not yet established.

In this review, we introduce the new WHO classification for those precursors that require follow-up, and estimate the need for follow-up of the polyps that do not feature in the earlier classification and follow-up recommendations.