The Presence of Large Serrated Polyps Increases Risk for Colorectal Cancer

Hiraoka, Sakiko; Kato, Jun; Fujiki, Shigeatsu; Kaji, Eisuke; Morikawa, Tamiya; Murakami, Takatoshi; Nawa, Toru; Kuriyama, Motoaki; Uraoka, Toshio; Ohara, Nobuya; Yamamoto, Kazuhide

doi:10.1053/j.gastro.2010.07.011

Cited by 192 publications

(155 citation statements)

References 28 publications

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“…In the present study, we found that patients with 1 LPD SP significantly more frequently had adenomas and advanced adenomas compared with patients with nondysplastic small distal or no serrated polyps, which is in line with previous data by us (5) and others (31,32). Taken together, these data suggest that older age, prior history of serrated polyps, current smoking, and nondaily/no aspirin use, as well as presence of adenomas, may define a risk phenotype which is associated with synchronous LPD SPs.…”

Section: Discussionsupporting

confidence: 94%

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: Discussionsupporting

confidence: 94%

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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“…7,24,25 The present study addresses the dearth of available data regarding such lesions in patients with inflammatory bowel disease by means of a retrospective evaluation of serrated polyps diagnosed during the course of endoscopic surveillance. A low prevalence of serrated polyps in the setting of inflammatory bowel disease, 1.2% in our cohort, might account for the relative lack of attention devoted hitherto to serrated polyps in the inflammatory bowel disease literature.…”

Section: Discussionmentioning

confidence: 99%

Serrated colorectal polyps in inflammatory bowel disease

Harpaz

McBride

et al. 2015

Modern Pathology

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Serrated colorectal polyps, which, besides hyperplastic polyps, comprise sessile serrated adenomas/polyps and traditional serrated adenomas, are presumptive precursors of at least 20% of sporadic colorectal carcinomas; however, their significance in patients with inflammatory bowel disease is unclear. We retrospectively evaluated 78 serrated polyps, removed over a 14-year period from 6602 inflammatory bowel disease patients undergoing endoscopic surveillance, with respect to morphologic, clinicopathologic, and molecular features, and compared rates of advanced neoplasia (high-grade dysplasia and carcinoma) development following the index serrated polyp diagnosis to reference inflammatory bowel disease cohorts without serrated polyps. Serrated polyps negative for dysplasia, which morphologically resembled sporadic sessile serrated adenoma/polyps, occurred mainly in females, in the proximal colon, and contained BRAF mutations. Serrated polyps with low-grade dysplasia resembled sporadic traditional serrated adenomas and occurred mainly in males, in the distal colon, and contained KRAS mutations. Serrated polyps indefinite for dysplasia were morphologically heterogeneous, but similar to serrated polyps positive for low-grade dysplasia with respect to male predominance, left-sided location, and KRAS mutation rates. Rates of prevalent neoplasia associated with serrated polyps positive for lowgrade dysplasia, indefinite for dysplasia, and negative for dysplasia were 76, 39, and 11%, respectively (Po 0.001). Actuarial 10-year rates of incident advanced neoplasia after an initial diagnosis of serrated polyp positive for low-grade dysplasia, indefinite for dysplasia, and negative for dysplasia were 17, 8, and 0%, respectively, the first and last being significantly different (P = 0.02) and comparable to those of corresponding reference populations of inflammatory bowel disease patients with and without low-grade dysplasia at baseline, respectively. We conclude that in serrated polyps from inflammatory bowel disease patients, dysplasia grade correlates with morphology, sex, anatomic location, BRAF and KRAS mutation status, prevalent conventional neoplasia, and rates of advanced neoplasia development. Modern Pathology (2015Pathology ( ) 28, 1584Pathology ( -1593 doi:10.1038/modpathol.2015 published online 25 September 2015 Recognition of the serrated neoplasia pathway to colorectal carcinoma has enhanced our understanding of sporadic carcinogenesis in the general population. Serrated polyps, which encompass, besides hyperplastic polyps, sessile serrated adenomas/ polyps and traditional serrated adenomas, have been implicated in the pathogenesis of at least 20% of sporadic colorectal carcinomas. 1,2 Sessile serrated adenoma/polyps are usually located in the proximal colon, predominate in women, and harbor BRAF mutations, whereas traditional serrated adenomas are usually left sided, occur more often in men, and contain KRAS mutations. [3][4][5] The significance of serrated polyps in the general population with respect to c...

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“…The submucosal invasion index for lateral spreading lesions with homogeneous surfaces is very low (< 2%), even in large lesions, while in those with mixed surfaces, with larger nodules, this ratio is higher (up to 7%) 24 . The two cases of carcinoma in this series occurred lesions with granular surface (1.5% of 133), one being serrated with 1 cm in G2, and the other non-serrated, with a 2.5 cm diameter in G1.…”

Section: In= Intraepithelial Neoplasiamentioning

confidence: 86%

“…However, one author considers the hyperplastic polyp with more than 1 cm also with malignant potential 24 . Sessile serrated adenomas with obvious dysplasia present, according to some authors, with an estimated higher probability to evolve to cancer than conventional adenomas (5.3% versus 2.2%).…”

Section: In= Intraepithelial Neoplasiamentioning

confidence: 99%

Comparative analysis of endoscopic and histopathological features of superficial elevated lesions resected by endoscopic mucosal resection in the distal and proximal colon

Parada

Ribas

Venco³

et al. 2016

Rev. Col. Bras. Cir.

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Objective: to compare endoscopic and histopathologic features of superficial, elevated lesions with one or more centimeters in diameter, diagnosed by videocolonoscopy on the distal and proximal colon, and subjected to mucosal resection. Methods: we conducted a retrospective, cross-sectional, observational study involving 8,075 videocolonoscopies. From this total, we evaluated 166 mucosectomies in 145 patients with superficial, elevated lesions with a diameter equal to or greater than 1cm. Results: the lesion prevalence was lower in G1 than in G2 (34.9% vs. 65%). The mean age, gender distribution and size (1.9cm in G1 versus 2.0cm in G2, p=0.921) were similar. There was no difference of mucosal surfaces in relation to the location (p=0.575). Considering Intraepithelial neoplasias, both the low grade, high grade (including carcinomas) and hyperplasic ones showedd no difference (p=0.527), nor did the neoplastic lesions when divided into serrated and non-serrated (p=0.124). Excluding 13 hyperplastic lesions and two carcinomas, 124 (82.1%) were non-serrated and 27 (17.9%), serrated. Conclusion: were found no significant differences between endoscopic and histopathological aspects of superficial, elevated lesions of 1cm or more in diameter in distal colon compared with the proximal, when resected by mucosectomy. Although not significant, there was a tendency of association between the location of the lesion and the presence of serrated features.

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The Presence of Large Serrated Polyps Increases Risk for Colorectal Cancer

Cited by 192 publications

References 28 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

Serrated colorectal polyps in inflammatory bowel disease

Comparative analysis of endoscopic and histopathological features of superficial elevated lesions resected by endoscopic mucosal resection in the distal and proximal colon

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