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Am J Gastroenterol. 2014 Nov;109(11):1698-704. doi: 10.1038/ajg.2014.78. Epub 2014 Jul 8.

Sessile serrated polyps at screening colonoscopy: have they been under diagnosed?

Author information

1
1] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada [2] Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
2
1] Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada [2] Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
3
1] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada [2] Department of Surgery, University of Toronto, Toronto, Ontario, Canada [3] Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
4
Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
5
1] Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada [2] Alberta Health Services Cancer Care, Calgary, Alberta, Canada.
6
1] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada [2] Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada [3] Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada [4] Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada [5] Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
7
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
8
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
9
1] Calgary Laboratory Services, Calgary, Alberta, Canada [2] Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada.
10
1] Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada [2] Department of Pathology, UHN Toronto General Hospital, Toronto, Ontario, Canada.
11
1] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada [2] Cancer Care Ontario, Toronto, Ontario, Canada [3] Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada [4] Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada [5] Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

Abstract

OBJECTIVES:

The sessile serrated adenoma/polyp (SSA/P) is increasingly recognized as an important precursor to colorectal cancer (CRC) and may contribute to proximal postcolonoscopy CRCs. Hyperplastic polyps (HPs) generally follow a more benign course than do SSA/Ps, but they have a similar histologic appearance. Our aims were to identify patient and polyp factors associated with reclassification of HPs as SSA/Ps during a central pathology review and to characterize and compare their subsequent clinical management with other polyps.

METHODS:

From 2003 to 2008, we prospectively enrolled asymptomatic persons aged 50-74 years in a study of screening colonoscopy. Because criteria for SSA/P diagnosis evolved over our study period, we initiated a second review of all HPs >5 mm in size in 2011, with reclassification of polyps if indicated. Rates of subsequent colonoscopies, polypectomies, and CRCs were identified.

RESULTS:

We enrolled 2,527 persons who underwent colonoscopy in whom 111 had HPs >5 mm. Thirty-two of the 111 participants (28.8%) with HPs >5 mm had their polyps reclassified as SSA/Ps. There were no significant differences in patient characteristics between those with reclassified SSA/Ps and those who had HPs >5 mm. SSA/Ps were more likely to be proximal (P<0.001) and larger (P<0.007) than the HPs. In all, 48.3% of those with high-risk adenomas received appropriate follow-up compared with 26.1% of those with high-risk SSA/Ps.

CONCLUSIONS:

Almost 1/3 of recently diagnosed HPs >5 mm were reclassified as SSA/Ps. Patients previously diagnosed with larger HPs in the proximal colon may benefit from a pathologic review to ensure appropriate diagnosis and follow-up.

PMID:
25001254
DOI:
10.1038/ajg.2014.78
[Indexed for MEDLINE]

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