Pathological reassessment of hyperplastic colon polyps in a city-wide pathology practice: implications for polyp surveillance recommendations

Singh, Harminder; Bay, Diane; Ip, Stephen; Bernstein, Çharles N.; Nugent, Zoann; Gheorghe, Rodica; Wightman, Robert

doi:10.1016/j.gie.2012.07.026

Cited by 59 publications

(51 citation statements)

References 19 publications

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“…Although we also found size to be an important factor associated with reclassifi cation, almost half (41.4 % ) of the reclassifi ed SSA / Ps in our cohort would have gone undetected had we reviewed only those polyps > 10 mm. Our results and those of other studies indicate that SSA / Ps are more likely to be located in the proximal colon ( 9,14,15 ).…”

Section: Discussionsupporting

confidence: 84%

“…Singh et al ( 9 ) evaluated the proportion of previously reported HPs without concomitant fi ndings that were reclassifi ed as SSA / Ps and found that polyp size and proximal location were associated with reclassifi cation ( 9 ). On the basis of these fi ndings, the authors ( 9 ) suggest that review of HPs be limited to those > 5 mm in size, as only two of the polyps that were reclassifi ed in their study were larger than 10 mm.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Sessile Serrated Polyps at Screening Colonoscopy: Have They Been Under Diagnosed?

Tinmouth

Henry

Hsieh

et al. 2014

American Journal of Gastroenterology

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Sessile Serrated Polyps at Screening Colonoscopy: Have They Been Under Diagnosed?

Tinmouth

Henry

Hsieh

et al. 2014

American Journal of Gastroenterology

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“…Of the 119 right-sided HP, 114 were re-analysed by two specialized GI pathologists using a mutual consensus process, alongside 90 randomly selected left-sided HP. In this study, 17 % of right-sided polyps and 20 % of those >5 mm were reclassified as SSA [12]. In a similar study from Australia, 6340 colorectal polyps diagnosed by one histopathologist were reviewed with regards to the occurrence of SSA which formed 12.1 % of this group (n = 741); 80 % were located in the proximal colon.…”

Section: Discussionmentioning

confidence: 86%

“…With regards to their relative distribution within the group of serrated lesions, the rise of SSA detection rate over time [10] could be at least partially due to a shift in diagnosis from hyperplastic polyps on histopathological review [11,12]. The distinction between SSA and HP, however, may be difficult, and previous studies have also reported poor to fair interobserver agreement rates for histopathological diagnosis of SSA versus HP, with kappa values ranging from 0.16 to 0.38 [11,13,14].…”

Section: Introductionmentioning

confidence: 99%

Impact of reassessment of colonic hyperplastic polyps by expert GI pathologists

Schachschal

Sehner

Choschzick

et al. 2016

Int J Colorectal Dis

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BACKGROUND: Recommended follow-up intervals after endoscopic removal of hyperplastic polyps (HP) and sessile serrated adenomas (SSA) differ because of assumed differences in biological behaviour. However, histopathologic differentiation is difficult, with higher SSA rates reported from specialist GI histopathologists. OBJECTIVE: The objective of this study was to clarify the relevance of histologic reassessment of HP. DESIGN AND SETTING: From a prospective screening colonoscopy study relevant serrated lesions (excluding distal small HP 5 mm) diagnosed by private practice pathologists were reassessed by four specialized GI pathologists PATIENTS: One thousand sixty-nine screening colonoscopies were performed in patients. MAIN OUTCOME MEASUREMENTS: In terms of main outcome measurements, there is a likelihood of changes of the HP diagnosis on reassessment, as well as interrater variability. RESULTS: SSA were initially diagnosed in 7 cases (0.7 %) and relevant HP in 83 (7.8 %; 101 lesions). Of the latter, the chance of a change in diagnosis from HP to SSA by any of the four specialist histopathologists was higher for larger (>5 mm) and right-sided lesions (19.1 vs 1.3 %, OR 18.4, p = 0.04) including a higher likelihood to change recommended follow-up intervals (32.1 vs 3.3 %, p < 0.01). However, follow-up intervals were determined by concomitant adenomas in 41 %. Interrater variability was also higher for these lesions (p = 0.04), with an overall kappa value of 0.48. However, this issue related to only 1.2 % of the 1069 study cases. LIMITATION: The limitations this study are the limited case number as well as limited retrospective assessment. CONCLUSIONS: Right-sided HP >5 mm had a higher chance of change in diagnosis to SSA; therefore, they should probably be treated like adenomas and be removed. However, reliable data for recommendations on follow-up intervals of HP or SSA will require follow-up studies. Abstract Background Recommended follow-up intervals after endoscopic removal of hyperplastic polyps (HP) and sessile serrated adenomas (SSA) differ because of assumed differences in biological behaviour. However, histopathologic differentiation is difficult, with higher SSA rates reported from specialist GI histopathologists.Objective The objective of this study was to clarify the relevance of histologic reassessment of HP.Design and setting From a prospective screening colonoscopy study relevant serrated lesions (excluding distal small HP ≤5 mm) diagnosed by private practice pathologists were reassessed by four specialized GI pathologists Patients One thousand sixty-nine screening colonoscopies were performed in patients.Main outcome measurements In terms of main outcome measurements, there is a likelihood of changes of the HP diagnosis on reassessment, as well as interrater variability.Results SSA were initially diagnosed in 7 cases (0.7 %) and relevant HP in 83 (7.8 %; 101 lesions). Of the latter, the chance of a change in diagnosis from HP to SSA by any of the four specialist histopathologists was hig...

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“…Singh et al 6 reported that 11.8% of polyps previously classified as HPs turned out to be reassessed as sessile serrated adenomas, and right side location and size > 5 mm were the two variables that independently increased the probability of reclassification.…”

Section: Discussionmentioning

confidence: 99%

Hyperplastic Polyp? Look Again... The Impact of the New Classification for Serrated Polyps

Fidalgo¹,

Santos²,

Rosa³

et al. 2014

Acta Med Port

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Material and Methods:Every patient with at least one sessile serrated adenoma diagnosed in a 5 year period was included. All polyps (regardless of type) resected during the study period were reviewed. Data concerning polyp's characteristics and patient variables were collected. Forty consecutive patients were included [13 female, mean age at 1 st sessile serrated adenoma -59 yrs (34-80)]. Results: Were reviewed 247 polyps: hyperplastic -42%; conventional adenomas -29%; sessile serrated adenoma -24%; serrated adenomas -5%. Sixty-three polyps were reclassified: 43 hyperplastic, 12 serrated adenomas, 7 sessile serrated adenoma and 1 conventional adenoma with low grade dysplasia. Reclassification was significantly greater for hyperplastic polyps when compared with the other subtypes. Forty-three of one hundred and four (41%) hyperplastic polyps were reclassified all as sessile serrated adenoma. In these polyps the probability of reclassification was independent from polyp location but was greater if polyp size ≥ 5 mm. Discussion: This is a single center, rectrospective study. The fact that it was done in an Oncology Referral Institution with a Family Risk Clinic may have influenced the results. Nevertheless the impressive reclassification rate for Hyperplastic Polyps and the fact that they were reclassified mainly as Serrated Adenomas makes these results relevant to daily practice. Conclusion: Our results suggest that, according to the new World Health Organization classification for serrated colonic polyps, a considerable proportion of hyperplastic polyps will be reclassified. The serrated pathway of colorectal carcinogenesis has probably been underestimated and at-risk patients may have been under inappropriate surveillance.

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Pathological reassessment of hyperplastic colon polyps in a city-wide pathology practice: implications for polyp surveillance recommendations

Cited by 59 publications

References 19 publications

Sessile Serrated Polyps at Screening Colonoscopy: Have They Been Under Diagnosed?

Sessile Serrated Polyps at Screening Colonoscopy: Have They Been Under Diagnosed?

Impact of reassessment of colonic hyperplastic polyps by expert GI pathologists

Hyperplastic Polyp? Look Again... The Impact of the New Classification for Serrated Polyps

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