Prevalence, distribution and risk of sessile serrated adenomas/polyps at a center with a high adenoma detection rate and experienced pathologists

Background and study aims: Sessile serrated adenomas/polyps (SSA/Ps) are the precursors of 15 % – 30 % of colorectal cancers (CRC). We aimed to determine the prevalence and distribution of SSA/Ps and to evaluate the association between SSA/Ps and the risk of synchronous advanced neoplasia at a high quality colonoscopy center.

Methods: Data from all colonoscopies performed within one dedicated colonoscopy center between 2011 and 2015 were prospectively retrieved using an automated reporting system. All lesions were assessed by an experienced gastrointestinal pathologist. Multiple logistic regression was used to evaluate influence of age, gender, and colonoscopy indication on prevalence of SSA/Ps, and to assess the association between SSA/Ps and synchronous advanced neoplasia.

Results: In total 4251 histologically confirmed polyps were resected in 3364 patients; 399 polyps were SSA/Ps (9.4 %). The prevalence of SSA/Ps was 8.2 % overall, increasing to 9.0 % for individuals older than 50 years. SSA/P detection rate varied between 2.5 % and 13.6 % among endoscopists. Increased SSA/P prevalence was associated with colonoscopy indications “familial CRC risk” (odds ratio [OR] 1.52, 95 % confidence interval [95 %CI] 1.05 – 2.22; P = 0.03) and “surveillance” (OR 1.73, 95 %CI 1.20 – 2.49; P < 0.01), when compared with the indication “symptoms.” The presence of synchronous advanced neoplasia was associated with SSA/Ps overall (OR 1.71, 95 %CI 1.25 – 2.34; P = 0.001), as well as with high risk SSA/Ps (defined as ≥ 10 mm and/or with dysplasia) (OR 2.70, 95 %CI 1.56 – 4.67; P < 0.001)

Conclusion: SSA/Ps are more common than previously reported and are associated with the presence of synchronous advanced neoplasia. Endoscopists should be assiduous in identifying SSA/Ps in daily practice and should carefully look for synchronous advanced neoplasia when an SSA/P has been recognized. Results from this study can guide detection standards in general colonoscopy practice adapted to the type of patient that may predominate in an individual department.

• References

• 1 Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2015. CA Cancer J Clin 2015; 65: 5-29
• 2 Jass JR. Classification of colorectal cancer based on correlation of clinical, morphological and molecular features. Histopathology 2007; 50: 113-130
• 3 Toyota M, Ahuja N, Ohe-Toyota M et al. CpG island methylator phenotype in colorectal cancer. Proc Natl Acad Sci USA 1999; 96: 8681-8686
• 4 Rex DK, Ahnen DJ, Baron J et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol 2012; 107: 1315-1329 ; quiz 1314, 1330
• 5 Snover DC, Ahnen DJ, Burt RW et al. Serrated polyps of the colon and rectum and serrated polyposis. In: Bosman T, Carneiro F, Hruban R, et al., editors. WHO classification of tumours of the digestive system. Lyon: IARC Press; 2010: 160-165
• 6 Bettington M, Walker N, Clouston A et al. The serrated pathway to colorectal carcinoma: current concepts and challenges. Histopathology 2013; 62: 367-386
• 7 IJspeert JEG, Vermeulen L, Meijer GA et al. Serrated neoplasia – role in colorectal carcinogenesis and clinical implications. Nat Rev Gastroenterol Hepatol 2015; 12: 401-409
• 8 IJspeert JEG, Bastiaansen BAJ, van Leerdam ME et al. Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps. Gut 2015; (Epub 2015 Mar 9)
• 9 Hassan C, Quintero E, Dumonceau J-M et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2013; 45: 842-851
• 10 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; 143: 844-857
• 11 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; 77: 916-924
• 12 Tadepalli US, Feihel D, Miller KM et al. A morphologic analysis of sessile serrated polyps observed during routine colonoscopy (with video). Gastrointest Endosc 2011; 74: 1360-1368
• 13 Bouwens MWE, van Herwaarden YJ, Winkens B et al. Endoscopic characterization of sessile serrated adenomas/polyps with and without dysplasia. Endoscopy 2014; 46: 225-235
• 14 Ensari A, Bilezikçi B, Carneiro F et al. Serrated polyps of the colon: How reproducible is their classification?. Virchows Arch 2012; 461: 495-504
• 15 Glatz K, Pritt B, Glatz D et al. A multinational, internet-based assessment of observer variability in the diagnosis of serrated colorectal polyps. Am J Clin Pathol 2007; 127: 938-945
• 16 Sandmeier D, Seelentag W, Bouzourene H. Serrated polyps of the colorectum: Is sessile serrated adenoma distinguishable from hyperplastic polyp in a daily practice?. Virchows Arch 2007; 450: 613-618
• 17 Hazewinkel Y, de Wijkerslooth TR, Stoop EM et al. Prevalence of serrated polyps and association with synchronous advanced neoplasia in screening colonoscopy. Endoscopy 2014; 46: 219-224
• 18 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; 62: 516-518
• 19 Gurudu SR, Heigh RI, de Petris G et al. Sessile serrated adenomas: Demographic, endoscopic and athological characteristics. World J Gastroenterol 2010; 16: 3402-3405
• 20 Lash RH, Genta RM, Schuler CM. Sessile serrated adenomas: prevalence of dysplasia and carcinoma in 2139 patients. J Clin Pathol 2010; 63: 681-686
• 21 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; 105: 2656-2664
• 22 Kumbhari V, Behary J, Hui JM. Prevalence of adenomas and sessile serrated adenomas in Chinese compared with Caucasians. J Gastroenterol Hepatol 2013; 28: 608-612
• 23 Payne SR, Church TR, Wandell M et al. Endoscopic detection of proximal serrated lesions and pathologic identification of sessile serrated adenomas/polyps vary on the basis of center. Clin Gastroenterol Hepatol 2014; 12: 1119-1126
• 24 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 (Epub 2012 Jan 5)
• 25 Abdeljawad K, Vemulapalli KC, Kahi CJ et al. Sessile serrated polyp prevalence determined by a colonoscopist with a high lesion detection rate and an experienced pathologist. Gastrointest Endosc 2015; 81: 517-524
• 26 World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 1997; 310: 2191-2194
• 27 Van Doorn SC, van Vliet J, Fockens P et al. A novel colonoscopy reporting system enabling quality assurance. Endoscopy 2014; 46: 181-187
• 28 Schlemper RJ. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
• 29 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
• 30 Bettington M, Walker N, Rosty C et al. Clinicopathological and molecular features of sessile serrated adenomas with dysplasia or carcinoma. Gut 2015; (Epub 2015 Oct 15)
• 31 Haque TR, Bradshaw PT, Crockett SD. Risk factors for serrated polyps of the colorectum. Dig Dis Sci 2014; 59: 2874-2889
• 32 Freedman JS, Harari DY, Bamji ND et al. The detection of premalignant colon polyps during colonoscopy is stable throughout the workday. Gastrointest Endosc 2011; 73: 1197-1206
• 33 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; 131: 1400-1407
• 34 Ng SC, Ching JYL, Chan VCW et al. Association between serrated polyps and the risk of synchronous advanced colorectal neoplasia in average-risk individuals. Aliment Pharmacol Ther 2015; 41: 108-115
• 35 Rau TT, Agaimy A, Gehoff A et al. Defined morphological criteria allow reliable diagnosis of colorectal serrated polyps and predict polyp genetics. Virchows Arch 2014; 464: 663-672