Elsevier

Gastrointestinal Endoscopy

Volume 76, Issue 5, November 2012, Pages 1003-1008
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
Pathological reassessment of hyperplastic colon polyps in a city-wide pathology practice: implications for polyp surveillance recommendations

https://doi.org/10.1016/j.gie.2012.07.026Get rights and content

Background

Sessile serrated adenomas (SSAs) and hyperplastic polyps (HP) are the two most common types of serrated colon polyps (SCPs). SSAs are suspected to be the precursor lesions for many colorectal cancers, and hence there is an emphasis on their detection and removal. On the other hand, recent guidelines such as those from the European Union consider HPs of limited clinical significance.

Objective

Evaluate the reclassification rate of recently diagnosed HPs to SSAs and the predictors of such reclassification.

Design, Setting, Intervention, Main Outcome Measurements

The provincial pathology database was searched for all colon polyps reported in the 6 pathology laboratories in the city of Winnipeg in 2009. All retrieved pathology slides for previously reported right-sided HPs and a 20% random sample of left-sided HPs were reassessed by two pathologists with a special interest in GI pathology. Polyp size, colon location, and age and sex of the study participants were evaluated as potential predictors of reclassification.

Results

A total of 4096 pathology reports by 25 different pathologists were reviewed. Twenty percent of the polyps were reported as SCPs. Seventeen percent of right-sided previously reported HPs and 20% of those >5 mm were reclassified as SSAs. Size >5 mm (odds ratio [OR] 4.2; 95% confidence interval [CI], 1.5-11.4) and location in the right side of the colon (OR 4.7; 95% CI, 1.4-15.4) were independent predictors of reclassification.

Limitations

Retrospective review.

Conclusion

A significant proportion of recently reported right-sided HPs may be SSAs. Surveillance recommendations for SCPs should consider the size and location of SCPs and not just the reported type.

Section snippets

Methods

Manitoba is a central Canadian province with a population of approximately 1.2 million. The pathology laboratories in the province are located in the cities of Winnipeg and Brandon, with most of the specimen processing and reporting done in Winnipeg (the largest city in Manitoba, with 56% of the provincial population). Diagnostic Services of Manitoba (DSM) administers all the pathology laboratories in the city of Winnipeg. DSM maintains an archive of all pathology reports from the city in the

Results

A total of 4096 pathology reports of colon polyps reported by 25 different pathologists were reviewed. Overall, approximately 20% of the colon polyps were reported to be some form of SCP (Table 2). The most common SCPs were left-sided HPs (516/876; 59%), followed by right-sided HPs (14%) (Table 2). However, right-sided HPs, with no concomitant other types of SCPs or traditional adenomatous polyps constituted a small minority (3%) of all colon polyp reports.

Slides could be retrieved for 114 of

Discussion

In this study, approximately one-fifth of the previously reported HPs in the right side of the colon and those >5 mm in size were reclassified as SSAs on reassessment by two pathologists with special interest in GI pathology. Polyp size and site of the polyp in the colon were independent predictors of reclassification.

Over the last decade, the serrated polyp pathway has been recognized as an important pathway for colorectal carcinogenesis, particularly for CRCs occurring in the right side of

References (19)

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Cited by (52)

  • Colorectal Cancer Screening for the Serrated Pathway

    2020, Gastrointestinal Endoscopy Clinics of North America
    Citation Excerpt :

    This rate combines important histology such as SSPs and TSAs with other factors such as HPs that are 5 mm or greater and located proximal to sigmoid or splenic flexure. Proximal location and larger size have been shown to be important factors in predicting an SSP histology in lesions that were previously diagnosed as HPs.68,69 Thus, this rate can account for potential misdiagnosed SSPs that have been incorrectly labeled as HPs.

  • Terminology, Molecular Features, Epidemiology, and Management of Serrated Colorectal Neoplasia

    2019, Gastroenterology
    Citation Excerpt :

    One study during this time period reviewed more than 1400 HPs, and reclassified 6% of HPs as SSLs.16 After SSLs (then called SSA/Ps) were included in the WHO classification of 2010, 8%–19% of HPs were reclassified as SSLs.17–19 When only larger HPs were taken into account, the proportion of reclassified HPs was as high as 28%.20,21

  • Colorectal Cancer Screening and Surveillance

    2019, Clinical Gastrointestinal Endoscopy
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DISCLOSURE: H. Singh's work is supported in part by an American College of Gastroenterology junior faculty development grant. No other financial relationships relevant to this publication were disclosed.

If you would like to chat with an author of this article, you may contact Dr Singh at [email protected].

See CME section; p. 1020.

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