Patients with small and diminutive proximal hyperplastic polyps have higher rates of synchronous advanced neoplasia compared with patients without serrated lesions

Abstract Background The presence of serrated lesions (SLs) is an established risk factor for colorectal neoplasia development in the general population. However, the impact of SLs on the colorectal neoplasia risk in inflammatory bowel disease (IBD) patients is unknown. In addition, SLs might have been misclassified in IBD patients in the past, in part due to revisions of classification systems. Presently, SLs are categorised as hyperplastic lesions, sessile SLs, and traditional serrated adenomas. We aimed (1) to compare the colorectal neoplasia risk in IBD patients with SLs vs. IBD patients without SLs, and 2) to study the subclassification of SLs in IBD patients before and after histopathological review by two expert gastrointestinal pathologists. Methods We identified all IBD patients with colonic SLs from 1996 to 2019 in a tertiary referral centre using the local histopathology database. Patients with neoplasia prior to SL diagnosis were excluded. Clinical data from patients’ charts were retrieved until June 2019. A subgroup of 135 SLs was reviewed by two pathologists. The log-rank analysis was used to compare the cumulative (advanced) neoplasia incidence in IBD patients with SL vs. IBD patients without SL undergoing surveillance in the same time period. Patients were censored at the end of surveillance or at colectomy. Results We identified 376 SLs in 204 IBD patients (61.9% ulcerative colitis (UC)). In the original reports, 91.9% was classified as a hyperplastic lesion. After histopathological review, 120/136 (88%) of the SLs were confirmed (16 were no SL). Of the 120 confirmed SLs, 62.2% was classified as a sessile SL, 37.8% as a hyperplastic lesion, and 0.8% as a traditional serrated adenoma. The mean time from IBD diagnosis to the first serrated lesion was 14.3 ( ± 12.3) years. A total of 41/204 (20.0%) of patients developed neoplasia (3 CRC, 3 HGD, and 35 LGD; including 2 HGD and 17 LGD at the moment of serrated lesion detection). In the 304 patients without SL (52.6% UC), 63 developed neoplasia (20.7%; 8 CRC, 5 HGD and 50 LGD). Patients who received follow-up colonoscopies after SL (n = 127) had an increased cumulative risk of neoplasia (p < 0.01), but no increased risk of advanced neoplasia (p = 0.50) compared with the group of IBD patients without SL (Figure 1). Conclusion The presence of SLs in IBD patients was associated with a relatively high risk of synchronous colorectal neoplasia as well as an increased risk of subsequent neoplasia, although not with an increased risk of advanced neoplasia. Histopathological review confirmed the SL diagnosis in the majority of lesions, although a large proportion of the hyperplastic lesions was reclassified as a sessile SL.

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Somatic targeted mutation profiling of colorectal cancer precursor lesions

10.21203/rs.3.rs-428174/v1 ◽

2021 ◽

Author(s):

Wellington dos Santos ◽

Mariana Bisarro dos Reis ◽

Jun Porto ◽

Ana Carolina de Carvalho ◽

Marcus Matsushita ◽

...

Keyword(s):

Driver Mutations ◽

Precursor Lesions ◽

Hyperplastic Polyps ◽

Serrated Polyps ◽

Targeted Mutation ◽

Mutation Profile ◽

Serrated Lesions ◽

Advanced Adenomas ◽

Biological History ◽

High Degree

Abstract Most colorectal cancers (CRC) arise from precursor lesions. We aimed to characterize the mutation profile of CRC precursor lesions in a Brazilian population. In total, 90 FFPE lesions, including 67 adenomas, 7 sessile serrated lesions, and 16 hyperplastic polyps, were analyzed by next-generation sequencing. The genetic ancestry of the patients was estimated. Somatic driver mutations were identified in 66.7% of cases, including alterations in APC (32.2%), TP53 (20.0%), KRAS (18.9%), BRAF (13.3%) and EGFR (7.8%). Adenomas displayed a higher number of mutations, mainly in APC, compared to serrated polyps (73.1% vs. 47.8%, p = 0.039). Advanced adenomas had a higher frequency of mutation in KRAS and GNAS and a high overall mutation rate than early adenomas (92.9% vs. 59%, p = 0.002). Concerning the serrated pathway, a higher frequency of mutations, mainly in BRAF, was observed in sessile serrated lesions (85.7%) compared to hyperplastic polyps (31.3%, p = 0.027). A high degree of ancestry admixture was observed in the population, with a predominance of European followed by African components. The mutation profile of Brazilian colorectal precursor lesions exhibits a similar landscape to other populations. These results bestow the knowledge of CRC's biological history and may contribute to a molecular screening approach.

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Isolated Small Right-Sided Hyperplastic Polyps Confer Higher Rates of Synchronous Advanced Neoplasia Compared to an Average Risk Screening Population

Gastroenterology ◽

10.1016/s0016-5085(17)31969-8 ◽

2017 ◽

Vol 152 (5) ◽

pp. S540

Author(s):

Thayer Hamoudah ◽

Karen Ma ◽

Marcus Juan L. Esteban ◽

Waqas Hayat ◽

Brett Mahon ◽

...

Keyword(s):

Average Risk ◽

Hyperplastic Polyps ◽

Risk Screening ◽

Advanced Neoplasia ◽

Screening Population

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Proximal Hyperplastic Polyps: Prevalence and Association with Advanced Neoplasia and Tubular Adenomas in the VA Cooperative Study Program #380

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2008.03.892 ◽

2008 ◽

Vol 67 (5) ◽

pp. AB304

Author(s):

Mitchal A. Schreiner ◽

David G. Weiss ◽

David A. Lieberman

Keyword(s):

Cooperative Study ◽

Hyperplastic Polyps ◽

Study Program ◽

Advanced Neoplasia

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High incidence of advanced colorectal neoplasia during endoscopic surveillance in serrated polyposis syndrome

Endoscopy ◽

10.1055/a-0656-5557 ◽

2018 ◽

Vol 51 (02) ◽

pp. 142-151 ◽

Cited By ~ 11

Author(s):

Daniel Rodríguez-Alcalde ◽

Sabela Carballal ◽

Leticia Moreira ◽

Luis Hernández ◽

Lorena Rodríguez-Alonso ◽

...

Keyword(s):

Cumulative Incidence ◽

Colorectal Neoplasia ◽

Endoscopic Surveillance ◽

Advanced Adenoma ◽

Polyposis Syndrome ◽

Advanced Neoplasia ◽

Increased Risk ◽

Substantial Risk ◽

Serrated Lesions ◽

Serrated Lesion

Abstract Background Serrated polyposis syndrome (SPS) has been associated with an increased risk of colorectal cancer (CRC). Accordingly, intensive surveillance with annual colonoscopy is advised. The aim of this multicenter study was to describe the risk of advanced lesions in SPS patients undergoing surveillance, and to identify risk factors that could guide the prevention strategy. Methods From March 2013 to April 2015, 296 patients who fulfilled criteria I and/or III for SPS were retrospectively recruited at 18 centers. We selected patients in whom successful clearing colonoscopy had been performed and who underwent subsequent endoscopic surveillance. Advanced neoplasia was defined as CRC, advanced adenoma, or advanced serrated lesion that were ≥ 10 mm and/or with dysplasia. Cumulative incidence of advanced neoplasia was calculated and independent predictors of advanced neoplasia development were identified. Results In 152 SPS patients a total of 315 surveillance colonoscopies were performed (median 2, range 1 – 7). The 3-year cumulative incidence of CRC and advanced neoplasia were 3.1 % (95 % confidence interval [CI] 0 – 6.9) and 42.0 % (95 %CI 32.4 – 51.7), respectively. Fulfilling both I + III criteria and the presence of advanced serrated lesions at baseline colonoscopy were independent predictors of advanced neoplasia development (odds ratio [OR] 1.85, 95 %CI 1.03 – 3.33, P = 0.04 and OR 2.62, 95 %CI 1.18 – 5.81, P = 0.02, respectively). During follow-up, nine patients (5.9 %) were referred for surgery for invasive CRC (n = 4, 2.6 %) or because of polyp burden (n = 5, 3.3 %). After total colectomy, 17.9 % patients developed advanced neoplasia in the retained rectum. Conclusions Patients with SPS have a substantial risk of developing advanced neoplasia under endoscopic surveillance, whereas CRC incidence is low. Personalized endoscopic surveillance based on polyp burden and advanced serrated histology could help to optimize prevention in patients with SPS.

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Advanced neoplasia detection using chromoendoscopy and white light colonoscopy for surveillance in patients with inflammatory bowel disease

Intestinal Research ◽

10.5217/ir.2019.00090 ◽

2020 ◽

Vol 18 (4) ◽

pp. 438-446

Author(s):

Kyeong Ok Kim ◽

Michael V. Chiorean

Keyword(s):

Inflammatory Bowel Disease ◽

White Light ◽

Bowel Disease ◽

Paired Comparison ◽

Interval Cancer ◽

White Light Endoscopy ◽

Advanced Neoplasia ◽

Serrated Lesions ◽

Inflammatory Bowel ◽

The Impact

Background/Aims: Chromoendoscopy (CE) has been shown to be superior to white light endoscopy (WLE) for neoplasia detection in inflammatory bowel disease (IBD). We aimed to compare the yield of CE and WLE for the detection of overall neoplasia and advanced neoplasia in IBD. Methods: Patients who underwent surveillance colonoscopy from 1999 to 2017 were identified from our IBD database. CE procedures were compared with their respective WLE controls in a paired comparison, and frequency of all neoplasia, advanced neoplasia, and serrated neoplasia was assessed for both targeted and random biopsies.Results: A total of 290 procedures performed in 98 individuals were identified with a median follow-up 4 years (median 3 colonoscopies/patient). CE and WLE were performed in 159 and 131 episodes, respectively. CE detected neoplasia in 40.9% of colonoscopies versus 23.7% with WLE (P= 0.002). In addition, CE detected more advanced neoplasia (18.2% vs. 6.1%, P= 0.002) and serrated lesions (14.5% vs. 6.1%, P= 0.022). Significantly fewer samples were obtained per procedure with CE (14.9 ± 9.7 vs. 20.9 ± 11.1, P< 0.001). Cancer was diagnosed in 2 cases.Conclusions: CE has a higher detection rate than WLE for advanced neoplasia and serrated lesions in patients with IBD under surveillance. Further prospective studies evaluating the impact of CE on decreasing the risk of interval cancer and colectomy in IBD patients are warranted.

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Hyperplastic polyp or sessile serrated lesion? The contribution of serial sections to reclassification

Diagnostic Pathology ◽

10.1186/s13000-020-01057-0 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Diana R. Jaravaza ◽

Jonathan M. Rigby

Keyword(s):

Potential Role ◽

Hyperplastic Polyp ◽

Fragment Size ◽

World Health ◽

Serial Sections ◽

Hyperplastic Polyps ◽

Serrated Polyps ◽

Serrated Lesions ◽

Serrated Lesion ◽

Health Organization

Abstract Background The histological discrimination of hyperplastic polyps from sessile serrated lesions can be difficult. Sessile serrated lesions and hyperplastic polyps are types of serrated polyps which confer different malignancy risks, and surveillance intervals, and are sometimes difficult to discriminate. Our aim was to reclassify previously diagnosed hyperplastic polyps as sessile serrated lesions or confirmed hyperplastic polyps, using additional serial sections. Methods Clinicopathological data for all colorectal hyperplastic polyps diagnosed in 2016 and 2017 was collected. The slides were reviewed and classified as hyperplastic polyps, sessile serrated lesion, or other, using current World Health Organization criteria. Eight additional serial sections were performed for the confirmed hyperplastic polyp group and reviewed. Results Of an initial 147 hyperplastic polyps from 93 patients, 9 (6.1%) were classified as sessile serrated lesions, 103 as hyperplastic polyps, and 35 as other. Of the 103 confirmed hyperplastic polyps, 7 (6.8%) were proximal, and 8 (7.8%) had a largest fragment size of ≥5 mm and < 10 mm. After 8 additional serial sections, 11 (10.7%) were reclassified as sessile serrated lesions. They were all less than 5 mm and represented 14.3% of proximal polyps and 10.4% of distal polyps. An average of 3.6 serial sections were required for a change in diagnosis. Conclusion Histopathological distinction between hyperplastic polyps and sessile serrated lesions remains a challenge. This study has uncovered a potential role for the use of additional serial sections in the morphological reappraisal of small hyperplastic polyps, especially when proximally located.

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