Risk of total metachronous advanced neoplasia in patients with both small tubular adenomas and serrated polyps

Hamoudah, Thayer; Vemulapalli, Krishna C.; Alsayid, Muhammad; Van, Jeremy; Ma, Karen; Jakate, Shriram; Rex, Douglas K.; Melson, Joshua

doi:10.1016/j.gie.2022.02.015

Cited by 3 publications

(4 citation statements)

References 18 publications

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“…This is attributed to the fact that most young-onset CRC (onset < 50 years) is distal and exhibits different molecular characteristics than SSLs [51]. A more recent study by Hamoudah et al, however, suggests an increased risk of metachronous advanced colorectal neoplasia when small, serrated lesions and adenomas coexist [52]. This means that when accounting for other factors like synchronous adenoma detection and variable SSL prevalence and sex distribution, the association between SSLs and young-onset CRC becomes less clear.…”

Section: Significance Of Ssls In Patients Under 50 Yearsmentioning

confidence: 99%

Disparate age and sex distribution of sessile serrated lesions and conventional adenomas in an outpatient colonoscopy population–implications for colorectal cancer screening?

Lall

Ismail

Ayonrinde

2022

Int J Colorectal Dis

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Purpose Colorectal cancer (CRC) is increasingly diagnosed in individuals aged < 50 years, resulting in advocacy of screening from age 45 years. Despite existing knowledge associating CRC with conventional adenomas, the significance of sessile serrated lesions (SSLs) on the burden of CRC is less detailed. We aimed to provide contemporary estimates for SSL prevalence and examine patient and procedure factors associated with SSL detection. Methods Retrospective observational study examining associations between SSL and conventional adenoma detection, polyp histopathology, patient, and procedure characteristics in an outpatient colonoscopy unit over 12 months. Results From 2097 colonoscopies, SSL detection was 13.8% overall and 12.5% in patients < 50 years. SSLs were mostly proximal in location (64%), and SSL detection was significantly higher in females compared with males (16.2% vs. 11.7%, p = 0.003), particularly in those < 50 years (16.8% vs. 8.6%, p < 0.001). In multivariable analysis, SSL detection was associated with female sex (adjusted odds ratio [aOR] 1.48, 95% confidence interval [CI] 1.15–1.91), synchronous conventional adenoma detection (aOR 1.36, 95% CI 1.04–1.78) and BMI ≥ 25 kg/m2 (aOR 1.34, 95% CI 1.02–1.77). Conventional adenoma detection was 33.6% and associated with age ≥ 50 years (aOR 3.57, 95% CI 2.84–4.47) and synchronous SSL detection (aOR 1.36, 95% CI 1.03–1.79). Conclusions We observed age and sex disparities in polyp types and prevalence in this outpatient colonoscopy population. SSLs were most prevalent in females aged < 50 years, suggesting a potential increased susceptibility of young females to SSLs and CRC. Our findings may have implications for the design of CRC screening programs.

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Section: Significance Of Ssls In Patients Under 50 Yearsmentioning

confidence: 99%

Disparate age and sex distribution of sessile serrated lesions and conventional adenomas in an outpatient colonoscopy population–implications for colorectal cancer screening?

Lall

Ismail

Ayonrinde

2022

Int J Colorectal Dis

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“…A large study found no increased risk of CRC after detection of small serrated lesions; however, distal HPPs < 10 mm were included in the serrated lesion definition, with many HPPs included in the study, in contrast to another study finding a trend toward increased CRC for proximal small SSLs 22 23 . There is increasing evidence that proximal small HPPs contribute toward metachronous advanced findings, with a recent study finding increased T-MAN for small SSLs and proximal HPPs, and another finding a trend toward increased CRC incidence for proximal small SSLs 22 25 . Further studies are required to determine the true risk of small proximal HPPs and to define adequate follow-up durations for these findings.…”

Section: Discussionmentioning

confidence: 99%

“…The strength of our study lies in the inclusion of a large and adequately powered sample size of patients with serrated lesions, allowing for granular substratification of index findings. The relatively low number of T-MAN in the control group led to lower precision for 95 %CIs; however, many studies include HPPs < 10 mm or distal HPPs in their definition of serrated lesion, include very small (50-150) sample sizes for SSLs, and do not incorporate advanced serrated lesions into outcomes, which could limit the interpretation of their findings [12,14,15,23,25]. The use of T-MAN as a primary outcome more adequately reflects the CRC potential of serrated lesions and allowed us to demonstrate that many findings were less benign than previously suggested in studies only utilizing metachronous advanced adenoma as the outcome.…”

Section: Index Findingsmentioning

confidence: 99%

Risk of total metachronous advanced neoplasia at surveillance colonoscopy after detection of serrated lesions: a matched case–cohort study

Djinbachian¹,

Lafontaine

Anderson

et al. 2023

Endoscopy

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Background and Study Aims: Serrated lesions (SLs), including sessile serrated lesions (SSL) and traditional serrated adenomas (TSA) have become subject of increased interest for their role as CRC precursors. Primary aim was to evaluate the presence of total metachronous advanced neoplasia (T-MAN) at follow-up in patients with index SL compared to a matched cohort without SL. Patients and Methods: Patients 45-74y with SLs were matched 2:1 by sex; age; synchronous polyps (high-risk adenoma [HRA], low-risk adenoma [LRA], no-adenoma); timing of index, to patients without SL. Primary outcome was presence of T-MAN (advanced adenoma or high-risk SL) at follow-up. Secondary outcomes included presence of T-MAN stratified by synchronous polyps and SL characteristics. Results: 1425 patients were included (475 patients, 642 SLs; 950 controls (median follow-up 2.9 vs 3.6y). The SL group had greater risk of T-MAN compared to the non-SL group [Hazard-ratio (HR)=6.1 (95%confidence-interval (CI)3.9-9.6)]. Patients with SL+HRA had higher risk of T-MAN compared to HRA alone [HR=2.6 (95%CI 1.4-4.7)], as well as patients with SL+LRA compared to LRA alone [HR=7.0 (95%CI 2.8-18.4)], and SL without adenoma compared to no-adenoma [HR=14.9 (95%CI 6.5-34.0)]. Presence of proximal SSL [HR=9.3 (95%CI 5.4-15.9)], large SSL [HR=17.8 (95%CI 7.4-43.3)] and proximal large SSL [HR=25.0 (95%CI 8.8-71.3)], but not distal SSL, was associated with greater risk for T-MAN. Conclusion: Patients with SLs are at greater risk for developing T-MAN regardless of synchronous adenomas. Patients with SL and HRA, and those with large or proximal SSLs appear to be at greatest risk for T-MAN.

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“…Colorectal cancer accounts for a significant amount of cancer deaths in various countries, especially in Taiwan. These abnormal growths are called polyps and can become colorectal cancer [1], [2]. The current technique for detecting colorectal cancer involves stool tests and colonoscopy.…”

Section: Introductionmentioning

confidence: 99%

Classification of Polyps in Endoscopic Images Using Self-Supervised Structured Learning

2023

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This study uses a two-stage learning computer-aided diagnosis (CAD) scheme that has a convolutional neural network(CNN) with self-supervised learning(SSL) to classify polyps as either a hyperplastic polyp (HP) or a Tubular Adenoma (TA). The proposed model uses look-into-object (LIO) and contrastive learning in SimCLR to focus on the holistic polyp region and allows greater model performance. However, the LIO scheme relies on pretraining a model to provide basic representations so this model is modified using a warm-up scheme to improve the loss function. There are insufficient medical images to train efficient representation for polyp classification so another approach uses natural images, instead of polyp images, for the pretext task. The experimental results show that the proposed scheme which uses polyp object structure information and self-supervised learning produces a robust model that allows better classification as either HP or TA in the prediction head by transferring a backbone. The backbone model uses ResNet-18 effectively to concentrate on the holistic polyp using limited labeled polyp images. The proposed scheme outperforms an existing method with a 4% increase in accuracy and a 3% improvement in F1-score.

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Risk of total metachronous advanced neoplasia in patients with both small tubular adenomas and serrated polyps

Cited by 3 publications

References 18 publications

Disparate age and sex distribution of sessile serrated lesions and conventional adenomas in an outpatient colonoscopy population–implications for colorectal cancer screening?

Disparate age and sex distribution of sessile serrated lesions and conventional adenomas in an outpatient colonoscopy population–implications for colorectal cancer screening?

Risk of total metachronous advanced neoplasia at surveillance colonoscopy after detection of serrated lesions: a matched case–cohort study

Classification of Polyps in Endoscopic Images Using Self-Supervised Structured Learning

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