A pathologist's survey on the reporting of sessile serrated adenomas/polyps

Chetty, Runjan; Bateman, A C; Torlakovic, Emina; Wang, Lai Mun; Gill, Paul; Al-Badri, Adnan; Arends, Mark J.; Biddlestone, L.; Burroughs, Susan; Carey, Frank; Cowlishaw, D.; Crowther, Stephen; Costa, Philip Da; Dada, M A; d'Adhemar, Charles; Dasgupta, Kaushik; Cates, C de; Feakins, Roger; Foria, B; Foria, Vipul; Fuller, Clare; Green, Bryan; Greenson, Joel K.; Griffiths, Paul; Hafezi-Bakhtiari, Sara; Henry, Jack; Jaynes, Eleanor; Jeffers, Michael; Kaye, Philip; Landers, R J; Lauwers, Gregory Y.; Loughrey, Maurice B.; Mapstone, Nicholas P.; Novelli, Marco; Odze, Robert D.; Poller, David; Rowsell, Corwyn; Sanders, Scott; Sarsfield, P.; Schofield, J. B.; Sheahan, Kieran; Shepherd, Neil A.; Sherif, Ali M.; Sington, James; Walsh, Shaun; Williams, Namor; Wong, Newton A C S

doi:10.1136/jclinpath-2013-202128

Cited by 10 publications

(8 citation statements)

References 14 publications

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“…Also, MTMG can be silenced by promoter methylation, which on its own results in an MSI-L phenotype. SSA/P are characterised by abnormally shaped (boot, inverted-anchor, J, L or inverted T) crypts or horizontal growth along the muscularis mucosae, with crypt dilatation and serration extending down to the crypt base [ 41 ]. These architectural changes (without genuine dysplasia) are the hallmark of SSA/P and are believed to result from a displacement of the maturation zone [ 33 , 41 , 42 ].…”

Section: Correlation Of Molecular Pathways With Serrated Morphologymentioning

confidence: 99%

Molecular pathological classification of colorectal cancer

2016

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Colorectal cancer (CRC) shows variable underlying molecular changes with two major mechanisms of genetic instability: chromosomal instability and microsatellite instability. This review aims to delineate the different pathways of colorectal carcinogenesis and provide an overview of the most recent advances in molecular pathological classification systems for colorectal cancer. Two molecular pathological classification systems for CRC have recently been proposed. Integrated molecular analysis by The Cancer Genome Atlas project is based on a wide-ranging genomic and transcriptomic characterisation study of CRC using array-based and sequencing technologies. This approach classified CRC into two major groups consistent with previous classification systems: (1) ∼16 % hypermutated cancers with either microsatellite instability (MSI) due to defective mismatch repair (∼13 %) or ultramutated cancers with DNA polymerase epsilon proofreading mutations (∼3 %); and (2) ∼84 % non-hypermutated, microsatellite stable (MSS) cancers with a high frequency of DNA somatic copy number alterations, which showed common mutations in APC, TP53, KRAS, SMAD4, and PIK3CA. The recent Consensus Molecular Subtypes (CMS) Consortium analysing CRC expression profiling data from multiple studies described four CMS groups: almost all hypermutated MSI cancers fell into the first category CMS1 (MSI-immune, 14 %) with the remaining MSS cancers subcategorised into three groups of CMS2 (canonical, 37 %), CMS3 (metabolic, 13 %) and CMS4 (mesenchymal, 23 %), with a residual unclassified group (mixed features, 13 %). Although further research is required to validate these two systems, they may be useful for clinical trial designs and future post-surgical adjuvant treatment decisions, particularly for tumours with aggressive features or predicted responsiveness to immune checkpoint blockade.

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Section: Correlation Of Molecular Pathways With Serrated Morphologymentioning

confidence: 99%

Molecular pathological classification of colorectal cancer

2016

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“…Although serrated polyps have in common a saw-tooth morphology of crypts, it is important to distinguish between hyperplastic polyps (HPs) and sessile serrated lesions (SSLs) because of the inherent difference in risk of malignant transformation [1]. This risk in turn informs colonoscopic surveillance intervals [1][2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Hyperplastic polyp or sessile serrated lesion? The contribution of serial sections to reclassification

Jaravaza

Rigby

2020

Diagn Pathol

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Background The histological discrimination of hyperplastic polyps from sessile serrated lesions can be difficult. Sessile serrated lesions and hyperplastic polyps are types of serrated polyps which confer different malignancy risks, and surveillance intervals, and are sometimes difficult to discriminate. Our aim was to reclassify previously diagnosed hyperplastic polyps as sessile serrated lesions or confirmed hyperplastic polyps, using additional serial sections. Methods Clinicopathological data for all colorectal hyperplastic polyps diagnosed in 2016 and 2017 was collected. The slides were reviewed and classified as hyperplastic polyps, sessile serrated lesion, or other, using current World Health Organization criteria. Eight additional serial sections were performed for the confirmed hyperplastic polyp group and reviewed. Results Of an initial 147 hyperplastic polyps from 93 patients, 9 (6.1%) were classified as sessile serrated lesions, 103 as hyperplastic polyps, and 35 as other. Of the 103 confirmed hyperplastic polyps, 7 (6.8%) were proximal, and 8 (7.8%) had a largest fragment size of ≥5 mm and < 10 mm. After 8 additional serial sections, 11 (10.7%) were reclassified as sessile serrated lesions. They were all less than 5 mm and represented 14.3% of proximal polyps and 10.4% of distal polyps. An average of 3.6 serial sections were required for a change in diagnosis. Conclusion Histopathological distinction between hyperplastic polyps and sessile serrated lesions remains a challenge. This study has uncovered a potential role for the use of additional serial sections in the morphological reappraisal of small hyperplastic polyps, especially when proximally located.

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“…27 Previous estimates of prevalence of serrated lesions have shown significant variation possibly partly due to inconsistency in histopathological categorisation of these lesions. 13,20,28 To address this variation, unlike the previous randomised controlled trials involving chromocolonoscopy, this study included an expert gastrointestinal central pathology panel reviewing all slides of proximal colonic polyps. 22 Randomisation was stratified by centre to ensure that any centre effects were balanced across trial groups.…”

Section: Discussionmentioning

confidence: 99%

“…15,16 This variability is further compounded by the existence of two different definitions of sessile serrated lesions promoted by WHO 17 and the American Gastro entero logical Association (AGA), 18 and estimated prevalence varies according to the criteria used. 19,20 Pancolonic chromocolonoscopy already forms part of standard practice in surveillance in high-risk patients with inflammatory bowel disease and is part of national and international guidelines. 21 Chromocolonoscopy has been investigated in different settings and has been shown to increase adenoma detection rates.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and economic assessment of chromocolonoscopy for detection of proximal serrated neoplasia within a population-based colorectal cancer screening programme (CONSCOP): an open-label, randomised controlled non-inferiority trial

Hurt

Ramaraj

Farr

et al. 2019

The Lancet Gastroenterology & Hepatology

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Background Most post-colonoscopy interval colorectal cancers are proximal; serrated polyps are often precursors to these cancers and are considered difficult to detect. We assessed the safety, feasibility, and economic effect of chromocolonoscopy on detection of proximal serrated neoplasia. Methods We did an open-label, multicentre, randomised, controlled non-inferiority trial including patients from Bowel Screening Wales centres. Participants who tested positive for faecal occult blood and who were eligible for and considered fit to have colonoscopy (patients with known cases of polyposis syndromes, Lynch syndrome, and chronic inflammatory disease were excluded) were randomly assigned (1:1; with the use of minimisation, stratified by centre with an 80:20 random element) to either standard white light colonoscopy (standard group) or chromocolonoscopy (indigo carmine dye [0•2%]; chromocolonoscopy group) using a secure, internet-based, computerised, randomisation system that used centralised, dynamic allocation. Participants were followed up for 1 year and data from index colonoscopies and associated clearance procedures were analysed. All proximal polyps were reviewed by an expert pathologist panel. The main outcome on which power was based was time taken to perform the colonoscopy procedure, defined as from the time when the scope was inserted to withdrawal from the anus, assessed in the per-protocol population. The non-inferiority margin was 15 min. This trial is complete and is registered with ClinicalTrials.gov, number NCT01972451.

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A pathologist's survey on the reporting of sessile serrated adenomas/polyps

Abstract: 98% of pathologists surveyed are aware that SSA/P is a precursor lesion to colorectal cancer, the majority agree on diagnostic criteria, and a significant number feel that there needs to be greater communication and awareness among pathologists and gastroenterologists about SSA/P.

Cited by 10 publications

References 14 publications

Molecular pathological classification of colorectal cancer

Molecular pathological classification of colorectal cancer

Hyperplastic polyp or sessile serrated lesion? The contribution of serial sections to reclassification

Feasibility and economic assessment of chromocolonoscopy for detection of proximal serrated neoplasia within a population-based colorectal cancer screening programme (CONSCOP): an open-label, randomised controlled non-inferiority trial

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