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Prevalence of serrated polyps: implications for significance as colorectal cancer precursors

    Nicholas J Tutticci

    The University of Queensland School of Medicine, Brisbane, Australia

    ,
    David G Hewett

    The University of Queensland School of Medicine, Brisbane, Australia

    &
    Barbara A Leggett

    * Author for correspondence

    Department of Gastroenterology & Hepatology, Royal Brisbane & Women’s Hospital, Brisbane, Australia.

    Queensland Institute of Medical Research Berghofer, Brisbane, Australia

    Published Online:https://doi.org/10.2217/crc.13.70

    SUMMARY Colorectal cancer remains a major cancer diagnosis, and a cause of mortality worldwide with screening and surveillance programs representing a significant healthcare commitment. The serrated pathway is responsible for 20–30% of colon cancers and evidence is accumulating for a major role in the relative failure of colonoscopy to provide high-level protection from cancer in the proximal colon. Although the significance of the serrated pathway and its precursor lesions are well established, the prevalence of the precursor lesions at colonoscopy is not. Multiple factors can impact attempts to accurately assess the prevalence of these lesions. This review discusses these factors and summarizes publications on sessile serrated adenoma and proximal serrated polyp prevalence.

    Papers of special note have been highlighted as: ▪ of interest ▪▪ of considerable interest

    References

    • Leggett B, Whitehall V. Role of the serrated pathway in colorectal cancer pathogenesis. Gastroenterology138(6),2088–2100 (2010).▪ Concise review of the serrated pathway including molecular aspects that are not covered in this review.
    • Snover DC. Update on the serrated pathway to colorectal carcinoma. Hum. Pathol.42(1),1–10 (2011).
    • Rosty C, Hewett DG, Brown IS, Leggett BA, Whitehall VL. Serrated polyps of the large intestine: current understanding of diagnosis, pathogenesis, and clinical management. J. Gastroenterol.48(3),287–302 (2012).
    • Jass JR. Classification of colorectal cancer based on correlation of clinical, morphological and molecular features. Histopathology50(1),113–130 (2007).
    • Winawer SJ, Zauber AG, Ho MN et al. The National Polyp Study. Eur. J. Cancer Prev.2(Suppl. 2),83–87 (1993).
    • Zauber AG, Winawer SJ, O’Brien MJ et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N. Engl. J. Med.366(8),687–696 (2012).
    • Brenner H, Hoffmeister M, Arndt V, Stegmaier C, Altenhofen L, Haug U. Protection from right- and left-sided colorectal neoplasms after colonoscopy: population-based study. J. Natl Cancer Inst.102(2),89–95 (2010).
    • Singh H, Nugent Z, Demers AA, Kliewer EV, Mahmud SM, Bernstein CN. The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer. Gastroenterology139(4),1128–1137 (2010).
    • Singh H, Nugent Z, Demers AA, Bernstein CN. Rate and predictors of early/missed colorectal cancers after colonoscopy in Manitoba: a population-based study. Am. J. Gastroenterol.105(12),2588–2596 (2010).
    • 10  Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L. Association of colonoscopy and death from colorectal cancer. Ann. Intern. Med.150(1),1–8 (2009).
    • 11  Arain MA, Sawhney M, Sheikh S et al. CIMP status of interval colon cancers: another piece to the puzzle. Am. J. Gastroenterol.105(5),1189–1195 (2010).
    • 12  Sawhney MS, Farrar WD, Gudiseva S et al. Microsatellite instability in interval colon cancers. Gastroenterology131(6),1700–1705 (2006).
    • 13  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.105(12),2656–2664 (2010).▪▪ Major study describing variable detection in serrated polyp detection by a colonoscopist and pathologist with discrimination between serrated polyp subtype.
    • 14  Spring KJ, Zhao ZZ, Karamatic R et al. High prevalence of sessile serrated adenomas with BRAF mutations: a prospective study of patients undergoing colonoscopy. Gastroenterology131(5),1400–1407 (2006).
    • 15  Kahi CJ, Hewett DG, Norton DL, Eckert GJ, Rex DK. Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy. Clin. Gastroenterol. Hepatol.9(1),42–46 (2011).▪ Demonstrates variable detection of proximal serrated polyps and correlation with adenoma detection.
    • 16  Kahi CJ, Li X, Eckert GJ, Rex DK. High colonoscopic prevalence of proximal colon serrated polyps in average-risk men and women. Gastrointest. Endosc.75(3),515–520 (2011).
    • 17  Wong NA, Hunt LP, Novelli MR, Shepherd NA, Warren BF. Observer agreement in the diagnosis of serrated polyps of the large bowel. Histopathology55(1),63–66 (2009).
    • 18  Kim SW, Cha JM, Lee JI et al. A significant number of sessile serrated adenomas might not be accurately diagnosed in daily practice. Gut Liver4(4),498–502 (2010).
    • 19  Khalid O. Reinterpretation of histology of proximal colon polyps called hyperplastic in 2001. World J. Gastroenterol.15(30),3767–3770 (2009).
    • 20  Bustamante-Balen M, Bernet L, Cano R, Morell L, Lopez A. Assessing the reproducibility of the microscopic diagnosis of sessile serrated adenoma of the colon. Rev. Esp. Enferm. Dig.101(4),258–264 (2009).
    • 21  Urbanski SJ, Kossakowska AE, Marcon N, Bruce WR. Mixed hyperplastic adenomatous polyps – an underdiagnosed entity. Report of a case of adenocarcinoma arising within a mixed hyperplastic adenomatous polyp. Am. J. Surg. Pathol.8(7),551–556 (1984).
    • 22  Longacre TA, Fenoglio-Preiser CM. Mixed hyperplastic adenomatous polyps/serrated adenomas. A distinct form of colorectal neoplasia. Am. J. Surg. Pathol.14(6),524–537 (1990).
    • 23  Torlakovic E, Skovlund E, Snover DC, Torlakovic G, Nesland JM. Morphologic reappraisal of serrated colorectal polyps. Am. J. Surg. Pathol.27(1),65–81 (2003).
    • 24  Snover DC, Jass JR, Fenoglio-Preiser C, Batts KP. Serrated polyps of the large intestine: a morphologic and molecular review of an evolving concept. Am. J. Clin. Pathol.124(3),380–391 (2005).
    • 25  Snover D, Ahnen DJ, Burt RW, Odze RD. Serrated Polyps of the Colon and Rectum and Serrated Polyposis: WHO Classification of Tumours of the Digestive System (4th Edition). IARC Press, Lyon, France, 160–165 (2010).▪ Overview of the current classification of serrated lesions.
    • 26  Bettington M, Walker N, Clouston A, Brown I, Leggett B, Whitehall V. The serrated pathway to colorectal carcinoma: current concepts and challenges. Histopathology62(3),367–386 (2013).▪▪ Comprehensive and current review of the serrated pathway and pathology of precursor lesions.
    • 27  Imperiale TF, Glowinski EA, Lin-Cooper C, Larkin GN, Rogge JD, Ransohoff DF. Five-year risk of colorectal neoplasia after negative screening colonoscopy. N. Engl. J. Med.359(12),1218–1224 (2008).
    • 28  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.3,e6 (2012).
    • 29  The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest. Endosc.58(Suppl. 6),S3–S43 (2003).
    • 30  Leedham S, East JE, Chetty R. Diagnosis of sessile serrated polyps/adenomas: what does this mean for the pathologist, gastroenterologist and patient?. J. Clin. Pathol.66(4),265–268 (2013).
    • 31  Vieth M, Quirke P, Lambert R, von Karsa L, Risio M. Annex to Quirke et al. Quality assurance in pathology in colorectal cancer screening and diagnosis: annotations of colorectal lesions. Virchows Arch.458(1),21–30 (2011).
    • 32  Tadepalli US, Feihel D, Miller KM et al. A morphologic analysis of sessile serrated polyps observed during routine colonoscopy (with video). Gastrointest. Endosc.74(6),1360–1368 (2011).
    • 33  Rondagh EJ, Masclee AA, Bouwens MW et al. Endoscopic red flags for the detection of high-risk serrated polyps: an observational study. Endoscopy43(12),1052–1058 (2011).
    • 34  Gancayco J, Siddiqui UD, Jain D, Aslanian HR. Narrow band imaging features and pathological correlations of sessile serrated polyps. Am. J. Gastroenterol.106(8),1559–1560 (2011).
    • 35  Kudo S, Tamura S, Nakajima T, Yamano H, Kusaka H, Watanabe H. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest. Endosc.44(1),8–14 (1996).
    • 36  Kimura T, Yamamoto E, Yamano HO et al. A novel pit pattern identifies the precursor of colorectal cancer derived from sessile serrated adenoma. Am. J. Gastroenterol.107(3),460–469 (2012).
    • 37  Hazewinkel Y, Lopez-Ceron 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.77(6),916–924 (2013).
    • 38  Boparai KS, van den Broek FJ, van Eeden S, Fockens P, Dekker E. Hyperplastic polyposis syndrome: a pilot study for the differentiation of polyps by using high-resolution endoscopy, autofluorescence imaging, and narrow-band imaging. Gastrointest. Endosc.70(5),947–955 (2009).
    • 39  Rex DK, Hewett DG, Snover DC. Editorial: detection targets for colonoscopy: from variable detection to validation. Am. J. Gastroenterol.105(12),2665–2669 (2010).▪ Erudite editorial covering variable detection and issues of serrated lesions.
    • 40  Rex DK, Ahnen DJ, Baron JA et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am. J. Gastroenterol.107(9),1315–1329 (2012).▪ Comprehensive summary of serrated lesions. The prevalence rates suggested, however, are lower than estimates proposed in this review.
    • 41  Mohammadi M, Garbyal RS, Kristensen MH, Madsen PM, Nielsen HJ, Holck S. Sessile serrated lesion and its borderline variant – variables with impact on recorded data. Pathol. Res. Pract.207(7),410–416 (2011).
    • 42  Li D, Jin C, McCulloch C et al. Association of large serrated polyps with synchronous advanced colorectal neoplasia. Am. J. Gastroenterol.104(3),695–702 (2009).
    • 43  Schreiner MA, Weiss DG, Lieberman DA. Proximal and large hyperplastic and nondysplastic serrated polyps detected by colonoscopy are associated with neoplasia. Gastroenterology139(5),1497–1502 (2010).
    • 44  Leung WK, Tang V, Lui PC. Detection rates of proximal or large serrated polyps in Chinese patients undergoing screening colonoscopy. J. Dig. Dis.13(9),466–471 (2012).
    • 45  Khalid O, Radaideh S, Cummings OW, O’Brien MJ, Goldblum JR, Rex DK. Reinterpretation of histology of proximal colon polyps called hyperplastic in 2001. World J. Gastroenterol.15(30),3767–3770 (2009).
    • 46  Pai RK, Hart J, Noffsinger AE. Sessile serrated adenomas strongly predispose to synchronous serrated polyps in non-syndromic patients. Histopathology56(5),581–588 (2010).
    • 47  Hiraoka S, Kato J, Fujiki S et al. The presence of large serrated polyps increases risk for colorectal cancer. Gastroenterology139(5),1503–1510, 1510.e1501–e1503 (2010).
    • 48  Oono Y, Fu K, Nakamura H et al. Progression of a sessile serrated adenoma to an early invasive cancer within 8 months. Dig. Dis. Sci.54(4),906–909 (2009).
    • 49  García-Solano J, Pérez-Guillermo M, Conesa-Zamora P et al. Clinicopathologic study of 85 colorectal serrated adenocarcinomas: further insights into the full recognition of a new subset of colorectal carcinoma. Hum. Pathol.41(10),1359–1368 (2010).
    • 50  Teriaky A, Driman DK, Chande N. Outcomes of a 5-year follow-up of patients with sessile serrated adenomas. Scand. J. Gastroenterol.47(2),178–183 (2012).
    • 51  Lu FI, van Niekerk de W, Owen D, Tha SP, Turbin DA, Webber DL. Longitudinal outcome study of sessile serrated adenomas of the colorectum: an increased risk for subsequent right-sided colorectal carcinoma. Am. J. Surg. Pathol.34(7),927–934 (2010).
    • 52  Salaria SN, Streppel MM, Lee LA, Iacobuzio-Donahue CA, Montgomery EA. Sessile serrated adenomas: high-risk lesions?. Hum. Pathol.43(11),1808–1814 (2012).
    • 53  Boparai KS, Mathus-Vliegen EM, Koornstra JJ et al. Increased colorectal cancer risk during follow-up in patients with hyperplastic polyposis syndrome: a multicentre cohort study. Gut59(8),1094–1100 (2010).
    • 54  Sheridan TB, Fenton H, Lewin MR et al. Sessile serrated adenomas with low- and high-grade dysplasia and early carcinomas: an immunohistochemical study of serrated lesions “caught in the act.” Am. J. Clin. Pathol.126(4),564–571 (2006).
    • 55  Anderson JC, Rangasamy P, Rustagi T et al. Risk factors for sessile serrated adenomas. J. Clin. Gastroenterol.45(8),694–699 (2011).
    • 56  Walker RG, Landmann JK, Hewett DG et al. Hyperplastic polyposis syndrome is associated with cigarette smoking, which may be a modifiable risk factor. Am. J. Gastroenterol.105(7),1642–1647 (2010).
    • 57  Brim H, Mokarram P, Naghibalhossaini F et al. Impact of BRAF, MLH1 on the incidence of microsatellite instability high colorectal cancer in populations based study. Mol. Cancer7,68 (2008).
    • 58  De Jesus-Monge WE, Gonzalez-Keelan C, Zhao R, Hamilton SR, Rodriguez-Bigas M, Cruz-Correa M. Mismatch repair protein expression and colorectal cancer in Hispanics from Puerto Rico. Fam. Cancer9(2),155–166 (2010).
    • 59  English DR, Young JP, Simpson JA et al. Ethnicity and risk for colorectal cancers showing somatic BRAF V600E mutation or CpG island methylator phenotype. Cancer Epidemiol. Biomarkers Prev.17(7),1774–1780 (2008).
    • 60  Daveson A, Jones JM, Hewett DM, David G. Polyp prevalence at colonoscopy in patients aged 40 years or less: a prospective multisite analysis. J. Gastroenterol. Hepatol.27(Suppl. 4), Abstract 34 (2012).
    • 61  Rosty C, Parry S, Young JP. Serrated polyposis: an enigmatic model of colorectal cancer predisposition. Pathol. Res. Int.2011,157073 (2011).
    • 62  Leggett BA, Devereaux B, Biden K, Searle J, Young J, Jass J. Hyperplastic polyposis: association with colorectal cancer. Am. J. Surg. Pathol.25(2),177–184 (2001).
    • 63  Kalady MF, Jarrar A, Leach B et al. Defining phenotypes and cancer risk in hyperplastic polyposis syndrome. Dis. Colon Rectum54(2),164–170 (2011).
    • 64  Buchanan DD, Sweet K, Drini M et al. Phenotypic diversity in patients with multiple serrated polyps: a genetics clinic study. Int. J. Colorectal Dis.25(6),703–712 (2010).
    • 65  Win AK, Walters RJ, Buchanan DD et al. Cancer risks for relatives of patients with serrated polyposis. Am. J. Gastroenterol.107(5),770–778 (2012).
    • 66  Boparai KS, Reitsma JB, Lemmens V et al. Increased colorectal cancer risk in first-degree relatives of patients with hyperplastic polyposis syndrome. Gut59(9),1222–1225 (2010).
    • 67  Burt R, Jass JR. Hyperplastic polyposis in Pathology and Genetics of Tumours of the Digestive System. IARC Press, Lyon, France, 135–136 (2000).
    • 68  Higuchi T, Jass JR. My approach to serrated polyps of the colorectum. J. Clin. Pathol.57(7),682–686 (2004).
    • 69  Swan HS, Myers RE. International colorectal cancer screening programs: population contact strategies, testing methods and screening rates. Prac. Gastroenterol.36(8),20–29 (2012).
    • 70  Anderson JC, Butterly L, Goodrich M, Robinson CM, Weiss JE. Differences in detection rates of adenomas and serrated polyps in screening versus surveillance colonoscopies, based on the New Hampshire Colonoscopy Registry. Clin. Gastroenterol. Hepatol.11(10),1308–1312 (2013).
    • 71  Hewett DG, Kahi CJ, Rex DK. Does colonoscopy work?. J. Natl Compr. Canc. Netw.8(1),67–76; quiz 77 (2010).
    • 72  Hewett DG, Kahi CJ, Rex DK. Efficacy and effectiveness of colonoscopy: how do we bridge the gap?. Gastrointest. Endosc. Clin. N. Am.20(4),673–684 (2010).
    • 73  Kaminski MF, Regula J, Kraszewska E et al. Quality indicators for colonoscopy and the risk of interval cancer. N. Engl. J. Med.362(19),1795–1803 (2010).
    • 74  Rex DK, Cutler CS, Lemmel GT et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology112(1),24–28 (1997).
    • 75  Van Rijn JC, Reitsma JB, Stoker J, Bossuyt PM, van Deventer SJ, Dekker E. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am. J. Gastroenterol.101(2),343–350 (2006).
    • 76  Chen SC, Rex DK. Variable detection of nonadenomatous polyps by individual endoscopists at colonoscopy and correlation with adenoma detection. J. Clin. Gastroenterol.42(6),704–707 (2008).
    • 77  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.77(4),617–623 (2013).
    • 78  Gross SA, Buchner AM, Crook JE et al. A comparison of high definition-image enhanced colonoscopy and standard white-light colonoscopy for colorectal polyp detection. Endoscopy43(12),1045–1051 (2011).
    • 79  Subramanian V, Mannath J, Hawkey CJ, Ragunath K. High definition colonoscopy vs. standard video endoscopy for the detection of colonic polyps: a meta-analysis. Endoscopy43(6),499–505 (2011).
    • 80  Hewett DG, Rex DK. Cap-fitted colonoscopy: a randomized, tandem colonoscopy study of adenoma miss rates. Gastrointest. Endosc.72(4),775–781 (2010).
    • 81  Pohl J, Schneider A, Vogell H, Mayer G, Kaiser G, Ell C. Pancolonic chromoendoscopy with indigo carmine versus standard colonoscopy for detection of neoplastic lesions: a randomised two-centre trial. Gut60(4),485–490 (2011).
    • 82  Boparai KS, van den Broek FJ, van Eeden S, Fockens P, Dekker E. Increased polyp detection using narrow band imaging compared with high resolution endoscopy in patients with hyperplastic polyposis syndrome. Endoscopy43(8),676–682 (2011).
    • 83  Singh TH, Kee A, Ng C et al. A prospective multicentre randomised controlled trial in the Asia Pacific region comparing a new high definition system usinghite light endoscopy or narrow band imaging in the detection and characterisation of colorectal polyps. J. Gastroenterol. Hepatol.28(2),AB-22 (2013).
    • 84  Pohl H, Srivastava A, Bensen SP et al. Incomplete polyp resection during colonoscopy-results of the Complete Adenoma Resection (CARE) study. Gastroenterology144(1),74–80.e71 (2013).
    • 85  Chung SM, Chen YT, Panczykowski A, Schamberg N, Klimstra DS, Yantiss RK. Serrated polyps with “intermediate features” of sessile serrated polyp and microvesicular hyperplastic polyp: a practical approach to the classification of nondysplastic serrated polyps. Am. J. Surg. Pathol.32(3),407–412 (2008).
    • 86  Ensari A, Bosman FT, Offerhaus GJ. The serrated polyp: getting it right! J. Clin. Pathol.63(8),665–668 (2010).
    • 87  Gunia S, Berg T, Gradhand E, Becker S. Knowledge of the anatomical polyp location might bias the pathological classification of histologically equivocal colorectal serrated polyps – a consensus study performed by pathology trainees. Pathol. Res. Pract.207(2),116–120 (2011).
    • 88  Higuchi T, Sugihara K, Jass JR. Demographic and pathological characteristics of serrated polyps of colorectum. Histopathology47(1),32–40 (2005).
    • 89  Carr NJ, Mahajan H, Tan KL, Hawkins NJ, Ward RL. 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.62(6),516–518 (2009).
    • 90  Lash RH, Genta RM, Schuler CM. Sessile serrated adenomas: prevalence of dysplasia and carcinoma in 2139 patients. J. Clin. Pathol.63(8),681–686 (2010).
    • 91  Gurudu SR. Sessile serrated adenomas: demographic, endoscopic and pathological characteristics. World J. Gastroenterol.16(27),3402–3405 (2010).
    • 92  Alvarez C, Andreu M, Castells A et al. Relationship of colonoscopy-detected serrated polyps with synchronous advanced neoplasia in average-risk individuals. Gastrointest. Endosc.78(2),333–341.e1 (2013).
    • 93  Freedman JS, Harari DY, Bamji ND et al. The detection of premalignant colon polyps during colonoscopy is stable throughout the workday. Gastrointest. Endosc.73(6),1197–1206 (2011).
    • 94  Kumbhari V, Behary J, Hui JM. Prevalence of adenomas and sessile serrated adenomas in Chinese compared with Caucasians. J. Gastroenterol. Hepatol.28(4),608–612 (2013).
    • 95  Min YW, Lee JH, Lee SH et al. Prevalence of proximal colon serrated polyps in a population at average risk undergoing screening colonoscopy: a multicenter study. Clin. Res. Hepatol. Gastroenterol.36(6),604–608 (2012).
    • 101  Ferlay JS, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008 V2.0 Cancer Incidence and Mortality Worldwide. IARC CancerBase (2010). http://globocan.iarc.fr (Accessed 12 April 2013)