Longitudinal Outcome Study of Sessile Serrated Adenomas of the Colorectum: An Increased Risk for Subsequent Right-sided Colorectal Carcinoma

Lu, Fang-I; Niekerk, De Wet van; Owen, David A.; Tha, Susan; Turbin, Dmitry; Webber, Douglas

doi:10.1097/pas.0b013e3181e4f256

Cited by 174 publications

(146 citation statements)

References 30 publications

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“…Several studies suggest that LPD SPs, in particular SSA/ Ps, might contribute to the occurrence of postcolonoscopy cancers through a serrated neoplastic pathway (10,35). It became clear that serrated polyps often have a subtle endoscopic appearance, thereby explaining the operatordependent variation in their detection, ranging from 8% to 32% (14,15).…”

Section: Discussionmentioning

confidence: 99%

“…Size of polyps was visually assessed using a biopsy forceps or mini-snare; large serrated polyps were defined as sized 6 mm or more. We used a cutoff of 6 mm for large serrated polyps for the following reasons: serrated polyps are usually smaller than adenomas, less than 6 mm in size (10,27), approximately 30% to 50% of all SSA/Ps are sized 6 to 9 mm (5, 10, 28), and experts recently recommended removal of all serrated polyps, excepting distal serrated polyps less than 6 mm in size (11). Histopathologic classification of all polyps was conducted by 2 experienced gastrointestinal pathologists (A. Driessen and R. Riedl) according to the WHO classification (29).…”

Section: Derivation Cohort and Data Collectionmentioning

confidence: 99%

“…The serrated neoplastic pathway may contribute to the occurrence of some postcolonoscopy cancers, as some precursor lesions, especially sessile serrated adenomas/polyps (SSA/P), are easily overlooked during colonoscopy (5,6) and are more challenging to remove endoscopically (7). It is generally accepted that large, proximal, or dysplastic (LPD) serrated polyps (SP) purport significant risk for malignant transformation, whereas nondysplastic small distal serrated polyps do not (8)(9)(10)(11). Some studies indicate that 31% of hyperplastic polyps and 27% of nonadenomatous polyps are missed during colonoscopy (12,13), which is consistent with a high variability in serrated polyp detection among endoscopists (i.e., ranging from 8%-32% for all serrated polyps, and from 1%-18% for proximal serrated polyps; refs.…”

Section: Introductionmentioning

confidence: 99%

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Simple Clinical Risk Score Identifies Patients with Serrated Polyps in Routine Practice

Bouwens

Winkens

Rondagh

et al. 2013

Cancer Prevention Research

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Large, proximal, or dysplastic (LPD) serrated polyps (SP) need accurate endoscopic recognition and removal as these might progress to colorectal cancer. Herewith, we examined the risk factors for having 1 LPD SP. We developed and validated a simple SP risk score as a potential tool for improving their detection. We reviewed clinical, endoscopic, and histologic features of serrated polyps in a study of patients undergoing elective colonoscopy (derivation cohort). A self-administered questionnaire was obtained. We conducted logistic regression analyses to identify independent risk factors for having 1 LPD SP and incorporated significant variables into a clinical score. We subsequently tested the performance of the SP score in a validation cohort. We examined 2,244 patients in the derivation and 2,402 patients in the validation cohort; 6.3% and 8.2% had 1 LPD SP, respectively. Independent risk factors for LPD SPs were age of more than 50 years [OR 2.2; 95% confidence interval (CI), 1.3-3.8; P ¼ 0.004], personal history of serrated polyps (OR 2.6; 95% CI, 1.3-4.9; P ¼ 0.005), current smoking (OR 2.2; 95% CI, 1.4-3.6; P ¼ 0.001), and nondaily/no aspirin use (OR 1.8; 95% CI, 1.1-3.0; P ¼ 0.016). In the validation cohort, a SP score 5 points was associated with a 3.0-fold increased odds for LPD SPs, compared with patients with a score <5 points. In the present study, age of more than 50 years, a personal history of serrated polyps, current smoking, and nondaily/no aspirin use were independent risk factors for having LPD SPs. The SP score might aid the endoscopist in the detection of such lesions. Cancer Prev Res; 6(8); 855-63. Ó2013 AACR.

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Section: Discussionmentioning

confidence: 99%

Section: Derivation Cohort and Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Simple Clinical Risk Score Identifies Patients with Serrated Polyps in Routine Practice

Bouwens

Winkens

Rondagh

et al. 2013

Cancer Prevention Research

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“…Furthermore, the presence of SSAs increases the risk of advanced neoplasia at subsequent colonoscopies. [17][18][19] The exact proportion of sporadic MSI-H CRCs that arise from an SSA, however, is unclear, and it remains possible that some of these tumors arise through another precursor lesion.…”

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confidence: 99%

Proximal colon cancers and the serrated pathway: a systematic analysis of precursor histology and BRAF mutation status

et al. 2012

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Although the serrated neoplasia pathway is thought to give rise to the majority of sporadic microsatellite instability-high (MSI-H) colon cancer, the exact proportion of these tumors that arise from serrated precursors has not been fully studied. Tubular and tubulovillous adenomas with features of the serrated neoplasia pathway have been described, and unlike sessile serrated adenomas, these lesions lack BRAF mutations. The contribution of these adenomas to sporadic MSI-H colon cancer is unclear. To this end, we conducted an analysis of right-sided sporadic MSI-H and microsatellite stable (MSS) colon cancer, with emphasis on precursor lesions. Overall 25% (19/75) of MSI-H colon cancer had a precursor, of which only 4 were recognized histologically as arising from a sessile serrated adenoma, and the remaining were best classified as adenomas. Of the 31 (of 89) MSS colon cancers with a precursor, only 1 was a sessile serrated adenoma (P ¼ 0.06). Histological analysis of the precursor adenomas to sporadic MSI-H colon cancer demonstrated a high frequency of crypt serrations compared with MSS colon cancer (93 vs 36%, Po0.001). BRAF mutations were found in 57/75 (76%) sporadic MSI-H and 10/89 (11%) MSS colon cancers (Po0.001). Molecular analysis demonstrated BRAF mutations in 11/12 adenoma and 3/3 sessile serrated adenoma precursors adjacent to BRAF-mutated MSI-H colon cancer. Similarly, all 4 precursors to BRAF-mutated MSS colon cancer were also BRAF mutated. The presence of BRAF mutations in these adenomatous precursors suggests that they represent sessile serrated adenomas with complete cytologic dysplasia. Finally, patients with sporadic MSI-H colon cancer were more likely to harbour synchronous sessile serrated adenomas (20 vs 8%; P ¼ 0.023). This is the largest study to rigorously evaluate the precursor and synchronous lesions in patients with right-sided colon cancer. Detailed molecular and histological analysis of these lesions confirms the importance of serrated precursors in the development of sporadic MSI-H colon cancer.

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“…Показано, что 15% SSA/P прогрессировали в коло-ректальную аденокарциному или дисплазию высокой сте-пени [43].…”

Section: рис 3 традиционная зубчатая аденома (Tsa)unclassified

Serrated lesions of the large bowel

Kharlova¹,

Данилова

Мальков

et al. 2015

Arkh. patol.

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До недавнего времени большинство полипов толстой кишки относились к одной из двух групп: гиперпластиче-ские или диспластические (аденомы тубулярные, тубуло-ворсинчатые, ворсинчатые). В 60-70-е годы прошлого века был достигнут консенсус в отношении их потенциала злокачественности. Аденомы, особенно с ворсинчатым компонентом, считались предшественниками аденокар-циномы, в то время как гиперпластические полипы -ли-шенными потенциала злокачественности [1]. Несмотря на отдельные сообщения о наличии фокусов аденокарци-номы в крупных (более 1 см) гиперпластических полипах и доказанной ассоциации высокого риска колоректально-го рака с множественными гиперпластическими полипа-ми [2], данная концепция долгое время оставалась неиз-менной. В 2010 г. в классификации ВОЗ была выделена новая группа предопухолевых поражений толстой кишки -зубчатые образования, включающая гиперпластические полипы (HP), зубчатые аденомы/полипы на широком основании (SSA/P) и традиционные зубчатые аденомы (TSA). Зубчатые образования -гетерогенная группа, характеризующаяся зубчатостью просвета желез, и в большинстве случаев отсутствием дисплазии. Для HP, помимо зубчатого просвета, характерны рас-ширение пролиферативной зоны, удлинение крипт и отсутствие цитологической атипии. Для SSA/P характерна миграция пролиферативной зоны на стенки крипт, что приводит к специфическим архитектурным нарушениям -расширению и горизонтальному росту базальных отделов желез вдоль мышечной пластинки слизистой оболочки. Для TSA характерно наличие коротких «эктопических» крипт, не достигающих мышечной пластинки, и эозинофильных изменений эпителия. SSA/P и TSA имеют своеобразный молекулярно-генетический профиль и доказанный потенциал злокачественности. ОБЗОР ЛИТЕРАТУРЫ Ключевые слова: зубчатые образования, гиперпластический полип, зубчатая аденома/полип на широком основании, традиционная зубчатая аденома.The 2010 WHO classification identifies a new group of pretumor lesions of the large bowel -serrated masses, which includes hyperplastic polyps (HPs), sessile serrated adenomas/polyps (SSA/P), and traditional serrated adenomas (TSA). Serrated masses are a heterogeneous group characterized by serrated gland lumens and, in most cases, without dysplasia. An enlarged proliferative zone, elongated crypts, and no cytological atypia in addition to a serrated lumen are typical of HPs. SSA/P is characterized by the migration of the proliferative zone to the crypt walls, giving rise to specific architectural disorders, such as expanded and horizontally growing basal gland segments along the lamina muscularis mucosae. TSA is typified by short ectopic crypts that cannot reach the lamina muscularis and by epithelial eosinophilic changes. SSA/P and TSA have peculiar molecular genetic profiles and proven malignant potential.

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Longitudinal Outcome Study of Sessile Serrated Adenomas of the Colorectum: An Increased Risk for Subsequent Right-sided Colorectal Carcinoma

Cited by 174 publications

References 30 publications

Simple Clinical Risk Score Identifies Patients with Serrated Polyps in Routine Practice

Simple Clinical Risk Score Identifies Patients with Serrated Polyps in Routine Practice

Proximal colon cancers and the serrated pathway: a systematic analysis of precursor histology and BRAF mutation status

Serrated lesions of the large bowel

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