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Clinical and endoscopic evaluations of sessile serrated adenoma/polyps with cytological dysplasia
Author(s) -
Sano Wataru,
Fujimori Takahiro,
Ichikawa Kazuhito,
Sunakawa Hironori,
Utsumi Takahiro,
Iwatate Mineo,
Hasuike Noriaki,
Hattori Santa,
Kosaka Hidekazu,
Sano Yasushi
Publication year - 2018
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14099
Subject(s) - medicine , dysplasia , colonoscopy , gastroenterology , adenoma , lesion , nodule (geology) , predictive value , pathology , colorectal cancer , cancer , paleontology , biology
Background and Aim Although sessile serrated adenoma/polyps (SSA/Ps) are considered to be premalignant lesions and rapidly progress to carcinomas after they develop cytological dysplasia (CD), a treatment strategy for SSA/Ps in Asian countries is still being debated and has not yet been established. The present study aimed to propose a treatment strategy for SSA/Ps. Methods Histopathological data of patients, who underwent colonoscopy at our center between January 2011 and December 2016, were reviewed. Data of patients with ≥ 1 SSA/P were retrieved, and clinicopathological characteristics were retrospectively analyzed. Results A total of 281 patients with 326 SSA/Ps, including 258 patients who had 300 SSA/Ps without CD (SSA/Ps‐CD[−]) and 23 patients who had 26 SSA/Ps with CD (SSA/Ps‐CD[+]), were evaluated in this study. Although SSA/Ps‐CD(+) were often found in older female patients and in the proximal colon, there were no significant differences between SSA/Ps‐CD(−) and SSA/Ps‐CD(+). Endoscopic morphological findings, such as large or small nodules on the surface and partial protrusion of the lesions, were significantly more common in SSA/Ps‐CD(+) than in SSA/Ps‐CD(−). Although the diagnostic ability of nodule/protrusion in lesions to predict CD within SSA/Ps was very high with an accuracy of 93.9% and a negative predictive value of 95.4%, sensitivity was low at 46.2%. SSA/Ps‐CD(+) were significantly larger than SSA/Ps‐CD(−), and the rate of CD within SSA/Ps significantly increased with lesion size (≤ 5 mm, 0%; 6–9 mm, 6.0%; ≥ 10 mm, 13.6%). Conclusion The study proposes removing all SSA/Ps ≥ 6 mm in order to remove high‐risk SSA/Ps‐CD(+), with high sensitivity.