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

ObjectiveThe longitudinal risk of colorectal cancer (CRC) associated with subtypes of serrated polyps (SPs) remains incompletely understood.DesignThis community-based, case–control study included 317 178 Kaiser Permanente Northern California members who underwent their first colonoscopy during 2006–2016. Nested within this population, we identified 695 cases of CRC and 3475 CRC-free controls (matched 5:1 to cases for age, sex and year of colonoscopy). Two expert pathologists reviewed the tissue slides of all SPs identified on the first colonoscopy and reclassified them to sessile serrated lesions (SSLs), hyperplastic polyps (HPs) and traditional serrated adenomas. SPs with borderline characteristics of SSLs but insufficient to make a definitive diagnosis were categorised as unspecified SPs. The association with development of CRC was assessed using multivariable logistic regression.ResultsCompared with individuals with no polyp, the adjusted ORs (aORs) for SSL alone or with synchronous adenoma were 2.9 (95% CI: 1.8 to 4.8) and 4.4 (95% CI: 2.7 to 7.2), respectively. The aORs for SSL with dysplasia, large proximal SSL,and small proximal SSL were 10.3 (95% CI: 2.1 to 50.3), 12.8 (95% CI: 3.5 to 46.9) and 1.9 (95% CI: 0.8 to 4.7), respectively. Proximal unspecified SP also conferred an increased risk (aOR: 5.8, 95% CI: 2.2 to 15.2). Women with SSL were associated with higher risk (aOR: 4.4; 95% CI: 2.3 to 8.2) than men (aOR: 1.7; 95% CI: 0.8 to 3.8).ConclusionIncreased risk of CRC was observed in individuals with SSLs, particularly large proximal ones or with dysplasia, supporting close endoscopic surveillance. Proximal unspecified SPs were also associated with increased risk of CRC and should be managed as SSLs.

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686 – Risk of Metachronous Colorectal Cancer Among Individuals with a History of Serrated Polyps – Data from a Large Integrated Healthcare System

Gastroenterology ◽

10.1016/s0016-5085(19)37160-4 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-148-S-149

Author(s):

Dan Li ◽

Helene Fevrier ◽

Laura B. Amsden ◽

Amanda R. Doherty ◽

Lawrence W. Browne ◽

...

Keyword(s):

Colorectal Cancer ◽

Healthcare System ◽

Integrated Healthcare ◽

Serrated Polyps ◽

History Of ◽

Metachronous Colorectal Cancer

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Increased Risk of Colorectal Cancer in Individuals With a History of Serrated Polyps

Gastroenterology ◽

10.1053/j.gastro.2020.04.004 ◽

2020 ◽

Vol 159 (2) ◽

pp. 502-511.e2 ◽

Cited By ~ 2

Author(s):

Dan Li ◽

Liyan Liu ◽

Helene B. Fevrier ◽

Stacey E. Alexeeff ◽

Amanda R. Doherty ◽

...

Keyword(s):

Colorectal Cancer ◽

Serrated Polyps ◽

Increased Risk ◽

History Of

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The frequency of early colorectal cancer derived from sessile serrated adenoma/polyps among 1858 serrated polyps from a single institution

International Journal of Colorectal Disease ◽

10.1007/s00384-015-2416-2 ◽

2015 ◽

Vol 31 (2) ◽

pp. 343-349 ◽

Cited By ~ 13

Author(s):

A. Chino ◽

N. Yamamoto ◽

Y. Kato ◽

K. Morishige ◽

H. Ishikawa ◽

...

Keyword(s):

Colorectal Cancer ◽

Early Colorectal Cancer ◽

Single Institution ◽

Sessile Serrated Adenoma ◽

Serrated Adenoma ◽

Serrated Polyps

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Fecal DNA Testing for Colorectal Cancer Screening

Annual Review of Medicine ◽

10.1146/annurev-med-103018-123125 ◽

2020 ◽

Vol 71 (1) ◽

pp. 59-69 ◽

Cited By ~ 5

Author(s):

John M. Carethers

Keyword(s):

Colorectal Cancer ◽

Average Risk ◽

Fecal Dna ◽

Polyp Detection ◽

Serrated Polyps ◽

Crc Screening ◽

Epigenetic Biomarkers ◽

Life Years ◽

Screening Strategies ◽

Stool Dna

Fecal (or stool) DNA examination is a noninvasive strategy recommended by several medical professional societies for colorectal cancer (CRC) screening in average-risk individuals. Fecal DNA tests assay stool for human DNA shed principally from the colon. Colonic lesions such as adenomatous and serrated polyps and cancers exfoliate cells containing neoplastically altered DNA that may be detected by sensitive assays that target specific genetic and epigenetic biomarkers to discriminate neoplastic lesions from non-neoplastic tissue. Cross-sectional validation studies confirmed initial case-control studies’ assessment of performance of an optimized multitarget stool DNA (mt-sDNA) test, leading to approval by the US Food and Drug Administration in 2014. Compared to colonoscopy, mt-sDNA showed sensitivity of 92% for detection of CRC, much higher than the 74% sensitivity of another recommended noninvasive strategy, fecal immunochemical testing (FIT). Detections of advanced adenomas and sessile serrated polyps were higher with mt-sDNA than FIT (42% versus 24% and 42% versus 5%, respectively), but overall specificity for all lesions was lower (87% versus 95%). The mt-sDNA test increases patient life-years gained in CRC screening simulations, but its cost relative to other screening strategies needs to be reduced by 80–90% or its sensitivity for polyp detection enhanced to be cost effective. Noninvasive CRC screening strategies such as fecal DNA, however, have the potential to significantly increase national screening rates due to their noninvasive nature and convenience for patients.

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Oncogene Mutations in Colorectal Polyps Identified in the Norwegian Colorectal Cancer Prevention (NORCCAP) Screening Study

Clinical Medicine Insights Pathology ◽

10.4137/cpath.s40143 ◽

2016 ◽

Vol 9 ◽

pp. CPath.S40143 ◽

Cited By ~ 8

Author(s):

Jon A. Lorentzen ◽

Krzysztof Grzyb ◽

Paula M. De Angelis ◽

Geir Hoff ◽

Tor J. Eide ◽

...

Keyword(s):

Colorectal Cancer ◽

De Novo ◽

Population Based ◽

Colorectal Polyps ◽

Braf Mutations ◽

Kras Mutations ◽

Serrated Polyps ◽

Screening Study ◽

Colorectal Cancer Prevention ◽

Mutation Spectra

Data are limited on oncogene mutation frequencies in polyps from principally asymptomatic participants of population-based colorectal cancer screening studies. In this study, DNA from 204 polyps, 5 mm or larger, were collected from 176 participants of the NORCCAP screening study and analyzed for mutations in KRAS, BRAF, and PIK3CA including the rarely studied KRAS exons 3 and 4 mutations. KRAS mutations were identified in 23.0% of the lesions and were significantly associated with tubulovillous adenomas and large size. A significantly higher frequency of KRAS mutations in females was associated with mutations in codon 12. The KRAS exon 3 and 4 mutations constituted 23.4% of the KRAS positive lesions, which is a larger proportion compared to previous observations in colorectal cancer. BRAF mutations were identified in 11.3% and were associated with serrated polyps. None of the individuals were diagnosed with de novo or recurrent colorectal cancer during the follow-up time (median 11.2 years). Revealing differences in mutation-spectra according to gender and stages in tumorigenesis might be important for optimal use of oncogenes as therapeutic targets and biomarkers.

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