Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study

Toledo, David E F W M van; IJspeert, Joep E. G.; Bossuyt, Patrick M.; Bleijenberg, Arne; Leerdam, Monique E. van; Vlugt, Manon van der; Lansdorp–Vogelaar, Iris; Spaander, Manon C.W.; Dekker, Evelien

doi:10.1016/s2468-1253(22)00090-5

Cited by 65 publications

(49 citation statements)

References 27 publications

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“…36 Further studies have demonstrated large SSLs with dysplasia are associated with increased risk of metachronous CRC. [37][38][39][40] Current guidelines consider SSLs of ≥10 mm or having dysplasia as high-risk lesions, requiring more intensive surveillance. 25,26 We observed a 1.5% prevalence of dysplasia in SSLs, much lower than previously reported.…”

Section: High-risk Polyp Characteristicsmentioning

confidence: 99%

Epidemiology of overall and early‐onset serrated polyps versus conventional adenomas in a colonoscopy screening cohort

Vithayathil

Smith

Song

2022

Intl Journal of Cancer

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Serrated polyps (SPs) are precursors to one‐third of colorectal cancers (CRCs), with histological subtypes: hyperplastic polyps (HPs), sessile serrated lesions (SSLs) and traditional serrated adenomas (TSAs). The incidence of early‐onset CRC before the age of 50 is increasing, with limited understanding of SPs in younger cohorts. Using a large colonoscopy‐based cohort, we characterized epidemiologic profiles of SP subtypes, compared to conventional adenomas, with secondary analysis on early‐onset polyps. Ninety‐four thousand four hundred and twenty‐seven patients underwent screening colonoscopies between 2010 and 2018. Demographic, endoscopic and histopathologic characteristics of each polyp subtype were described. High‐risk polyps included SSLs ≥10 mm/with dysplasia and conventional adenomas ≥10 mm/with tubulovillous/villous histology/high‐grade dysplasia. We examined polyp prevalence with age and compared early‐ (age < 50) and late‐onset polyps (age ≥ 50). Eighteen thousand one hundred and twenty‐five patients had SPs (4357 SSLs, 15 415 HPs, 120 TSAs) and 26 699 had conventional adenomas. High‐risk SSLs were enriched in the ascending colon (44.1% vs 2.6‐35.8% for other locations; P < .003). Early‐ and late‐onset SPs had similar subsite distribution. Early‐onset conventional adenomas were more enriched in the distal colon/rectum (51.8% vs 43.4%, P < .001). Multiple conventional adenomas were more represented in late‐onset groups (40.8% vs 33.8%, P < .001), with no difference in SSLs. The prevalence of conventional adenomas/high‐risk conventional adenomas increased continuously with age, whereas the prevalence of SSLs/high‐risk SSLs was stable from age 40 years onwards. A higher proportion of women were diagnosed with early‐onset than late‐onset SSLs (62.9% vs 57.6%, P = .03). Conventional adenomas, SSLs, early‐ and late‐onset polyps have distinct epidemiology. The findings have implications for improved colonoscopy screening and surveillance and understanding the etiologic heterogeneity of CRC.

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Section: High-risk Polyp Characteristicsmentioning

confidence: 99%

Epidemiology of overall and early‐onset serrated polyps versus conventional adenomas in a colonoscopy screening cohort

Vithayathil

Smith

Song

2022

Intl Journal of Cancer

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“…Hyperplastic polyps (HPs) are still considered to be benign lesions with no risk of malignant transformation. The subtype mucin-poor hyperplastic polyp has been deleted leaving only microvascular and goblet cell-rich subtypes 100. Yet, the malignant potential of SSL is confirmed and may contribute significantly to PCCRCs 101.…”

Section: Resultsmentioning

confidence: 98%

“…Traditional serrated adenomas (TSAs) are rare but clearly also a precursor of malignancy. Both TSAs and SSLs may progress via the serrated pathway to CRC 100…”

Section: Resultsmentioning

confidence: 99%

“…In a matched cohort study through prospective record linkage in Sweden among patients aged 18 years or older with a first diagnosis of colorectal polyps in the nationwide gastrointestinal ESPRESSO histopathology cohort (1993–2016), CRC mortality rates of patients diagnosed with tubulovillous adenomas, villous adenomas as well as SSLs were higher than those in controls 105. Recently it has been shown in a FIT-positive screening population that, just like ADR and alongside the ADR, the proximal serrated polyp detection rate is inversely correlated with the incidence of interval postcolonoscopy CRC 100. Therefore, SSLs are indeed associated with CRC.…”

Section: Resultsmentioning

confidence: 99%

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Third Asia-Pacific consensus recommendations on colorectal cancer screening and postpolypectomy surveillance

Sung¹,

Chiu

Lieberman

et al. 2022

Gut

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The Asia-Pacific region has the largest number of cases of colorectal cancer (CRC) and one of the highest levels of mortality due to this condition in the world. Since the publishing of two consensus recommendations in 2008 and 2015, significant advancements have been made in our knowledge of epidemiology, pathology and the natural history of the adenoma-carcinoma progression. Based on the most updated epidemiological and clinical studies in this region, considering literature from international studies, and adopting the modified Delphi process, the Asia-Pacific Working Group on Colorectal Cancer Screening has updated and revised their recommendations on (1) screening methods and preferred strategies; (2) age for starting and terminating screening for CRC; (3) screening for individuals with a family history of CRC or advanced adenoma; (4) surveillance for those with adenomas; (5) screening and surveillance for sessile serrated lesions and (6) quality assurance of screening programmes. Thirteen countries/regions in the Asia-Pacific region were represented in this exercise. International advisors from North America and Europe were invited to participate.

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“…An additional driver for inclusion of the SSL detection rate among the quality indicators for colonoscopy has been recent evidence about an inverse relationship between the level of detection of proximal SSLs by individual endoscopists and the risk of post-colonoscopy CRC after having adjusted for the individual ADR 3 . It may be argued that again, the plausibility of this association is unclear, as the vast majority of SSLs are not dysplastic at the time of diagnosis and unlikely to progress to CRC.…”

mentioning

confidence: 99%

Could the sessile serrated lesion detection rate become an ESGE quality parameter?

et al. 2023

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Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study

Cited by 65 publications

References 27 publications

Epidemiology of overall and early‐onset serrated polyps versus conventional adenomas in a colonoscopy screening cohort

Epidemiology of overall and early‐onset serrated polyps versus conventional adenomas in a colonoscopy screening cohort

Third Asia-Pacific consensus recommendations on colorectal cancer screening and postpolypectomy surveillance

Could the sessile serrated lesion detection rate become an ESGE quality parameter?

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