Prevalence of serrated polyps and association with synchronous advanced neoplasia in screening colonoscopy

Background and study aims: Serrated polyps of the large intestine comprise a heterogeneous group of lesions with distinct histological and malignant features. The aim of the study was to estimate the prevalence of serrated polyp subtypes in a cohort of individuals undergoing screening colonoscopy, and to identify associations between the detection of serrated polyp subtypes and advanced neoplasia.

Patients and methods: Data on serrated polyps, adenomas, and cancers were collected from participants of a randomized screening trial that compared colonoscopy with computed tomography colonography. Only data from participants in the colonoscopy arm were used. Logistic regression analyses were performed to identify associations between patients’ age, sex, and prevalence of the different types of serrated polyps and to identify associations between the detection of these polyps and advanced neoplasia (defined as an adenoma ≥ 10 mm, villous component, high grade dysplasia or colorectal cancer).

Results: A total of 1426 screen-naïve individuals (51 % male) with a median age of 60 years (IQR 55 – 65) were included. The prevalence of hyperplastic polyps, sessile serrated adenomas/polyps (SSA/Ps), and traditional serrated adenomas (TSAs) was 23.8 %, 4.8 %, and 0.1 %, respectively. SSA/Ps comprised 7.3 % of all polyps. No differences based on age or sex were observed in the prevalence of SSA/Ps. Proximal and large (≥ 10 mm) hyperplastic polyps, as well as proximal and large (≥ 10 mm) SSA/Ps, were associated with synchronous advanced neoplasia.

Conclusions: Serrated polyps, including SSA/Ps, were frequently encountered in routine screening colonoscopies. Large and proximal hyperplastic polyps, as well large and proximal SSA/Ps, were associated with advanced neoplasia.

• References

• 1 Singh H, Nugent Z, Demers AA et al. The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer. Gastroenterology 2010; 1128-1137
• 2 Brenner H, Chang-Claude J, Seiler CM et al. Protection from colorectal cancer after colonoscopy: a population-based, case–control study. Ann Intern Med 2011; 22-30
• 3 Baxter NN, Goldwasser MA, Paszat LF et al. Association of colonoscopy and death from colorectal cancer. Ann Intern Med 2009; 1-8
• 4 Leggett B, Whitehall V. Role of the serrated pathway in colorectal cancer pathogenesis. Gastroenterology 2010; 2088-2100
• 5 Snover DC. Update on the serrated pathway to colorectal carcinoma. Hum Pathol 2011; 1-10
• 6 Samowitz WS, Albertsen H, Herrick J et al. Evaluation of a large, population-based sample supports a CpG island methylator phenotype in colon cancer. Gastroenterology 2005; 837-845
• 7 Snover DC, Ahnen D, Burt R et al. WHO classification of tumours of the digestive system. Serrated polyps of the colon and rectum and serrated polyposis. In: Bosman T, Carneiro F, Hruban R, eds Lyon: IARC Press; 2010: 160-165
• 8 Lieberman DA, Rex DK, Winawer SJ et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 844-857
• 9 Carr NJ, Mahajan H, Tan KL et al. Serrated and non-serrated polyps of the colorectum: their prevalence in an unselected case series and correlation of BRAF mutation analysis with the diagnosis of sessile serrated adenoma. J Clin Pathol 2009; 516-518
• 10 Lash RH, Genta RM, Schuler CM. Sessile serrated adenomas: prevalence of dysplasia and carcinoma in 2139 patients. J Clin Pathol 2010; 681-686
• 11 Hetzel JT, Huang CS, Coukos JA et al. Variation in the detection of serrated polyps in an average risk colorectal cancer screening cohort. Am J Gastroenterol 2010; 2656-2664
• 12 De Wijkerslooth TR, De Haan MC, Stoop EM et al. Study protocol: population screening for colorectal cancer by colonoscopy or CT colonography: a randomized controlled trial. BMC Gastroenterol 2010; 47
• 13 Stoop EM, De Haan MC, De Wijkerslooth TR et al. Participation and yield of colonoscopy versus non-cathartic CT colonography in population-based screening for colorectal cancer: a randomised controlled trial. Lancet Oncol 2012; 55-64
• 14 De Wijkerslooth TR, Stoop EM, Bossuyt PM et al. Differences in proximal serrated polyp detection among endoscopists are associated with variability in withdrawal time. Gastrointest Endosc 2013; 617-623
• 15 Endoscopic ClassificationReview Group. Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 2005; 570-578
• 16 Rostom A, Jolicoeur E. Validation of a new scale for the assessment of bowel preparation quality. Gastrointest Endosc 2004; 482-486
• 17 Schlemper RJ, Riddell RH, Kato Y et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 251-255
• 18 Rex DK, Petrini JL, Baron TH et al. Quality indicators for colonoscopy. Gastrointest Endosc 2006; 16-28
• 19 Farris AB, Misdraji J, Srivastava A et al. Sessile serrated adenoma: challenging discrimination from other serrated colonic polyps. Am J Surg Pathol 2008; 30-35
• 20 Khalid O, Radaideh S, Cummings OW et al. Reinterpretation of histology of proximal colon polyps called hyperplastic in 2001. World J Gastroenterol 2009; 3767-3770
• 21 Spring KJ, Zhao ZZ, Karamatic R et al. High prevalence of sessile serrated adenomas with BRAF mutations: a prospective study of patients undergoing colonoscopy. Gastroenterology 2006; 1400-1407
• 22 Higuchi T, Sugihara K, Jass JR. Demographic and pathological characteristics of serrated polyps of colorectum. Histopathology 2005; 32-40
• 23 Buda A, De Bona M, Dotti I et al. Prevalence of different subtypes of serrated polyps and risk of synchronous advanced colorectal neoplasia in average-risk population undergoing first-time colonoscopy. Clin Transl Gastroenterol 2012; 3 e6
• 24 Kahi CJ, Hewett DG, Norton DL et al. Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy. Clin Gastroenterol Hepatol 2011; 9: 42-46
• 25 Pohl H, Srivastava A, Bensen SP et al. Incomplete polyp resection during colonoscopy – results of the Complete Adenoma Resection (CARE) Study. Gastroenterology 2013; 74-80
• 26 Singh H, Bay D, Ip S et al. Pathological reassessment of hyperplastic colon polyps in a city-wide pathology practice: implications for polyp surveillance recommendations. Gastrointest Endosc 2012; 1003-1008
• 27 Rex DK, Ahnen DJ, Baron JA et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol 2012; 1315-1329
• 28 Hazewinkel Y, López-Cerón M, East JE et al. Endoscopic features of sessile serrated adenomas: validation by international experts using high-resolution white-light endoscopy and narrow-band imaging. Gastrointest Endosc 2013; 916-924
• 29 Gurudu SR, Heigh RI, De Petris G et al. Sessile serrated adenomas: demographic, endoscopic and pathological characteristics. World J Gastroenterol 2010; 3402-3405
• 30 Weisenberger DJ, Siegmund KD, Campan M et al. CpG island methylator phenotype underlies sporadic microsatellite instability and is tightly associated with BRAF mutation in colorectal cancer. Nat Genet 2006; 787-793
• 31 Sawhney MS, Farrar WD, Gudiseva S et al. Microsatellite instability in interval colon cancers. Gastroenterology 2006; 1700-1705
• 32 Rondagh EJA, Bouwens MWE, Riedl RG et al. Endoscopic appearance of proximal colorectal neoplasms and potential implications for colonoscopy in cancer prevention. Gastrointest Endos 2012; 1218-1225
• 33 Schreiner MA, Weiss DG, Lieberman DA. Proximal and large hyperplastic and nondysplastic serrated polyps detected by colonoscopy are associated with neoplasia. Gastroenterology 2010; 1497-1502
• 34 Hiraoka S, Kato J, Fujiki S et al. The presence of large serrated polyps increases risk for colorectal cancer. Gastroenterology 2010; 1503-1510
• 35 Li D, Jin C, McCulloch C et al. Association of large serrated polyps with synchronous advanced colorectal neoplasia. Am J Gastroenterol 2009; 695-702