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Gastrointest Endosc. 2013 Dec;78(6):902-9. doi: 10.1016/j.gie.2013.06.004. Epub 2013 Jul 9.

Optical biopsy of sessile serrated adenomas: do these lesions resemble hyperplastic polyps under narrow-band imaging?

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  • 1Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California.

Abstract

BACKGROUND:

Serrated colorectal lesions include hyperplastic polyps (HPs) and sessile serrated adenomas (SSAs). Optical biopsy could misclassify SSAs as unimportant if they resemble HPs.

OBJECTIVE:

To explore the narrow-band imaging (NBI) features of SSAs. We hypothesized that SSAs resemble HPs under NBI.

DESIGN:

Retrospective analysis of data from our prospective study of NBI in routine practice.

SETTING:

Single specialty group.

PATIENTS:

Patients undergoing colonoscopy.

INTERVENTION:

Colonoscopy.

MAIN OUTCOME MEASUREMENTS:

Polyp histology prediction by community gastroenterologists. Features of SSAs versus HPs and adenomas by using the Narrow-Band Imaging International Colorectal Endoscopic (NICE) Classification.

RESULTS:

Among 2388 lesions, 141 were diagnosed on pathology as SSAs, 465 as HPs, and 1546 as adenomas. Each individual NICE feature of HPs was found in 38% to 42% of SSAs, 66% to 67% of HPs, and 15% to 20% of adenomas (P < .001 for each). Each individual NICE feature of adenomas was found in 57% to 62% of SSAs, 33% to 34% of HPs, and 80% to 84% of adenomas (P < .001 for each). Compared with HPs, SSAs were less likely (odds ratio [OR] 0.74; 95% confidence interval [CI], 0.69-0.79) and adenomas were even less likely (OR 0.62; 95% CI, 0.59-0.64) to have all 3 NICE features of HPs. SSAs >5 mm were more likely than smaller SSAs to have all 3 NICE features of adenomas. SSA location did not predict NBI features. Analyses restricted to high-confidence lesions showed similar results.

LIMITATIONS:

The endoscopists were not NBI experts.

CONCLUSION:

Community gastroenterologists observed a profile of NICE features among SSAs that was intermediate to the profiles observed for HPs and adenomas. These results require confirmation by NBI experts.

Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

KEYWORDS:

HP; NBI; NBI International Colorectal Endoscopic (classification); NICE; SSA; hyperplastic polyp; narrow-band imaging; sessile serrated adenoma

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PMID:
23849819
[PubMed - indexed for MEDLINE]
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