Factors associated with reclassification of hyperplastic polyps after pathological reassessment from screening and surveillance colonoscopies

Schramm, C; Kaiser, M. Shamim; Drebber, Uta; Gruenewald, Inga; Franklin, Jeremy; Kuetting, Fabian; Bowe, Andrea; Hoffmann, V.; Gatzke, Sebastian; Toex, Ulrich; Steffen, Hans‐Michael

doi:10.1007/s00384-015-2404-6

Cited by 17 publications

(15 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Usually, SSP/As are larger than HPs and localized predominantly in the proximal colon [ 48 , 49 ] which is similar to our findings. Interestingly, the specific BRAF or KRAS mutations were identified in almost all polyps from the proximal but no polyp from the distal colon although the relevant genomic regions had a minimum of 30× and 50× coverage for BRAF and KRAS, respectively, in the DNA derived from mutation negative polyps.…”

Section: Discussionsupporting

confidence: 91%

Exome sequencing characterizes the somatic mutation spectrum of early serrated lesions in a patient with serrated polyposis syndrome (SPS)

Horpaopan

Kirfel

Peters

et al. 2017

Hered Cancer Clin Pract

View full text Add to dashboard Cite

BackgroundSerrated or Hyperplastic Polyposis Syndrome (SPS, HPS) is a yet poorly defined colorectal cancer (CRC) predisposition characterised by the occurrence of multiple and/or large serrated polyps throughout the colon. A serrated polyp-CRC sequence (serrated pathway) of CRC formation has been postulated, however, to date only few molecular signatures of serrated neoplasia (BRAF, KRAS, RNF43 mutations, CpG Island Methylation, MSI) have been described in a subset of SPS patients and neither the etiology of the syndrome nor the distinct genetic alterations during tumorigenesis have been identified.MethodsTo identify somatic point mutations in potential novel candidate genes of SPS-associated lesions and the involved pathways we performed exome sequencing of eleven early serrated polyps obtained from a 41 year-old female patient with clinically confirmed SPS. For data filtering and analysis, standard pipelines were used. Somatic mutations were identified by comparison with leukocyte DNA and were validated by Sanger sequencing.ResultsThe BRAF p.V600E or KRAS p.G12D mutation was identified in six polyps (~50%) and not found in polyps from the distal colon. In addition, we found seven unique rare somatic alterations of seven different genes in four serrated tumours, all of which are missense variants. The variant in ABI3BP and CATSPERB are predicted to be deleterious. No established cancer gene or candidate genes related to serrated tumorigenesis were affected.ConclusionsSomatic mutations seem to be rare events in early hyperplastic and serrated lesions of SPS patients. Neither frequently affected genes nor enrichment of specific pathways were observed. Thus, other alterations such as non-coding variants or epigenetic changes might be the major driving force of tumour progression in SPS.Electronic supplementary materialThe online version of this article (10.1186/s13053-017-0082-9) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionsupporting

confidence: 91%

Exome sequencing characterizes the somatic mutation spectrum of early serrated lesions in a patient with serrated polyposis syndrome (SPS)

Horpaopan

Kirfel

Peters

et al. 2017

Hered Cancer Clin Pract

View full text Add to dashboard Cite

show abstract

“…16 After SSLs (then called SSA/Ps) were included in the WHO classification of 2010, 8%-19% of HPs were reclassified as SSLs. [17][18][19] When only larger HPs were taken into account, the proportion of reclassified HPs was as high as 28%. 20,21 Application of the 1 crypt rule, per the recent revised WHO criteria, likely increases the sensitivity of detection of SSLs further.…”

Section: Pathology Interpretation and Reclassification Of Serrated Pomentioning

confidence: 99%

Terminology, Molecular Features, Epidemiology, and Management of Serrated Colorectal Neoplasia

2019

View full text Add to dashboard Cite

In addition to the adenoma to carcinoma sequence, colorectal carcinogenesis can occur via the serrated pathway. Studies have focused on clarification of categories and molecular features of serrated polyps, as well as endoscopic detection and risk assessment. Guidelines from the World Health Organization propose assigning serrated polyps to categories of hyperplastic polyps, traditional serrated adenomas, and sessile serrated lesions (SSLs). Traditional serrated adenomas and SSLs are precursors to colorectal cancer. The serrated pathway is characterized by mutations in RAS and RAF, disruptions to the Wnt signaling pathway, and widespread methylation of CpG islands. Epidemiology studies of serrated polyps have been hampered by inconsistencies in terminology and reporting, but the prevalence of serrated class polyps is 20%-40% in average-risk individuals; most serrated polyps detected are hyperplastic. SSLs, the most common premalignant serrated subtype, and are found in up to 15% of average-risk patients by highdetecting endoscopists. Variations in rate of endoscopic detection of serrated polyps indicate the need for careful examination, with adequate bowel preparation and sufficient withdrawal times. Risk factors for SSLs include white race, family history of colorectal cancer, smoking, and alcohol intake. Patients with serrated polyps, particularly SSLs and traditional serrated adenomas, have an increased risk of synchronous and metachronous advanced neoplasia. Surveillance guidelines vary among countries, but SSLs and proximal hyperplastic polyps require special attention in assignment of surveillance interval-especially in light of concerns regarding incomplete detection and resection.

show abstract

“…This reclassification represents a higher proportion than when we applied the current WHO criteria alone (6.1%). Reported rates of reclassification in the literature range from 2.6-85%, in studies from 2007 to 2019 [4,11,19,24,25,[33][34][35][36][37][38][39][40]. The wide range is mostly attributable to the multiple diagnostic criteria with different levels of stringency that characterised earlier years [4,7,23,31].…”

Section: Diagnostic Criteriamentioning

confidence: 99%

“…Of the aforementioned studies, only Bettington et al, and Janjua et al relied solely on the WHO criteria (2010), whilst Gill et al, and Khalid et al used a combination of criteria that included reference to the WHO [23][24][25]37]. The remainder relied on those of Torlakovic et al, Snover et al, and local Pathology Societies [4,11,[33][34][35][36][38][39][40]. In a systematic review and meta-analysis in 2017 by Niv et al, a reclassification rate of 17% was reported, which is comparable to this study [19].…”

Section: Diagnostic Criteriamentioning

confidence: 99%

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

Jaravaza

Rigby

2020

Diagn Pathol

View full text Add to dashboard Cite

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.

show abstract

Factors associated with reclassification of hyperplastic polyps after pathological reassessment from screening and surveillance colonoscopies

Abstract: Considering these factors may be helpful in serrated lesions that are difficult to allocate. Incorrect recommendations regarding control colonoscopy intervals due to misdiagnosed HPs can explain only a small fraction of interval colorectal cancers.

Cited by 17 publications

References 35 publications

Exome sequencing characterizes the somatic mutation spectrum of early serrated lesions in a patient with serrated polyposis syndrome (SPS)

Exome sequencing characterizes the somatic mutation spectrum of early serrated lesions in a patient with serrated polyposis syndrome (SPS)

Terminology, Molecular Features, Epidemiology, and Management of Serrated Colorectal Neoplasia

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

Contact Info

Product

Resources

About