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Calibrating Histopathology Image Classifiers Using Label Smoothing. Artif Intell Med 2022. [DOI: 10.1007/978-3-031-09342-5_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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2
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Shiu SI, Kashida H, Komeda Y. The prevalence of sessile serrated lesion in the colorectum and its relationship to synchronous colorectal advanced neoplasia: a systemic review and meta-analysis. Eur J Gastroenterol Hepatol 2021; 33:1495-1504. [PMID: 33470706 PMCID: PMC8555953 DOI: 10.1097/meg.0000000000002062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/18/2020] [Indexed: 12/10/2022]
Abstract
BACKGROUND The aim of this systemic review and meta-analysis was to evaluate the prevalence of sessile serrated lesion (SSL) and its relationship to synchronous colorectal advanced neoplasia. MATERIALS AND METHODS Comprehensive, computerized research was performed on PubMed and published from 1 January 2010 to 6 July 2018 which searched relevant articles without any language limitations. Clinical trials were included in the narrative systemic review if they matched the following inclusion criteria: (1) published as a case-controlled study, cohort study or cross-sectional study; (2) defined objectively for diagnosis of SSL within the studies; (3) addressed the prevalence and characteristics of SSL. Within these trials, if they met additional criteria involving the reported outcome of risk regarding advanced neoplasia in relation to SSL, they were enrolled into meta-analysis. RESULTS Forty-one trials were enrolled for the systematic review, with a total of eight analyzed for the meta-analysis. The prevalence of all SSL ranged from 0.038 to 20.23% and the prevalence by pooled analysis was 2.7%. In a subgroup analysis, the overall prevalence of SSL during the periods of 2010-2014 and 2015-2018 was shown to be 2.7 and 2.8%, respectively. We calculated the pooled data on the cancer risk of SSL and the risk of synchronous advanced neoplasia in patients with SSL made available from the eight trials, which resulted in a pooled odds ratio of 3.53 (95% confidence interval 2.39-5.20, I2 = 4%, P = 0.40). CONCLUSION In this systemic review, SSL was found to be associated with an increased risk of synchronous advanced neoplasia in the colorectum.
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Affiliation(s)
- Sz-Iuan Shiu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital
- Department of Critical Care Medicine, Taichung Veterans General Hospital
- Evidence-based Practice and Policymaking Committee, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hiroshi Kashida
- Department of Gastroenterology and Hepatology, Kindai University, Osakasayama, Japan
| | - Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Kindai University, Osakasayama, Japan
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Bonert M, Collins A, Xenodemetropoulos T, Dmetrichuk JM, Al-Haddad S, Major P, Naqvi A. Application of Next Generation Quality/Statistical Process Control and Expert-Led Case Review to Increase the Consistency of Diagnostic Rates in Precancerous Colorectal Polyps. Qual Manag Health Care 2021; 30:176-183. [PMID: 33405466 PMCID: PMC8219089 DOI: 10.1097/qmh.0000000000000299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Prior work suggests high interrater variability in the pathologist diagnostic rate (PDR) of the precancerous polyp sessile serrated adenoma (SSA). OBJECTIVES To improve the diagnostic consistency in the pathological evaluation of colorectal polyp specimens with diagnostic rate awareness, using funnel plots (FPs)/control charts (CCs), and a focused group case review. METHODS All colorectal polyp specimen (CRPS) reports September 2015 to August 2017 were analyzed at one institution. PDRs were extracted using a hierarchical free-text string matching algorithm and visualized using FPs, showing pathologist specimen volume versus PDR, and CCs, showing pathologist versus normed PDR. The FPs/CCs were centered on the group median diagnostic rate (GMDR). Pathologists were shown their baseline SSA diagnostic rate in relation to the practice, and in January 2017, there was a focused group case review/open discussion of approximately 40 sequential cases signed as SSA with a gastrointestinal pathology expert. RESULTS Nine pathologists interpreted more than 250 CRPSs per year. FPs/CCs for the first and second years showed 6/4 and 3/1 P < .05/P < .001 pathologist outliers, respectively, in relation to the GMDR for SSA and 0/0 and 0/0 P < .05/P < .001 pathologist outliers, respectively, in relation to the GMDR for tubular adenoma (TA). An in silico kappa (ISK) for SSA improved from 0.52 to 0.62. CONCLUSION Diagnostic rate awareness facilitated by FPs/CCs coupled with focused expert-led reviews may help calibrate PDR. Variation in SSA PDRs still remains high in relation to TA. ISK represents an intuitive, useful metric and Next Generation Quality/Statistical Process Control a promising approach for objectively increasing diagnostic consistency.
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Affiliation(s)
- Michael Bonert
- Departments of Pathology and Molecular Medicine (Drs Bonert, Dmetrichuk, Al-Haddad, and Naqvi), Medicine (Dr Collins), and Oncology (Dr Major), McMaster University, Hamilton, Ontario, Canada; St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada (Drs Bonert and Naqvi); Farncombe Family Digestive Health Research Institute/Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (Dr Xenodemetropoulos); and Juravinski Hospital/Hamilton Health Sciences Centre/Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (Ms Al-Haddad and Dr Major)
| | - Andrew Collins
- Departments of Pathology and Molecular Medicine (Drs Bonert, Dmetrichuk, Al-Haddad, and Naqvi), Medicine (Dr Collins), and Oncology (Dr Major), McMaster University, Hamilton, Ontario, Canada; St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada (Drs Bonert and Naqvi); Farncombe Family Digestive Health Research Institute/Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (Dr Xenodemetropoulos); and Juravinski Hospital/Hamilton Health Sciences Centre/Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (Ms Al-Haddad and Dr Major)
| | - Ted Xenodemetropoulos
- Departments of Pathology and Molecular Medicine (Drs Bonert, Dmetrichuk, Al-Haddad, and Naqvi), Medicine (Dr Collins), and Oncology (Dr Major), McMaster University, Hamilton, Ontario, Canada; St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada (Drs Bonert and Naqvi); Farncombe Family Digestive Health Research Institute/Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (Dr Xenodemetropoulos); and Juravinski Hospital/Hamilton Health Sciences Centre/Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (Ms Al-Haddad and Dr Major)
| | - Jennifer M. Dmetrichuk
- Departments of Pathology and Molecular Medicine (Drs Bonert, Dmetrichuk, Al-Haddad, and Naqvi), Medicine (Dr Collins), and Oncology (Dr Major), McMaster University, Hamilton, Ontario, Canada; St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada (Drs Bonert and Naqvi); Farncombe Family Digestive Health Research Institute/Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (Dr Xenodemetropoulos); and Juravinski Hospital/Hamilton Health Sciences Centre/Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (Ms Al-Haddad and Dr Major)
| | - Sahar Al-Haddad
- Departments of Pathology and Molecular Medicine (Drs Bonert, Dmetrichuk, Al-Haddad, and Naqvi), Medicine (Dr Collins), and Oncology (Dr Major), McMaster University, Hamilton, Ontario, Canada; St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada (Drs Bonert and Naqvi); Farncombe Family Digestive Health Research Institute/Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (Dr Xenodemetropoulos); and Juravinski Hospital/Hamilton Health Sciences Centre/Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (Ms Al-Haddad and Dr Major)
| | - Pierre Major
- Departments of Pathology and Molecular Medicine (Drs Bonert, Dmetrichuk, Al-Haddad, and Naqvi), Medicine (Dr Collins), and Oncology (Dr Major), McMaster University, Hamilton, Ontario, Canada; St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada (Drs Bonert and Naqvi); Farncombe Family Digestive Health Research Institute/Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (Dr Xenodemetropoulos); and Juravinski Hospital/Hamilton Health Sciences Centre/Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (Ms Al-Haddad and Dr Major)
| | - Asghar Naqvi
- Departments of Pathology and Molecular Medicine (Drs Bonert, Dmetrichuk, Al-Haddad, and Naqvi), Medicine (Dr Collins), and Oncology (Dr Major), McMaster University, Hamilton, Ontario, Canada; St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada (Drs Bonert and Naqvi); Farncombe Family Digestive Health Research Institute/Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (Dr Xenodemetropoulos); and Juravinski Hospital/Hamilton Health Sciences Centre/Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (Ms Al-Haddad and Dr Major)
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4
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Interobserver variability in histological diagnosis of serrated colorectal polyps. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2015.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Abstract
Objectives To compare the interobserver variability in the diagnostic of serrated and non-serrated adenomatous lesions and hyperplastic polyps of colon between two groups of pathologists.
Methods 310 colorectal polyps were studied, with histological diagnoses established by a group of pathologists comprising three general pathologists for initial diagnosis, and two gastrointestinal pathologists for expert diagnosis.
Results High interobserver variability was observed in the diagnosis of serrated polyps, when comparing the initial diagnosis with the expert diagnosis (kappa = 0.102). For the majority of both traditional serrated adenomas and sessile serrated adenomas (27/31), a diagnosis of hyperplastic polyps was established at the initial diagnosis.
Conclusions Poor agreement was observed in the diagnosis of serrated polyps between the two groups of pathologists. The accuracy in the diagnosis of these lesions is essential for the prevention of colorectal cancer.
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5
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Marra G. An "expressionistic" look at serrated precancerous colorectal lesions. Diagn Pathol 2021; 16:4. [PMID: 33423702 PMCID: PMC7797135 DOI: 10.1186/s13000-020-01064-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/27/2020] [Indexed: 01/10/2023] Open
Abstract
Background Approximately 60% of colorectal cancer (CRC) precursor lesions are the genuinely-dysplastic conventional adenomas (cADNs). The others include hyperplastic polyps (HPs), sessile serrated lesions (SSL), and traditional serrated adenomas (TSAs), subtypes of a class of lesions collectively referred to as “serrated.” Endoscopic and histologic differentiation between cADNs and serrated lesions, and between serrated lesion subtypes can be difficult. Methods We used in situ hybridization to verify the expression patterns in CRC precursors of 21 RNA molecules that appear to be promising differentiation markers on the basis of previous RNA sequencing studies. Results SSLs could be clearly differentiated from cADNs by the expression patterns of 9 of the 12 RNAs tested for this purpose (VSIG1, ANXA10, ACHE, SEMG1, AQP5, LINC00520, ZIC5/2, FOXD1, NKD1). Expression patterns of all 9 in HPs were similar to those in SSLs. Nine putatively HP-specific RNAs were also investigated, but none could be confirmed as such: most (e.g., HOXD13 and HOXB13), proved instead to be markers of the normal mucosa in the distal colon and rectum, where most HPs arise. TSAs displayed mixed staining patterns reflecting the presence of serrated and dysplastic glands in the same lesion. Conclusions Using a robust in situ hybridization protocol, we identified promising tissue-staining markers that, if validated in larger series of lesions, could facilitate more precise histologic classification of CRC precursors and, consequently, more tailored clinical follow-up of their carriers. Our findings should also fuel functional studies on the pathogenic significance of specific gene expression alterations in the initiation and evolution of CRC precursor subtypes. Supplementary Information The online version contains supplementary material available at 10.1186/s13000-020-01064-1.
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Affiliation(s)
- Giancarlo Marra
- Institute of Molecular Cancer Research, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.
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A Petri Dish for Histopathology Image Analysis. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-77211-6_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Booth AL, Taggart MW, Ono Y, Gonzalez RS. From Mixed Hyperplastic/Adenomatous Polyp to Sessile Serrated Lesion: A Long and Winding Road for Long and Winding Crypts. Arch Pathol Lab Med 2020; 145:1289-1296. [PMID: 33351878 DOI: 10.5858/arpa.2020-0591-ra] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— During the past 3 decades, numerous articles in the literature have offered terminology, diagnostic criteria, and consensus recommendations regarding the entity currently referred to by the World Health Organization as sessile serrated lesion. Given the many names and various, variably reproducible diagnostic criteria ascribed to sessile serrated lesion, confusion persists for many pathologists and gastroenterologists regarding the diagnosis. This distinction is important, as sessile serrated lesion can progress to malignancy, unlike its main differential diagnosis, hyperplastic polyp. Research studies have shed light on the characteristic architecture and morphology, immunohistochemical patterns, and molecular alterations of sessile serrated lesion, and multiple consensus meetings around the globe have developed their criteria and nomenclature, often clashing or mixing terms. OBJECTIVE.— To provide a narrative review from the entity's early description to our current understanding. DATA SOURCES.— The existing scientific and clinical literature, published texts, medical society recommendations, and specialty consensus guidelines. CONCLUSIONS.— The current World Health Organization criteria are a distillation of this scientific process, but terminology is still a point of contention worldwide.
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Affiliation(s)
- Adam L Booth
- From the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Booth, Ono, Gonzalez)
| | - Melissa W Taggart
- The Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas M.D. Anderson Cancer Center, Houston (Taggart)
| | - Yuho Ono
- From the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Booth, Ono, Gonzalez)
| | - Raul S Gonzalez
- From the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Booth, Ono, Gonzalez)
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Kolb JM, Molmenti CL, Patel SG, Lieberman DA, Ahnen DJ. Increased Risk of Colorectal Cancer Tied to Advanced Colorectal Polyps: An Untapped Opportunity to Screen First-Degree Relatives and Decrease Cancer Burden. Am J Gastroenterol 2020; 115:980-988. [PMID: 32618646 PMCID: PMC9351033 DOI: 10.14309/ajg.0000000000000639] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Advanced adenomas represent a subset of colorectal polyps that are known to confer an increased risk of colorectal neoplasia to the affected individual and their first-degree relatives (FDRs). Accordingly, professional guidelines suggest earlier and more intensive screening for FDRs of those with advanced adenomas similar to FDRs of those with colorectal cancer (CRC). Although the risk to family members is less clear among patients with advanced serrated polyps, they are often considered in the same category. Unfortunately, there is a growing concern that patients, endoscopists, and primary care providers are unaware of the familial risk associated with these polyps, leaving a wide gap in screening these high-risk individuals. Herein, we propose a standardized language around advanced colorectal polyps and present a detailed review of the literature on associated familial risk. We outline the challenges to implementing the current screening recommendations and suggest approaches to overcome these limitations, including a proposed new colonoscopy quality metric to capture communication of familial CRC risk. Improving screening in these high-risk groups has the potential to substantially reduce the burden of CRC.
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Affiliation(s)
- Jennifer M. Kolb
- Division of Gastroenterology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christine L. Molmenti
- Department of Occupational, Medicine, Epidemiology, and Prevention, Center for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Hofstra/Northwell School of Medicine, Northwell Health, Manhasset, New York, USA
| | - Swati G. Patel
- Division of Gastroenterology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - David A. Lieberman
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon, USA
- Portland Veterans Affairs Medical Center, Portland, Oregon, USA
| | - Dennis J. Ahnen
- Division of Gastroenterology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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9
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Rickelt S, Condon C, Mana M, Whittaker C, Pfirschke C, Roper J, Patil DT, Brown I, Mattia AR, Zukerberg L, Zhao Q, Chetty R, Lauwers GY, Neyaz A, Leijssen LGJ, Boylan K, Yilmaz OH, Deshpande V, Hynes RO. Agrin in the Muscularis Mucosa Serves as a Biomarker Distinguishing Hyperplastic Polyps from Sessile Serrated Lesions. Clin Cancer Res 2020; 26:1277-1287. [PMID: 31852835 PMCID: PMC7073301 DOI: 10.1158/1078-0432.ccr-19-2898] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/25/2019] [Accepted: 12/12/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Sessile serrated lesions (SSL) are precursors to colon carcinoma, and their distinction from other polyps, in particular hyperplastic polyps (HP), presents significant diagnostic challenges. We evaluated expression patterns in colonic polyps of previously identified colon carcinoma-associated extracellular matrix (ECM) proteins to identify markers distinguishing SSLs from other polyps. EXPERIMENTAL DESIGN Gene-expression analyses of ECM proteins were performed using publicly available data on preneoplastic colonic polyps. In parallel, we evaluated by IHC the expression of agrin (AGRN) in over 400 colonic polyps, including HP, SSL with and without dysplasia, traditional serrated adenomas (TSA), and tubular adenomas (TA), and compared the consistency of standard histologic diagnosis of SSLs by experienced gastrointestinal pathologists with that of AGRN IHC. RESULTS Differential gene expression analysis and IHC identified AGRN, serine peptidase inhibitor (SERPINE2), and TIMP metallopeptidase inhibitor 1 (TIMP1) elevated in SSLs and HPs but decreased in TAs and absent in normal colon. AGRN-positive basal laminae were noted in all TA, TSA, HP, and SSL in distinguishable patterns, whereas other polyps and normal mucosa were negative. SSL with or without dysplasia consistently showed IHC staining for AGRN in the muscularis mucosae, which was absent in HP, TSA, TA, and other polyps. In contrast, histologic evaluation showed only weak interobserver agreement (kappa value = 0.493) in distinguishing SSLs. CONCLUSIONS Muscularis mucosae-based AGRN immunostaining is a novel biomarker to distinguish SSL from HP, TSA, and TA, with a specificity of 97.1% and sensitivity of 98.9% and can assist in diagnosis of morphologically challenging colonic polyps.
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Affiliation(s)
- Steffen Rickelt
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts.
| | - Charlene Condon
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Swanson Biotechnology Center, David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Miyeko Mana
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Charlie Whittaker
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Swanson Biotechnology Center, David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Christina Pfirschke
- Center for Systems Biology, Massachusetts General Hospital Research Institute, Harvard Medical School, Boston, Massachusetts
| | - Jatin Roper
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Deepa T Patil
- Cleveland Clinic, Department of Pathology, Cleveland, Ohio
| | - Ian Brown
- Envoi Pathology, Kelvin Grove, Queensland, Australia
| | - Anthony R Mattia
- Department of Pathology, North Shore Medical Center, Salem, Massachusetts
| | - Lawrence Zukerberg
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Qing Zhao
- Department of Pathology and Laboratory Medicine, Boston University Medical Center, Boston, Massachusetts
| | - Runjan Chetty
- Department of Pathology, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Azfar Neyaz
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Lieve G J Leijssen
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Katherine Boylan
- Department of Pathology, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Omer H Yilmaz
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Vikram Deshpande
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Richard O Hynes
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts.
- Howard Hughes Medical Institute, Chevy Chase, Maryland
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts
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10
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Biller LH, Ukaegbu C, Dhingra TG, Burke CA, Chertock Y, Chittenden A, Church JM, Koeppe ES, Leach BH, Levinson E, Lim RM, Lutz M, Salo-Mullen E, Sheikh R, Idos G, Kastrinos F, Stoffel E, Weiss JM, Hall MJ, Kalady MF, Stadler ZK, Syngal S, Yurgelun MB. A Multi-Institutional Cohort of Therapy-Associated Polyposis in Childhood and Young Adulthood Cancer Survivors. Cancer Prev Res (Phila) 2020; 13:291-298. [PMID: 32051178 DOI: 10.1158/1940-6207.capr-19-0416] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/10/2019] [Accepted: 01/09/2020] [Indexed: 12/30/2022]
Abstract
Prior small reports have postulated a link between gastrointestinal polyposis and childhood and young adulthood cancer (CYAC) treatment (therapy-associated polyposis; TAP), but this remains a poorly understood phenomenon. The aim of this study was to describe the phenotypic spectrum of TAP in a multi-institutional cohort. TAP cases were identified from eight high-risk cancer centers. Cases were defined as patients with ≥10 gastrointestinal polyps without known causative germline alteration or hereditary colorectal cancer predisposition syndrome who had a history of prior treatment with chemotherapy and/or radiotherapy for CYAC. A total of 34 TAP cases were included (original CYAC: 27 Hodgkin lymphoma, three neuroblastoma, one acute myeloid leukemia, one medulloblastoma, one nephroblastoma, and one non-Hodgkin lymphoma). Gastrointestinal polyposis was first detected at a median of 27 years (interquartile range, 20-33) after CYAC treatment. A total of 12 of 34 (35%) TAP cases had ≥50 colorectal polyps. A total of 32 of 34 (94%) had >1 histologic polyp type. A total of 25 of 34 (74%) had clinical features suggestive of ≥1 colorectal cancer predisposition syndrome [e.g., attenuated familial adenomatous polyposis (FAP), serrated polyposis syndrome, extracolonic manifestations of FAP, mismatch repair-deficient colorectal cancer, or hamartomatous polyposis] including 8 of 34 (24%) with features of multiple such syndromes. TAP is an apparently acquired phenomenon that should be considered in patients who develop significant polyposis without known causative germline alteration but who have had prior treatment for a CYAC. Patients with TAP have features that may mimic various hereditary colorectal cancer syndromes, suggesting multiple concurrent biologic mechanisms, and recognition of this diagnosis may have implications for cancer risk and screening.
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Affiliation(s)
- Leah H Biller
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | | | - Ramona M Lim
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Megan Lutz
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Rania Sheikh
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory Idos
- University of Southern California, Los Angeles, California
| | | | | | - Jennifer M Weiss
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | | | - Sapna Syngal
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew B Yurgelun
- Dana-Farber Cancer Institute, Boston, Massachusetts. .,Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
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11
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Intraobserver and Interobserver Variability in the Assessment of Dysplasia in Ampullary Mucosal Biopsies. Am J Surg Pathol 2019; 42:1095-1100. [PMID: 29738360 DOI: 10.1097/pas.0000000000001079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Endoscopic mucosal biopsies of the ampulla of Vater (AmpBx) are obtained to histologically assess for dysplasia or carcinoma. However, biopsy material is often scant and a host of factors can induce histologic changes that pose diagnostic challenges. We sought to investigate observer variability in interpretation of AmpBx and the impact clinical data may have on diagnostic interpretation. Thirty-one cases from institutional archives were selected, including 12 cases of reactive atypia (RA), 8 indefinite for dysplasia (ID), and 11 showing low-grade dysplasia (LGD). Slides were independently reviewed at 3 time points with and without clinical information by 6 pathologists who categorized the biopsies RA, ID, or LGD. Following the reviews, intraobserver and interobserver agreement was assessed. Review of AmpBx without clinical data showed fair (κ, 0.27), poor (κ, 0.07), and good (κ, 0.42) interobserver agreement for diagnoses of RA, ID, and LGD, respectively. Interobserver agreement improved for LGD (κ, 0.66 and 0.73) when clinical information was provided; however, agreement remained fair for RA (κ, 0.4 and 0.42) and poor-to-fair for ID (κ, 0.17 and 0.25). When follow-up data were reviewed, all cases that reached unanimous agreement had that diagnosis substantiated by subsequent endoscopic or histologic findings. The same was true of 13 of 19 cases that reached majority consensus. Given the potential clinical consequences of these diagnoses combined with the significant intraobserver and interobserver variability found in this study, we conclude that better-defined diagnostic criteria and consensus reads on difficult cases would assist in the histologic assessment of these challenging cases.
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12
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Kashida H. Endoscopic diagnosis of sessile serrated polyp: A systematic review. Dig Endosc 2019; 31:16-23. [PMID: 30151942 PMCID: PMC7379725 DOI: 10.1111/den.13263] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/22/2018] [Indexed: 12/14/2022]
Abstract
The aim of the present review was to clarify how we should detect and diagnose sessile serrated polyps (SSP) endoscopically. A systematic search was conducted of MEDLINE from January 2004 through March 2018. Nine findings: (i) proximal location; (ii) size >10 mm; (iii) irregular shape; (iv) indistinctive border; (v) cloud-like surface; (vi) mucus cap; (vii) rim of debris in white-light endoscopy; (viii) dilated vessels; and (ix) dilated crypts (pits) in image-enhanced endoscopy were considered to be candidate discriminators of SSP from hyperplastic polyps. Prospective studies in a general setting are warranted to validate the above-mentioned endoscopic features of SSP during real-time colonoscopy and to determine whether these features are useful for the differential diagnosis of SSP.
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Affiliation(s)
- Hiroshi Kashida
- Department of Gastroenterology and HepatologyKindai UniversityOsakaJapan
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Anderson JC, Calderwood AH, Christensen BC, Robinson CM, Amos CI, Butterly L. Smoking and Other Risk Factors in Individuals With Synchronous Conventional High-Risk Adenomas and Clinically Significant Serrated Polyps. Am J Gastroenterol 2018; 113:1828-1835. [PMID: 30385834 PMCID: PMC6768665 DOI: 10.1038/s41395-018-0393-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Serrated polyps (SPs) and conventional high-risk adenomas (HRAs) derive from two distinct biological pathways but can also occur synchronously. Adults with synchronous SPs and adenomas have been shown to be a high-risk group and may have a unique risk factor profile that differs from adults with conventional HRAs alone. We used the population-based New Hampshire Colonoscopy Registry (NHCR) to examine the risk profile of individuals with synchronous conventional HRAs and SPs. METHODS Our study population included 20,281 first time screening colonoscopies from asymptomatic NHCR participants 40 years or older between 2004-15. Exams were categorized by findings: (1) normal, (2) HRA only (adenomas ≥ 1 cm, villous, high grade dysplasia, multiple adenomas ( > 2) and adenocarcinoma), (3) clinically significant SP (CSSP) only (any hyperplastic polyp ≥ 1 cm, sessile serrated adenomas/polyps or traditional serrated adenomas), and (4) synchronous HRA + CSSP. Risk factors examined included exposure of interest, smoking (never, past, and current/pack years), as well as age, sex, alcohol, education, and family history of colorectal cancer (CRC). Multivariable unconditional logistic regression tested the relation of risk factors with having synchronous HRA + CSSP versus having a normal exam or HRA alone. RESULTS Among NHCR participants with 18,354 screening colonoscopies (with complete smoking, sex, bowel preparation data, and adequate preparation) there were 16,495 normal; 1309 HRA alone; 461 CSSP alone, and 89 synchronous HRA + CSSP. Current smoking was associated with an almost threefold increased risk for HRA or CSSP, and an eightfold risk for synchronous HRA + CSSP (aOR = 8.66; 95% CI: 4.73-15.86) compared to normal exams. Adults with synchronous HRA + CSSP were threefold more likely to be current smokers than those with HRA alone (aOR = 3.27; 95% CI:1.74-6.16). CONCLUSIONS Our data suggest that current smokers may be at a higher risk for synchronous CSSP + HRA even when compared to having HRA alone.
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Affiliation(s)
- Joseph C. Anderson
- 1Department of Veterans Affairs Medical Center, White River Junction, Hartford, VT, USA.,2The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Audrey H. Calderwood
- 2The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,3Section of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Brock C. Christensen
- 4Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Christopher I. Amos
- 4Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,5Baylor College of Medicine, Houston, TX, USA. Lynn Butterly is the senior author on the paper and the Director of the New Hampshire Colonoscopy Registry
| | - Lynn Butterly
- 2The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,3Section of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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14
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Carot L, Castells A, Hernández C, Alvarez-Urturi C, Balaguer F, Lanas A, Cubiella J, Tasende JD, Jover R, Hernandez V, Carballo F, Bujanda L, Quintero E, Andreu M, Bessa X. Detection of serrated lesions in proximal colon by simulated sigmoidoscopy vs faecal immunochemical testing in a multicentre, pragmatic, randomised controlled trial. United European Gastroenterol J 2018; 6:1527-1537. [PMID: 30574323 DOI: 10.1177/2050640618804722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/27/2018] [Indexed: 12/16/2022] Open
Abstract
Background The diagnostic yield of the faecal immunochemical test and sigmoidoscopy in detecting proximal serrated polyps in a colorectal cancer screening programme has not been fully assessed. Aim We determined the detection rate of proximal serrated polyps by simulated sigmoidoscopy and faecal immunochemical test compared with total colonoscopy in a population-based, multicentre, nationwide, randomised controlled trial (ColonPrev study). Methods Sigmoidoscopy yield was simulated based on the UK-Flexible Sigmoidoscopy Trial for total colonoscopy referral. Definitions were: proximal serrated polyp (proximal serrated polyp): sessile serrated polyp or hyperplastic polyp of any size and proximal at-risk serrated polyp (at-risk proximal serrated polyp): sessile serrated polyp of any size or hyperplastic polyp ≥ 10 mm, both located proximally to the splenic flexure. Results A total of 10,611 individuals underwent faecal immunochemical test and 5059 underwent total colonoscopy and were evaluated by simulated sigmoidoscopy. Sigmoidoscopy and faecal immunochemical test were less accurate in detecting proximal serrated polyps (odds ratio: 0.13; 95% confidence interval: 0.10-0.18 and 0.13; 0.09-0.18, p < 0.0001, respectively). Both tests were inferior to colonoscopy in detecting at-risk proximal serrated polyps, and sigmoidoscopy was inferior to faecal immunochemical test in detecting these lesions (odds ratio: 0.17; 95% confidence interval: 0.10-0.30 and 0.25; 0.17-0.37, p < 0.0001, respectively). Conclusion Sigmoidoscopy and faecal immunochemical test are less accurate in detecting proximal serrated polyps than colonoscopy, particularly in women.
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Affiliation(s)
- Laura Carot
- Gastroenterology Department, Hospital del Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Cristina Hernández
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain
| | - Cristina Alvarez-Urturi
- Gastroenterology Department, Hospital del Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Angel Lanas
- Gastroenterology Department, Hospital Clinico Universitario, Zaragoza, Spain
| | - Joaquín Cubiella
- Gastroenterology Department, Instituto de Investigación Biomédica Galicia Sur, Orense, Spain
| | - Jose D Tasende
- Gastroenterology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rodrigo Jover
- Gastroenterology Department, Hospital General Universitario, Alicante, Spain
| | - Vicent Hernandez
- Gastroenterology Department, Complexo Hospitalario Universitario, Vigo, Spain
| | - Fernando Carballo
- Unidad de Gestión Clínica de Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Luis Bujanda
- Gastroenterology Department, Donostia Hospital, San Sebastian, Spain
| | - Enrique Quintero
- Gastroenterology Department, Hospital Universitario La Laguna, Tenerife, Spain
| | - Montserrat Andreu
- Gastroenterology Department, Hospital del Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Xavier Bessa
- Gastroenterology Department, Hospital del Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
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15
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Factors Associated With Classification of Hyperplastic Polyps as Sessile Serrated Adenomas/Polyps on Morphologic Review. J Clin Gastroenterol 2018; 52:524-529. [PMID: 28723863 DOI: 10.1097/mcg.0000000000000840] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Distinguishing sessile serrated adenomas/polyp (SSA/P), a subset of serrated polyps, from hyperplastic polyps (HPs) remains a challenge and has surveillance implications. Our goal was to identify clinical and pathologic factors associated with serrated polyps originally read as HPs being reassessed as SSA/Ps versus confirmed as HPs. METHODS Data were collected from consecutive patients with a right-sided HP and a corresponding comparison group with conventional adenomas between 1993 and 2003. Two experienced gastrointestinal pathologists, blinded to polyp and clinical factors, reinterpreted the HPs using current SSA/P classification criteria. These HPs were classified as SSA/P when diagnostic histologic feature(s) were present in at least 3 crypts. Analyses, conducted on a per polyp basis, examined the factors associated with risk of individual HPs being reassessed as SSA/Ps as opposed to being confirmed as HPs. RESULTS Of the 702 HPs (355 adults), 188 (26.8%) were reclassified as SSA/Ps. Predictors of HPs being reinterpreted as SSA/Ps included: size ≥5 mm [odds ratio (OR), 2.09; 95% confidence interval (CI), 1.34-3.26], proximal location (OR, 2.83; 95% CI, 1.69-4.74), synchronous adenomas with advanced pathology (OR, 2.61; 95% CI, 1.22-5.55) and ≥1 synchronous HPs (other than HP being reassessed) reclassified as SSA/Ps (OR, 11.76; 95% CI, 6.75-20.49). CONCLUSIONS Because HP versus SSP is not very reproducible the predictors of SSA/P that we identified, including size, location, and synchronous lesions, can offer some additional help to endoscopists when determining surveillance intervals in patients with serrated polyps. In addition, observed association between SSA/P with advanced conventional neoplasia (but not low-grade adenomas) suggests 2 distinct groups of patient predisposition, one with both advanced conventional and important serrated precursors (SSA/P) and the other largely restricted to nonadvanced conventional adenomas and HPs only. Whether the association reported here has to do with SSA/P diagnosis per se or generally larger size of SSA/P remains to be determined in future studies.
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16
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Gourevitch RA, Rose S, Crockett SD, Morris M, Carrell DS, Greer JB, Pai RK, Schoen RE, Mehrotra A. Variation in Pathologist Classification of Colorectal Adenomas and Serrated Polyps. Am J Gastroenterol 2018; 113:431-439. [PMID: 29380819 PMCID: PMC6049074 DOI: 10.1038/ajg.2017.496] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/15/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Endoscopist quality measures such as adenoma detection rate (ADR) and serrated polyp detection rates (SPDRs) depend on pathologist classification of histology. Although variation in pathologic interpretation is recognized, we add to the literature by quantifying the impact of pathologic variability on endoscopist performance. METHODS We used natural language processing to abstract relevant data from colonoscopy and related pathology reports performed over 2 years at four clinical sites. We quantified each pathologist's likelihood of classifying polyp specimens as adenomas or serrated polyps. We estimated the impact on endoscopists' ADR and SPDR of sending their specimens to pathologists with higher or lower classification rates. RESULTS We observed 85,526 colonoscopies performed by 119 endoscopists; 50,453 had a polyp specimen, which were analyzed by 48 pathologists. There was greater variation across pathologists in classification of serrated polyps than in classification of adenomas. We estimate the endoscopist's average SPDR would be 0.5% if all their specimens were analyzed by the pathologist in our sample with the lowest classification rate and 12.0% if all their specimens were analyzed by the pathologist with the highest classification rate. In contrast, the endoscopist's average ADR would be 28.5% and 42.4% if their specimens were analyzed by the pathologist with lowest and highest classification rate, respectively. CONCLUSIONS There is significant variation in pathologic interpretation, which more substantially affects endoscopist SPDR than ADR.
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Affiliation(s)
| | | | - Seth D. Crockett
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Michele Morris
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA
| | - David S. Carrell
- Kaiser Permanente of Washington Health Research Institute (formerly Group Health Research Institute), Seattle, WA
| | - Julia B. Greer
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Reetesh K. Pai
- Department of Pathology, UPMC Presbyterian Hospital, Pittsburgh, PA
| | - Robert E. Schoen
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ateev Mehrotra
- Harvard Medical School, Boston MA
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA
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17
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Krishn SR, Kaur S, Sheinin YM, Smith LM, Gautam SK, Patel A, Jain M, Juvvigunta V, Pai P, Lazenby AJ, Roy HK, Batra SK. Mucins and associated O-glycans based immunoprofile for stratification of colorectal polyps: clinical implication for improved colon surveillance. Oncotarget 2018; 8:7025-7038. [PMID: 27705923 PMCID: PMC5351688 DOI: 10.18632/oncotarget.12347] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/20/2016] [Indexed: 12/23/2022] Open
Abstract
Sessile serrated adenoma/polyps (SSA/P) are premalignant lesions of colorectal cancer that are difficult to distinguish histologically from hyperplastic polyps (HP) of minimal to no malignant potential. Specific markers for differentiating SSA/P from HP can aid clinicians for optimizing colon surveillance intervals. The present study investigates the potential of mucins and associated O-glycans to distinguish SSA/P from HP. Expression of colonic mucins (MUC1, MUC4, MUC17, MUC2, and MUC5AC) and O-glycans [Sialyl LewisA (CA19-9) and Tn/Sialyl-Tn on MUC1] were analyzed in HP (n=33), SSA/P (n=39), and tubular adenoma (TA) (n=36) samples by immunohistochemistry. A significantly reduced expression of MUC4 (p=0.0066), elevated expression of MUC17 (p=0.0002), and MUC5AC (p<0.0001) was observed in SSA/P cases in comparison to HP cases. Interestingly, significantly higher number of SSA/P cases (p<0.0001) exhibited MUC5AC expression in the goblet cells as well as filled the crypt lumen compared to only goblet cells in majority of the HP cases. Improved diagnostic potential was revealed by multivariate logistic regression analysis where combinatorial panel of MUC5AC/MUC17 discriminated SSA/P from HP (SN/SP=85/82%). Finally, the decision tree model based marker panel (CA19-9/MUC17/MUC5AC) predicted HP, SSA/P and TA with SN/SP of 58%/95%, 79%/90% and 97%/83%, respectively. Overall, the mucin and associated O-glycan based panel defined in the present study could aid in discriminating SSA/P from HP to devise better colon surveillance strategies.
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Affiliation(s)
- Shiv Ram Krishn
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sukhwinder Kaur
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Yuri M Sheinin
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Lynette M Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shailendra K Gautam
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Asish Patel
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Maneesh Jain
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Vasthala Juvvigunta
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Priya Pai
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Audrey J Lazenby
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Hemant K Roy
- Department of Gastroenterology, Boston Medical Center, Boston, Massachusetts, USA
| | - Surinder K Batra
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Fred and Pamela Buffett Cancer Center, Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
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18
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Bettington M, Walker N, Rahman T, Vandeleur A, Whitehall V, Leggett B, Croese J. High prevalence of sessile serrated adenomas in contemporary outpatient colonoscopy practice. Intern Med J 2017; 47:318-323. [PMID: 27860102 DOI: 10.1111/imj.13329] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/02/2016] [Accepted: 11/05/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sessile serrated adenomas (SSA) are the polyp precursor of 15-20% of colorectal carcinomas. There is debate about their prevalence and increasing discussion about the need for a serrated polyp detection rate as a quality indicator for colonoscopy. AIMS To assess the prevalence of SSA at an outpatient gastroenterology service. METHODS This is a retrospective study of an unselected consecutive series of patients who had an outpatient colonoscopy between April 2013 and May 2014. The colonoscopy reports were reviewed to identify age, gender, indication for procedure, completion, withdrawal time, adequacy of bowel preparation, number, size and location of polyps. The pathology of all polyps was centrally reviewed by a gastrointestinal pathologist. RESULTS A total of 707 patients underwent colonoscopy within the study period. The mean age of the cohort was 58 years, and 50.6% were female. Polyp(s) were identified in 66.5% of patients. The SSA detection rate was 20.1%, and the adenoma detection rate was 48.0%. SSA detection was associated with longer withdrawal times. Conventional adenoma detection was associated with older age, male gender, longer withdrawal time and a positive faecal occult blood test result. CONCLUSION SSA are highly prevalent in an unselected series of patients attending a gastroenterology outpatient department. Identifying and removing these polyps may help prevent interval colorectal carcinoma. This result may serve as a benchmark for a high-quality colonoscopy service.
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Affiliation(s)
- Mark Bettington
- Department of Anatomical Pathology, Envoi Specialist Pathologists, Brisbane, Queensland, Australia.,The Conjoint Gastroenterology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Neal Walker
- Department of Anatomical Pathology, Envoi Specialist Pathologists, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Tony Rahman
- Department of Gastroenterology and Hepatology, The Prince Charles Hospital, Brisbane, Queensland, Australia.,The Centre for Biodiscovery and Molecular Development of Therapeutics, James Cook University, Cairns, Queensland, Australia
| | - Ann Vandeleur
- Department of Gastroenterology and Hepatology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Vicki Whitehall
- The Conjoint Gastroenterology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Chemical Pathology, Pathology Queensland, Brisbane, Queensland, Australia
| | - Barbara Leggett
- The Conjoint Gastroenterology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Gastroenterology and Hepatology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - John Croese
- Department of Gastroenterology and Hepatology, The Prince Charles Hospital, Brisbane, Queensland, Australia.,The Centre for Biodiscovery and Molecular Development of Therapeutics, James Cook University, Cairns, Queensland, Australia
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19
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De Maio G, Zama E, Rengucci C, Calistri D. What influences preneoplastic colorectal lesion recurrence? Oncotarget 2017; 8:12406-12416. [PMID: 27902488 PMCID: PMC5355354 DOI: 10.18632/oncotarget.13628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/15/2016] [Indexed: 12/16/2022] Open
Abstract
The hypothesis of the local recurrence of preneoplastic lesions was first put forward in the 1950s. Disease recurrence may result from an inherent imbalance in cell proliferation that promotes carcinogenesis in apparently normal mucosa. Our review sheds light on how early preneoplastic lesions could be used to diagnose relapsed preneoplastic and, developing neoplastic lesions. We focus in detail on the clinical-pathological and molecular features of adenoma subtypes and their role in relapsed adenoma and their development into colorectal carcinoma. Moreover, we include the data available on microbiota and its metabolites and their role in recurrence. We strongly believe that a significant improvement could be achieved in colorectal screening by introducing personalized endoscopic surveillance for polyp-bearing patients on the basis of the presence of molecular markers that are predictive of recurrence.
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Affiliation(s)
- Giulia De Maio
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - Elisa Zama
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - Claudia Rengucci
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - Daniele Calistri
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
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20
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Berger AW, Raedler K, Langner C, Ludwig L, Dikopoulos N, Becker KF, Slotta-Huspenina J, Quante M, Schwerdel D, Perkhofer L, Kleger A, Zizer E, Oswald F, Seufferlein T, Meining A. Genetic Biopsy for Prediction of Surveillance Intervals after Endoscopic Resection of Colonic Polyps: Results of the GENESIS Study. United European Gastroenterol J 2017; 6:290-299. [PMID: 29511559 DOI: 10.1177/2050640617723810] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/03/2017] [Indexed: 12/30/2022] Open
Abstract
Background and objective Current surveillance strategies for colorectal cancer following polypectomy are determined by endoscopic and histopathological factors. Such a distinction has been challenged. The present study was designed to identify molecular parameters in colonic polyps potentially defining new sub-groups at risk. Methods One hundred patients were enrolled in this multicentre study. Polyps biopsies underwent formalin-free processing (PAXgene, PreAnalytiX) and targeted next generation sequencing (38 genes (QIAGEN), NextSeq 500 platform (Illumina)). Genetic and histopathological analyses were done blinded to other data. Results In 100 patients, 224 polyps were removed. Significant associations of genetic alterations with endoscopic or histological polyp characteristics were observed for BRAF, KRAS, TCF7L2, FBXW7 and CTNNB1 mutations. Multivariate analysis revealed that polyps ≥ 10 mm have a significant higher relative risk for harbouring oncogene mutations (relative risk 3.467 (1.742-6.933)). Adenomas and right-sided polyps are independent risk factors for CTNNB1 mutations (relative risk 18.559 (2.371-145.245) and 12.987 (1.637-100.00)). Conclusions Assessment of the mutational landscape of polyps can be integrated in the workflow of current colonoscopy practice. There are distinct genetic patterns related to polyp size and location. These results suffice to optimise individual risk calculation and may help to better define surveillance intervals.
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Affiliation(s)
| | - Katja Raedler
- Clinic for Internal Medicine I, Ulm University, Ulm, Germany
| | - Cord Langner
- Institute for Pathology, Medical University Graz, Graz, Austria
| | - Leopold Ludwig
- Outpatient Clinic for Gastroenterology, Dornstadt, Germany
| | | | - Karl F Becker
- Institute for General Pathology and Pathological Anatomy, Technical University Munich, Munich, Germany
| | - Julia Slotta-Huspenina
- Institute for General Pathology and Pathological Anatomy, Technical University Munich, Munich, Germany
| | - Michael Quante
- Department of Internal Medicine, Technical University Munich, Munich, Germany
| | | | - Lukas Perkhofer
- Clinic for Internal Medicine I, Ulm University, Ulm, Germany
| | | | - Eugen Zizer
- Clinic for Internal Medicine I, Ulm University, Ulm, Germany
| | - Franz Oswald
- Clinic for Internal Medicine I, Ulm University, Ulm, Germany
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21
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Lloyd MC, Johnson JO, Kasprzak A, Bui MM. Image Analysis of the Tumor Microenvironment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 936:1-10. [PMID: 27739040 DOI: 10.1007/978-3-319-42023-3_1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In the field of pathology it is clear that molecular genomics and digital imaging represent two promising future directions, and both are as relevant to the tumor microenvironment as they are to the tumor itself (Beck AH et al. Sci Transl Med 3(108):108ra113-08ra113, 2011). Digital imaging, or whole slide imaging (WSI), of glass histology slides facilitates a number of value-added competencies which were not previously possible with the traditional analog review of these slides under a microscope by a pathologist. As an important tool for investigational research, digital pathology can leverage the quantification and reproducibility offered by image analysis to add value to the pathology field. This chapter will focus on the application of image analysis to investigate the tumor microenvironment and how quantitative investigation can provide deeper insight into our understanding of the tumor to tumor microenvironment relationship.
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Affiliation(s)
- Mark C Lloyd
- Analytic Microscopy Core, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA.
- Department of Biological Sciences, University of Chicago Illinois, 845 W. Taylor St., Chicago, IL 60607, USA.
| | - Joseph O Johnson
- Analytic Microscopy Core, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
| | - Agnieszka Kasprzak
- Analytic Microscopy Core, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
| | - Marilyn M Bui
- Analytic Microscopy Core, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
- Analytic Microscopy Core, Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
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22
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East JE, Atkin WS, Bateman AC, Clark SK, Dolwani S, Ket SN, Leedham SJ, Phull PS, Rutter MD, Shepherd NA, Tomlinson I, Rees CJ. British Society of Gastroenterology position statement on serrated polyps in the colon and rectum. Gut 2017; 66:1181-1196. [PMID: 28450390 PMCID: PMC5530473 DOI: 10.1136/gutjnl-2017-314005] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 02/07/2023]
Abstract
Serrated polyps have been recognised in the last decade as important premalignant lesions accounting for between 15% and 30% of colorectal cancers. There is therefore a clinical need for guidance on how to manage these lesions; however, the evidence base is limited. A working group was commission by the British Society of Gastroenterology (BSG) Endoscopy section to review the available evidence and develop a position statement to provide clinical guidance until the evidence becomes available to support a formal guideline. The scope of the position statement was wide-ranging and included: evidence that serrated lesions have premalignant potential; detection and resection of serrated lesions; surveillance strategies after detection of serrated lesions; special situations-serrated polyposis syndrome (including surgery) and serrated lesions in colitis; education, audit and benchmarks and research questions. Statements on these issues were proposed where the evidence was deemed sufficient, and re-evaluated modified via a Delphi process until >80% agreement was reached. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool was used to assess the strength of evidence and strength of recommendation for finalised statements. Key recommendation: we suggest that until further evidence on the efficacy or otherwise of surveillance are published, patients with sessile serrated lesions (SSLs) that appear associated with a higher risk of future neoplasia or colorectal cancer (SSLs ≥10 mm or serrated lesions harbouring dysplasia including traditional serrated adenomas) should be offered a one-off colonoscopic surveillance examination at 3 years (weak recommendation, low quality evidence, 90% agreement).
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Affiliation(s)
- James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Wendy S Atkin
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Adrian C Bateman
- Department of Cellular Pathology, Southampton General Hospital, Southampton, UK
| | - Susan K Clark
- The Polyposis Registry, St. Mark's Hospital, London, UK
| | - Sunil Dolwani
- Cancer Screening, Prevention and Early Diagnosis Group, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Shara N Ket
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Simon J Leedham
- Gastrointestinal Stem-cell Biology Laboratory, Oxford Centre for Cancer Gene Research, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Perminder S Phull
- Department of Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Matt D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK
- School of Medicine, Durham University, Durham, UK
| | - Neil A Shepherd
- Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Cheltenham, UK
| | - Ian Tomlinson
- Oxford Centre for Cancer Gene Research, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Colin J Rees
- School of Medicine, Durham University, Durham, UK
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK
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Abstract
BACKGROUND Optical diagnosis of diminutive (1 to 5 mm) polyps could result in a more cost-effective colonoscopy practice. Previous optical diagnosis studies did not incorporate the differentiation of sessile serrated polyps (SSPs). This study aimed to evaluate the impact of optical diagnosis of diminutive SSPs on the overall performance of endoscopic polyp differentiation in daily colonoscopy practice. METHODS Endoscopy data were prospectively collected between 2011 and 2014 in a colonoscopy center. Each endoscopist reported a real-time optical diagnosis (SSP, adenoma or hyperplastic polyp) for all lesions in a structured colonoscopy reporting system, using narrow band imaging at their discretion. Study outcomes were accuracy of optical diagnosis, surveillance interval agreement and negative predictive value for diminutive rectosigmoid neoplastic histology based on the optical diagnosis of diminutive polyps compared to histopathology. RESULTS Of 2853 removed diminutive polyps, 202 (7.1%) were histologically proven SSPs. Optical diagnosis of diminutive SSPs was accurate in 24.4%. Diminutive SSPs determined 6.9% of postpolypectomy surveillance assignments. Inaccurate optical diagnosis of diminutive SSPs led to lower surveillance interval agreement (78.1% vs. 53.3%, P<0.01) and pooled negative predictive value per polyp (84.3% vs. 50.0%; P<0.01) in patients with diminutive SSPs when compared to patients without diminutive SSPs. Accurate endoscopic identification of diminutive SSPs improved from 0% in 2011 to 47% in 2014 (P=0.02). CONCLUSIONS Endoscopic characterization of diminutive SSPs is difficult, impairing overall performance of optical diagnosis in patients with diminutive SSPs. Future optical diagnosis studies should use validated trainings and classification algorithms that include differentiation of SSPs.
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Abstract
Digitization of glass slides of surgical pathology samples facilitates a number of value-added capabilities beyond what a pathologist could previously do with a microscope. Image analysis is one of the most fundamental opportunities to leverage the advantages that digital pathology provides. The ability to quantify aspects of a digital image is an extraordinary opportunity to collect data with exquisite accuracy and reliability. In this review, we describe the history of image analysis in pathology and the present state of technology processes as well as examples of research and clinical use.
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Rashtak S, Rego R, Sweetser SR, Sinicrope FA. Sessile Serrated Polyps and Colon Cancer Prevention. Cancer Prev Res (Phila) 2017; 10:270-278. [PMID: 28325827 DOI: 10.1158/1940-6207.capr-16-0264] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/21/2016] [Accepted: 03/15/2017] [Indexed: 11/16/2022]
Abstract
Evidence suggests that up to one fifth of colorectal carcinomas develop from serrated polyps, named for their pattern of colonic crypts, and include the sessile serrated adenoma/polyp (SSA/P) that has malignant potential. SSA/Ps are typically located in the proximal colon and have molecular features of hypermethylation of CpG islands in gene promoters and activating point mutations (V600E) in the BRAF oncogene. Both of these features are seen in sporadic colorectal carcinomas with microsatellite instability (MSI) which is potentially consistent with an origin of these cancers from precursor SSA/Ps. Dysplasia is detected in a subset of SSA/Ps with a high risk of progression to carcinoma. An uncommon serrated polyp is the traditional serrated adenoma that is typically found in the left colon, has a tubulovillous architecture, and frequently harbors mutant KRAS To date, the epidemiology of these serrated lesions is poorly understood, and limited observational data suggest a potential chemopreventive benefit of nonsteroidal anti-inflammatory drugs. The current primary strategy to reduce the risk of colorectal carcinoma from serrated polyps is to enhance their detection at colonoscopy and to ensure their complete removal. This review provides insight into the epidemiologic, clinical, histopathologic, and molecular features of serrated polyps and includes data on their endoscopic detection and chemoprevention. Cancer Prev Res; 10(5); 270-8. ©2017 AACR.
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Affiliation(s)
- Shahrooz Rashtak
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rafaela Rego
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota.,Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Seth R Sweetser
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Frank A Sinicrope
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota. .,Department of Oncology, Mayo Clinic, Rochester, Minnesota
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26
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IJspeert JEG, Madani A, Overbeek LIH, Dekker E, Nagtegaal ID. Implementation of an e-learning module improves consistency in the histopathological diagnosis of sessile serrated lesions within a nationwide population screening programme. Histopathology 2017; 70:929-937. [DOI: 10.1111/his.13155] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/19/2016] [Accepted: 12/18/2016] [Indexed: 01/16/2023]
Affiliation(s)
- Joep E G IJspeert
- Department of Gastroenterology and Hepatology; Academic Medical Centre; Amsterdam The Netherlands
| | - Ariana Madani
- Foundation PALGA (the nationwide network and registry of histo- and cytopathology in the Netherlands); Houten The Netherlands
- Department of Gastroenterology and Hepatology; Erasmus University Medical Centre; Rotterdam The Netherlands
| | - Lucy I H Overbeek
- Foundation PALGA (the nationwide network and registry of histo- and cytopathology in the Netherlands); Houten The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology; Academic Medical Centre; Amsterdam The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology; Radboud University Medical Centre; Nijmegen The Netherlands
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Rees CJ, Bevan R, Zimmermann-Fraedrich K, Rutter MD, Rex D, Dekker E, Ponchon T, Bretthauer M, Regula J, Saunders B, Hassan C, Bourke MJ, Rösch T. Expert opinions and scientific evidence for colonoscopy key performance indicators. Gut 2016; 65:2045-2060. [PMID: 27802153 PMCID: PMC5136701 DOI: 10.1136/gutjnl-2016-312043] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/08/2016] [Accepted: 09/11/2016] [Indexed: 12/12/2022]
Abstract
Colonoscopy is a widely performed procedure with procedural volumes increasing annually throughout the world. Many procedures are now performed as part of colorectal cancer screening programmes. Colonoscopy should be of high quality and measures of this quality should be evidence based. New UK key performance indicators and quality assurance standards have been developed by a working group with consensus agreement on each standard reached. This paper reviews the scientific basis for each of the quality measures published in the UK standards.
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Affiliation(s)
- Colin J Rees
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK
| | - Roisin Bevan
- Department of Gastroenterology, North Tees University Hospital, Stockton-on-Tees, UK
| | | | - Matthew D Rutter
- Department of Gastroenterology, North Tees University Hospital, Stockton-on-Tees, UK
| | - Douglas Rex
- Department of Gastroenterology, Indiana University, Indianapolis, USA
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Thierry Ponchon
- Department of Gastroenterology and Hepatology, Edouard Herriot Hospital, Lyon University, Lyon, France
| | - Michael Bretthauer
- Department of Health Management and Health Economics and KG Jebsen Center for Colorectal Cancer Research, University of Oslo, Oslo, Norway
| | - Jaroslaw Regula
- Department of Gastroenterology, Medical Center for Postgraduate Education and the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Brian Saunders
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, Harrow, UK
| | - Cesare Hassan
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Sydney, Australia
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Mirzaie AZ, Khakpour H, Mireskandari M, Shayanfar N, Fatahi L. Investigating The Frequency of Serrated Polyps/Adenomas and Their Subtypes in Colonic Polyp Samples. Med Arch 2016; 70:198-202. [PMID: 27594746 PMCID: PMC5010071 DOI: 10.5455/medarh.2016.70.198-202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/25/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the frequency of Serrated polyps of colonic polyps samples in Hazrat_e Rasoul_e Akram Hospital over ten years. MATERIALS The target group in this study was patients with colonic polyps in Hazrat_e Rasoul_e Akram Hospital. Pathologic evaluation of these patients was done. Serrated polyps, by location, gender, age and type of polyps were divided and frequency of them were determined separately. RESULTS Of 381 patients studied, 224 (58.79%) and 157(41.20%) were males and females, respectively. Mean age of patients was 59.25 years. In initial diagnosis, frequency of Adenomatous polyp, Hyperplastic polyp and Mixed polyp were 92.44% and 5.33%, and 2.22%, respectively. In final diagnosis (Second evaluation), frequency of Adenomatous polyp, Hyperplastic polyp, Mixed polyp, Sessile Serrated Adenoma/ Polyp, Traditional Serrated Adenoma and SPU (Serrated Polyp Unclassifiable) were 90.44%, 4.88%, 2.44%, 1.11%, 0.66% and 0.44%, respectively. 72.13% and 27.86% of polyps were low grade dysplasia and high grade dysplasia, respectively. According to the results of this study, the incidence of all types of polyps detected was more in men than women. Rectum and sigmoid were most abundant in the area polyp in both initial and final diagnosis. CONCLUSION Despite the low prevalence of Serrated polyps in patients, early diagnosis is the best action to reduce morbidity and mortality. Probability of the risk of progression from low grade to high grade dysplasia and transforming into Adenocarcinoma is high in Serrated polyps.
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Affiliation(s)
- Ali Zare Mirzaie
- Department of Pathology, Iran University of Medical Sciences, Tehran, Iran
| | - Hakimeh Khakpour
- Department of Pathology, Iran University of Medical Sciences, Tehran, Iran
| | | | - Nasrin Shayanfar
- Department of Pathology, Iran University of Medical Sciences, Tehran, Iran
| | - Ladan Fatahi
- Department of Pathology, Iran University of Medical Sciences, Tehran, Iran
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29
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Abstract
Sessile serrated adenoma/polyp (SSA/p) is a precancerous lesion, and its differential diagnosis from hyperplastic polyp (HP) could be challenging in certain circumstances based on morphology alone. Hes1 is a downstream target of Notch-signaling pathway and plays an important role in intestinal development by regulating differentiation of enterocytes. In this study, we evaluated the expression patterns of Hes1 in SSA/p and HP, and determine whether Hes1 immunostaining can help differentiate between these 2 entities. Serrated polyps with cytologic dysplasia (SSA with cytologic dysplasia, tubular adenoma, and traditional serrated adenoma) were also studied. Hes1 is ubiquitously expressed in the nuclei of normal colon epithelial cells. The complete loss or a very weak expression of Hes1 is observed in the majority of the SSA/p in the study (58/63, 92%) compared with the normal expression of Hes1 in HP (35/35,100%). In SSA/p with cytologic dysplasia, dysplastic area demonstrated cytoplasmic and/or nuclear staining for Hes1. Tubular adenoma and traditional serrated adenoma showed variability of Hes1 staining within the polyp with a mixed positive and negative staining pattern. Our study suggests that loss of Hes1 could be used as a sensitive and specific marker to differentiate SSA/p from HP, which helps the diagnosis in morphologically challenging cases.
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30
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Gibson JA, Odze RD. Pathology of premalignant colorectal neoplasia. Dig Endosc 2016; 28:312-23. [PMID: 26861656 DOI: 10.1111/den.12633] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/29/2016] [Accepted: 02/05/2016] [Indexed: 02/08/2023]
Abstract
Colorectal cancer is a heterogeneous oncological disease that develops through several molecular pathways. Each pathway is associated with specific neoplastic precursor lesions. Classification of colorectal polyps and the molecular features of associated colorectal cancers have undergone significant changes. An understanding of colorectal carcinogenesis and the molecular features of colorectal carcinomas is now regarded as necessary for personalized treatment and management of patients with colon cancer, and even for patients undergoing screening colonoscopy for early detection and prevention of colorectal cancer. In the present review, we describe the pathological and molecular features of epithelial precursor lesions involved in the early phases of colorectal carcinogenesis.
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Affiliation(s)
- Joanna A Gibson
- Department of Pathology, Yale University School of Medicine, New Haven, USA
| | - Robert D Odze
- Department of Pathology, Brigham and Women's Hospital, Boston, USA
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31
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Rau TT, Atreya R, Aust D, Baretton G, Eck M, Erlenbach-Wünsch K, Hartmann A, Lugli A, Stöhr R, Vieth M, Wirsing AM, Zlobec I, Katzenberger T. Inflammatory response in serrated precursor lesions of the colon classified according to WHO entities, clinical parameters and phenotype-genotype correlation. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2016; 2:113-24. [PMID: 27499921 PMCID: PMC4907061 DOI: 10.1002/cjp2.41] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/23/2016] [Indexed: 12/14/2022]
Abstract
Studies on traditional serrated adenoma (TSA) and sessile serrated adenoma with dysplasia (SSA‐D) are rare due to the low frequency of these lesions, which are well defined by the latest WHO classification. However, introducing new morphological criteria such as intra‐epithelial lymphocytes (IELs) might facilitate colorectal polyp diagnoses. Additionally, the phenotype–genotype correlation needs to be updated as the terminology has repeatedly changed. This study analysed 516 polyps, consisting of 118 classical adenomas (CAD), 116 hyperplastic polyps (HPP), 179 SSAs, 41 SSA‐Ds, and 62 TSAs. The lesions were analysed in relation to the patients’ clinical parameters including gender, age, localisation, and size. The inflammatory background of the polyps was quantified and BRAF and KRAS mutations as well as MLH1 and CDKN2A promoter methylation were assessed. In multivariate analyses, an increase in IELs was an independent and robust new criterion for the diagnosis of SSA‐D (p < 0.001). Superficial erosions and acute neutrophil granulocytes led to reactive changes potentially resembling dysplasia. KRAS and BRAF mutations were associated with CAD/TSA and HPP/SSA, respectively. However, almost half of TSAs had a BRAF mutation and were KRAS wild type. CDKN2A seems to precede MLH1 hyper‐methylation within the serrated carcinogenesis model. The genotyping of WHO‐based entities – and especially SSA – has sharpened in comparison to previously published data. TSAs can be sub‐grouped according to their mutation status. Of note, the higher number of IELs in SSA‐D reflects their close relationship to colorectal cancers with micro‐satellite instability. Therefore, IELs might represent a new diagnostic tool for SSA‐D.
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Affiliation(s)
- Tilman T Rau
- Institute of Pathology, University Bern, BernSwitzerland; Institute of Pathology, Friedrich-Alexander University Erlangen-NurembergErlangenGermany
| | - Raja Atreya
- Medical Clinic 1, Friedrich-Alexander University Erlangen-Nuremberg Erlangen Germany
| | - Daniela Aust
- Institute of Pathology, University Hospital Dresden Carl Gustav Carus Dresden Germany
| | - Gustavo Baretton
- Institute of Pathology, University Hospital Dresden Carl Gustav Carus Dresden Germany
| | - Matthias Eck
- Institute of Pathology, Hospital Aschaffenburg Aschaffenburg Germany
| | | | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg Erlangen Germany
| | | | - Robert Stöhr
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg Erlangen Germany
| | - Michael Vieth
- Institute of Pathology, Hospital Bayreuth Bayreuth Germany
| | - Anna M Wirsing
- Institute of Pathology, Friedrich-Alexander University Erlangen-NurembergErlangenGermany; Department of Medical Biology, Faculty of Health SciencesUniversity of TromsøTromsøNorway
| | - Inti Zlobec
- Institute of Pathology, University Bern, Bern Switzerland
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Yoon JY, Kim HT, Hong SP, Kim HG, Kim JO, Yang DH, Park DI, Park SJ, Kim HS, Keum B, Park CH, Eun CS, Lee SH, Baek IH, Chang DK, Kim TI. High-risk metachronous polyps are more frequent in patients with traditional serrated adenomas than in patients with conventional adenomas: a multicenter prospective study. Gastrointest Endosc 2015; 82:1087-93.e3. [PMID: 26117178 DOI: 10.1016/j.gie.2015.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 05/06/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Although the malignant progression of serrated polyps has been clearly documented, the malignant potential of the traditional serrated adenoma (TSA) subtype has not been established. We compared the prevalence of metachronous polyps in surveillance colonoscopies between patients with TSA and those with conventional adenomas (CAs). METHODS Four hundred twenty patients were diagnosed with TSAs by current diagnostic criteria at 10 tertiary care university hospitals in Korea from January 2003 to December 2005; 186 patients who received surveillance colonoscopy after removal of initial polyps were enrolled. During the same time period, 372 age- and sex-matched patients diagnosed with CAs were used as a control group. RESULTS TSA patients had a significantly higher recurrence rate of colorectal polyps compared with CA patients (66.1% vs 43.5%, respectively). TSA patients had a greater number (3 vs 2) and larger size (8.6 ± 5.7 vs 6.3 ± 5.2 mm) of recurrent polyps compared with CA patients. TSA patients also had a higher rate of CA (54.8% vs 37.9%), serrated adenoma (14.0% vs. 0.8%), and hyperplastic polyp (33.3% vs. 13.7%) recurrence compared with CA patients. TSA patients had significantly greater odds of having a recurrent high-risk polyp than CA patients (odds ratio, 2.37; 95% confidence interval, 1.55-3.63). CONCLUSIONS In comparison with patients with CAs, patients with TSAs have a higher metachronous occurrence rate of all polyp subtypes including CAs, serrated adenomas, and hyperplastic polyps. Moreover, the presence of TSAs is an independent predictor of a high-risk polyp occurrence.
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Affiliation(s)
- Jin Young Yoon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Tae Kim
- Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Pil Hong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Gun Kim
- Soonchunhyang University College of Medicine, Seoul, Cheonan, Korea
| | - Jin-Oh Kim
- Soonchunhyang University College of Medicine, Seoul, Cheonan, Korea
| | | | - Dong Il Park
- Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seun Ja Park
- Kosin University College of Medicine, Pusan, Korea
| | - Hyun-Soo Kim
- Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Bora Keum
- Korea University College of Medicine, Seoul, Korea
| | - Cheol Hee Park
- Hallym University College of Medicine, Pyeongchon, Korea
| | | | - Suck-Ho Lee
- Soonchunhyang University College of Medicine, Seoul, Cheonan, Korea
| | - Il Hyun Baek
- Hallym University College of Medicine, Pyeongchon, Korea
| | | | - Tae Il Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Munding J, Tannapfel A. Epidemiology of Colorectal Adenomas and Histopathological Assessment of Endoscopic Specimens in the Colorectum. VISZERALMEDIZIN 2015; 30:10-6. [PMID: 26288577 PMCID: PMC4513795 DOI: 10.1159/000357744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Colorectal cancer is one of the most frequently observed neoplasms in the world. It develops from intraepithelial neoplasia of the colorectal mucosa, and these precursor lesions are also known as adenoma. As the precursor lesion is known and can be detected easily, efficient screening strategies are available for a reliable prevention of colorectal adenocarcinoma, e.g. by colonoscopy. METHODS Literature databases (PubMed) were searched selectively for the keywords 'colorectal adenoma', 'epidemiology', and 'resection techniques'. The results are presented in the following text, also taking into account our own experience and the current S3 guidelines. RESULTS Endoscopic resection samples are one of the specimens most frequently assessed by pathologists. Therefore, gastroenterologists expect standardized and well-structured pathology reports, stating relevant information concerning the removed lesions and recommendations for clinical management. These aspects are summarized in the evidence-based S3 guideline. CONCLUSION As a consequence of colorectal adenoma resection during screening procedures, the carcinoma incidence is decreasing. For further advancements in successful prevention, knowledge of different precursor lesions (conventional adenoma, serrated adenoma) is important, but also structured communication between the different disciplines engaged in colorectal cancer screening.
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Holme Ø, Bretthauer M, Eide TJ, Løberg EM, Grzyb K, Løberg M, Kalager M, Adami HO, Kjellevold Ø, Hoff G. Long-term risk of colorectal cancer in individuals with serrated polyps. Gut 2015; 64:929-36. [PMID: 25399542 DOI: 10.1136/gutjnl-2014-307793] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/18/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Although serrated polyps may be precursors of colorectal cancer (CRC), prospective data on the long-term CRC risk in individuals with serrated polyps are lacking. DESIGN In a population-based randomised trial, 12,955 individuals aged 50-64 years were screened with flexible sigmoidoscopy, while 78 220 individuals comprised the control arm. We used Cox models to estimate HRs with 95% CIs for CRC among individuals with ≥1 large serrated polyp (≥10 mm in diameter), compared with individuals with adenomas at screening, and to population controls, and multivariate logistic regression to assess polyp risk factors for CRC. RESULTS A total of 103 individuals had large serrated polyps, of which 81 were included in the analyses. Non-advanced adenomas were found in 1488 individuals, advanced adenomas in 701. Median follow-up was 10.9 years. Compared with the control arm, the HR for CRC was 2.5 (95% CI 0.8 to 7.8) in individuals with large serrated polyps, 2.0 (95% CI 1.3 to 2.9) in individuals with advanced adenomas and 0.6 (95% CI 0.4 to 1.1) in individuals with non-advanced adenomas. A large serrated polyp was an independent risk factor for CRC, adjusted for histology, size and multiplicity of concomitant adenomas (OR 3.3; 95% CI 1.3 to 8.6). Twenty-three large serrated polyps found at screening were left in situ for a median of 11.0 years. None developed into a malignant tumour. CONCLUSIONS Individuals with large serrated polyps have an increased risk of CRC, comparable with individuals with advanced adenomas. However, this risk may not be related to malignant growth of the serrated polyp. TRIAL REGISTRATION NUMBER The Norwegian Colorectal Cancer Screening trial is registered at clinicaltrials.gov (NCT00119912).
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Affiliation(s)
- Øyvind Holme
- Department of Medicine, Sørlandet Hospital, Kristiansand, Norway Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Michael Bretthauer
- Department of Medicine, Sørlandet Hospital, Kristiansand, Norway Institute of Health and Society, University of Oslo, Oslo, Norway Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Tor J Eide
- Department of Pathology, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Else Marit Løberg
- Department of Pathology, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Krzysztof Grzyb
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Magnus Løberg
- Institute of Health and Society, University of Oslo, Oslo, Norway Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Mette Kalager
- Institute of Health and Society, University of Oslo, Oslo, Norway Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA Telemark Hospital, Skien, Norway
| | - Hans-Olov Adami
- Institute of Health and Society, University of Oslo, Oslo, Norway Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Geir Hoff
- Institute of Health and Society, University of Oslo, Oslo, Norway Telemark Hospital, Skien, Norway Cancer Registry of Norway, Oslo, Norway
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Bateman AC, Shepherd NA. UK guidance for the pathological reporting of serrated lesions of the colorectum. J Clin Pathol 2015; 68:585-91. [PMID: 25934843 DOI: 10.1136/jclinpath-2015-203016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/13/2015] [Indexed: 11/04/2022]
Abstract
Bowel cancer screening programmes have highlighted to endoscopists and clinicians the spectrum of serrated colorectal lesions. One of the most significant developments has been the recognition that sessile serrated lesions (SSLs), while bearing histological resemblance to hyperplastic polyps (HPs), may be associated with the enhanced development of epithelial dysplasia and colorectal adenocarcinoma. Different minimum criteria exist for the diagnosis of SSLs and their differentiation from HPs. Furthermore, the spectrum of terminology used to describe the entire range of serrated lesions is wide. This variability has impaired interobserver agreement during their histopathological assessment. Here, we provide guidance for the histopathological reporting of serrated lesions, including a simplified nomenclature system. Essentially, we recommend use of the following terms: HP, SSL, SSL with dysplasia, traditional serrated adenoma (TSA) and mixed polyp. It is hoped that this standardisation of nomenclature will facilitate studies of the biological significance of serrated lesions in terms of the relative risk of disease progression.
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Affiliation(s)
- Adrian C Bateman
- Department of Cellular Pathology, Southampton General Hospital, Southampton, UK
| | - Neil A Shepherd
- Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Cheltenham, UK
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36
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Baker AM, Graham TA, Elia G, Wright NA, Rodriguez-Justo M. Characterization of LGR5 stem cells in colorectal adenomas and carcinomas. Sci Rep 2015; 5:8654. [PMID: 25728748 PMCID: PMC4345329 DOI: 10.1038/srep08654] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/23/2015] [Indexed: 12/20/2022] Open
Abstract
LGR5 is known to be a stem cell marker in the murine small intestine and colon, however the localization of LGR5 in human adenoma samples has not been examined in detail, and previous studies have been limited by the lack of specific antibodies. Here we used in situ hybridization to specifically examine LGR5 mRNA expression in a panel of human adenoma and carcinoma samples (n = 66). We found that a small number of cells express LGR5 at the base of normal colonic crypts. We then showed that conventional adenomas widely express high levels of LGR5, and there is no evidence of stereotypic cellular hierarchy. In contrast, serrated lesions display basal localization of LGR5, and the cellular hierarchy resembles that of a normal crypt. Moreover, ectopic crypts found in traditional serrated adenomas show basal LGR5 mRNA, indicating that they replicate the stem cell organization of normal crypts with the development of a cellular hierarchy. These data imply differences in the stem cell dynamics between the serrated and conventional pathways of colorectal carcinogenesis. Furthermore we noted high LGR5 expression in invading cells, with later development of a stem cell niche in adenocarcinomas of all stages.
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Affiliation(s)
- Ann-Marie Baker
- Centre for Tumor Biology, Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK, EC1M 6BQ
| | - Trevor A. Graham
- Centre for Tumor Biology, Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK, EC1M 6BQ
| | - George Elia
- Centre for Tumor Biology, Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK, EC1M 6BQ
| | - Nicholas A. Wright
- Centre for Tumor Biology, Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK, EC1M 6BQ
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Abdeljawad K, Vemulapalli KC, Kahi CJ, Cummings OW, Snover DC, Rex DK. Sessile serrated polyp prevalence determined by a colonoscopist with a high lesion detection rate and an experienced pathologist. Gastrointest Endosc 2015; 81:517-24. [PMID: 24998465 DOI: 10.1016/j.gie.2014.04.064] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 04/29/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prevalence of sessile serrated adenomas and/or polyps (SSA/Ps) is uncertain. OBJECTIVE To determine the prevalence of SSA/Ps and SSA/Ps with cytologic dysplasia (SSA/P-CD) by using a colonoscopist with a high lesion detection rate and an expert in serrated lesion pathology. DESIGN Retrospective screening colonoscopy study. SETTING Academic endoscopy unit. PATIENTS A total of 1910 average risk, asymptomatic patients aged ≥50 years underwent screening colonoscopy between August 2005 and April 2012 by a single colonoscopist with a high lesion detection rate. INTERVENTIONS Slides of all lesions in the serrated class proximal to the sigmoid colon and all rectal and sigmoid colon serrated lesions >5 mm in size were reviewed by an experienced GI pathologist. MAIN OUTCOME MEASUREMENTS Prevalence of SSA/Ps, defined as the proportion of patients with ≥1 SSA/P. RESULTS There were 1910 patients, of whom 389 had 656 lesions in the serrated class. Review by the experienced GI pathologist determined a prevalence of SSA/Ps without cytologic dysplasia of 7.4% and SSA/Ps-CD of 0.6% (total SSA/P prevalence 8.1%). SSA/Ps and SSA/Ps-CD comprised 5.6% and 0.3%, respectively, of all resected polyps. The mean size of SSA/Ps was 7.13 mm (standard deviation [SD] 4.66), and 51 of 77 (66.2%) polyps ≥10 mm in the serrated class were SSA/Ps. LIMITATIONS Retrospective design. CONCLUSION A colonoscopist with a high lesion detection rate and an experienced pathologist identified a high prevalence (8.1%) of SSA/Ps in a screening population. SSA/Ps are more common than previously believed.
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Affiliation(s)
- Khaled Abdeljawad
- Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Krishna C Vemulapalli
- Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Charles J Kahi
- Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA; Richard L. Roudebush Veterans Affairs Medical Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Oscar W Cummings
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Dale C Snover
- Department of Pathology, Fairview Southdale Hospital, Edina, Minnesota and Department of Laboratory Medicine and Pathology, the University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Douglas K Rex
- Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Rzouq F, Gupta N, Wani S, Sharma P, Bansal A, Rastogi A. Cap assisted colonoscopy for the detection of serrated polyps: a post-hoc analysis. BMC Gastroenterol 2015; 15:11. [PMID: 25652842 PMCID: PMC4334853 DOI: 10.1186/s12876-015-0234-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 01/15/2015] [Indexed: 02/08/2023] Open
Abstract
Background Colonoscopy offers limited protection against right-sided colon cancer, a significant proportion of which arise from the serrated pathway of carcinogenesis. The aim of this study was to compare cap-assisted colonoscopy and standard high-definition white light colonoscopy regarding serrated polyps’ detection. Methods Post hoc analysis was performed of a previously conducted randomized controlled trial comparing standard and cap-assisted colonoscopy for adenoma detection. Randomization was stratified based on the indication of colonoscopy and all procedures were performed by three experienced endoscopists. Following cecal intubation, the colonic mucosa was carefully inspected during withdrawal of colonoscope and all polyps detected were documented for their size, location, morphology and then removed and sent for histopathology. Detection rates of significant serrated polyps between both arms were compared using the Fisher’s exact test and Wilcoxon Rank Sum test. Results 427 patients were enrolled (7 exclusions, 210 completed study in each arm, mean age of 61 years, 95% male, 75% Caucasian, 67% screening colonoscopies). There were no significant differences in baseline characteristics between both groups. Cap-assisted colonoscopy detected a significantly higher proportion of subjects with significant serrated polyps as well as a higher total number of significant serrated polyps compared to standard colonoscopy (12.8% vs. 6.6%, p =0.047 and 40 vs. 20,p = 0.03 respectively). Conclusions In this post-hoc analysis, Cap-assisted colonoscopy is a safe technique that offers a higher detection rate of significant serrated polyps when compared to standard colonoscopy. If confirmed in future trials, this simple technique has the potential to improve protection against interval colon cancers.
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Affiliation(s)
- Fadi Rzouq
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, KS, 66160, USA.
| | - Neil Gupta
- Department of Gastroenterology, Loyola University Medical Center, Maywood, IL, 60153, USA.
| | - Sachin Wani
- Department of Gastroenterology, University of Colorado and Veterans Affairs Medical Center, Aurora, CO, 80045, USA.
| | - Prateek Sharma
- Department of Gastroenterology, University of Kansas School of Medicine, Kansas City Veterans Affairs Medical Center, Kansas City, MO, 64128, USA.
| | - Ajay Bansal
- Department of Gastroenterology, University of Kansas School of Medicine, Kansas City Veterans Affairs Medical Center, Kansas City, MO, 64128, USA.
| | - Amit Rastogi
- Department of Gastroenterology, University of Kansas School of Medicine, Kansas City Veterans Affairs Medical Center, Kansas City, MO, 64128, USA.
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Hafezi-Bakhtiari S, Wang LM, Colling R, Serra S, Chetty R. Histological overlap between colorectal villous/tubulovillous and traditional serrated adenomas. Histopathology 2014; 66:308-13. [PMID: 25257227 DOI: 10.1111/his.12555] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 09/19/2014] [Indexed: 12/25/2022]
Abstract
AIMS To ascertain the degree of histological overlap between conventional villous/tubulovillous (VA/TVAs) and traditional serrated adenomas (TSA). METHODS AND RESULTS A total of 180 polyps from the left colon/rectum diagnosed as VA/TVAs were retrieved randomly and reviewed by five pathologists looking specifically at luminal serration, cytoplasmic eosinophilia and the presence of ectopic crypt foci (ECF). For comparative purposes, 100 tubular adenomas and 80 TSAs were also examined. Twenty VA/TVAs were reclassified as TSA. Luminal serration as noted in TSA was not seen in any of the remaining 160 polyps, ECFs were noted in 55 of the 160 VA/TVAs (34%), while cytoplasmic eosinophilia (constituting <50% of the adenoma) was noted in only 10 of 160 cases (6.2%). CONCLUSIONS Ectopic crypt foci and cytoplasmic eosinophilia are encountered in sporadic VA/TVAs but not to the same extent and degree as in TSA. ECFs were found in one-third of cases, but cytoplasmic eosinophilia is rare. The pattern of luminal serration in TSA is very characteristic and not recapitulated in VA/TVA. The occurrence of all three histological features together occurs only in TSA. ECFs are not a sine qua non for TSA and are encountered commonly in VA/TVAs. VA/TVAs often contain occasional glands typical of TSA.
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Affiliation(s)
- Sara Hafezi-Bakhtiari
- Department of Pathology, Laboratory Medicine Program, University Health Network and University of Toronto, Toronto, ON, Canada
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Abstract
Colonoscopy offers incomplete protection from colorectal cancer, particularly in the right colon. Part of this inadequacy may be related to serrated neoplasia. Serrated polyps of the colorectum are now understood to be a heterogeneous group of polyps, some of which are cancer precursors, such as the sessile serrated adenoma (SSA) and the traditional serrated adenoma (TSA). In contrast to conventional adenomas, there is limited published literature on the epidemiology and natural history of these lesions. Furthermore, existing guidelines regarding screening and surveillance practices for these polyps are based largely on expert opinion without firm evidence. In this review, we describe the current understanding of the molecular biology, histopathology, and endoscopic features of serrated neoplasia of the colorectum, with an emphasis on aspects relevant to the practicing gastroenterologist.
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Detection of serrated lesions: we are still in the teething stage. Clin Gastroenterol Hepatol 2014; 12:1127-9. [PMID: 24486409 DOI: 10.1016/j.cgh.2014.01.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 01/22/2014] [Accepted: 01/22/2014] [Indexed: 02/07/2023]
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Payne SR, Church TR, Wandell M, Rösch T, Osborn N, Snover D, Day RW, Ransohoff DF, Rex DK. Endoscopic detection of proximal serrated lesions and pathologic identification of sessile serrated adenomas/polyps vary on the basis of center. Clin Gastroenterol Hepatol 2014; 12:1119-26. [PMID: 24333512 DOI: 10.1016/j.cgh.2013.11.034] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 11/05/2013] [Accepted: 11/12/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We investigated rates of detection of proximal serrated lesions in a cohort of average-risk patients undergoing screening colonoscopies. METHODS We reviewed results from screening colonoscopies performed by attending gastroenterologists at 32 endoscopy centers from 2008-2010. Pathology slides were interpreted at the individual centers. For this analysis, serrated lesions included hyperplastic polyps larger than 10 mm, those interpreted as sessile serrated adenomas (or sessile serrated polyp), and traditional serrated adenomas. Rates of detection for conventional adenomas and serrated lesions were compared among centers. RESULTS A total of 5778 lesions were detected in 7215 screening colonoscopies. Of the 5548 lesions with pathology results, 3008 (54.2%) were conventional adenomas, 350 (6.3%) were serrated, and 232 (4.2%) were proximal serrated. The proportion of colonoscopies with at least 1 proximal serrated lesion was 2.8% (range among centers, 0%-9.8%). The number of serrated lesions per colonoscopy ranged from 0.00-0.11 (average, 0.05 ± 0.25). Overall lesion detection rates correlated with proximal serrated lesion detection rates (R = 0.91, P < .0001); conventional adenoma and proximal serrated lesion detection rates also correlated (R = .43, P = .025). The detection rate of proximal serrated lesions differed significantly among centers (P < .0001); odds ratios for detection ranged from 0-0.79. Some centers' pathologists never identified proximal serrated lesions as sessile serrated adenomas/polyps. CONCLUSIONS In an average-risk screening cohort, detection of proximal serrated lesions varied greatly among endoscopy centers. There was also substantial variation among pathologists in identification of sessile serrated adenomas/polyps. Nationally, a significant proportion of proximal serrated lesions may be missed during colonoscopy examination or incorrectly identified during pathology assessment. ClinicalTrials.gov Number: NCT00855348.
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Affiliation(s)
| | - Timothy R Church
- University of Minnesota School of Public Health, Minneapolis, Minnesota
| | | | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Neal Osborn
- Atlanta Gastroenterology Associates, Atlanta, Georgia
| | - Dale Snover
- Fairview Southdale Hospital, Minneapolis, Minnesota
| | - Robert W Day
- Fred Hutchinson Cancer Research Center, Seattle, Washington; Epigenomics, Inc, Seattle, Washington
| | - David F Ransohoff
- Departments of Medicine and Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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de Leon MP. What clinicians wish to know about benign colorectal polyps: an operative classification. Pathol Res Pract 2014; 210:645-8. [PMID: 25070622 DOI: 10.1016/j.prp.2014.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/25/2014] [Accepted: 06/10/2014] [Indexed: 01/21/2023]
Abstract
INTRODUCTION In recent years we assisted to a real "boom" of colorectal polyps, mainly due to the diffusion of screening procedures and of colonoscopy. This new "Polyp Epidemic" raises a series of problems and challenges. It became clear that many syndromes are defined by the number, histological type and location of polyps, together with extraintestinal manifestations and, in most cases, specific molecular changes. This paper discusses some of the above mentioned points, focusing on the relative role of endoscopists and pathologists. The objective is to reach an operative classification of the most common polyps observed in daily practice which might be of help for the identification of inherited syndromes. METHODS AND RESULTS Six main histological types of polyps are defined and underlined: Adenoma, hyperplastic/serrated, hamartoma, ganglioneuroma, mixed, inflammatory. The importance of a brief description, in pathology reports, of each type of polyps is fundamental for a correct diagnosis. Each of the defined polyps is associated with inherited syndromes whose genetic basis has recently been elucidated. Relevant information should be given, and separated from additional (and not strictly necessary) information. RECOMMENDATIONS A correct polyp analysis is a valuable element for identifying specific inherited syndromes. Polyps represent a precious tool for planning screening and follow-up in a given individual. In addition, these lesions focus the interest of clinicians toward syndrome which were considered as rare diseases; indeed, the explosion of molecular biology and the diffusion of colonoscopy revealed that these conditions are frequent and amenable of treatment.
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Affiliation(s)
- Maurizio Ponz de Leon
- Dipartimento di Medicina Diagnostica, Clinica e Sanità Pubblica, Università di Modena e Reggio Emilia, Italy.
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Morimoto T, Mitomi H, Saito T, Takahashi M, Murakami T, Sakamoto N, Yao T, Watanabe S. Distinct profile of HIF1α, PTCH, EphB2, or DNA repair protein expression and BRAF mutation in colorectal serrated adenoma. J Gastroenterol Hepatol 2014; 29:1192-9. [PMID: 24612059 DOI: 10.1111/jgh.12553] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS The serrated colorectal carcinoma (CRC) as proposed to arise from serrated adenoma (SA) is characterized by upregulation of HIF1α, suppression of PTCH or EphB2, loss of DNA repair proteins, and BRAF mutation. The aim of this study was to evaluate alterations of these candidates involved in the serrated pathway in colorectal polyps. METHODS We analyzed immunoreactivity of these proteins, methylation of PTCH and EphB2, and mutation of BRAF and Kras in sessile SAs (SSAs; n = 32), traditional SAs (n = 28), hyperplastic polyps (HPs; n = 24), and conventional adenomas (ADs; n = 21). RESULTS Increase of nuclear HIF1α expression was more frequent in SA than HP, but less frequent in SA than AD (P < 0.001). Increase of PTCH expression was not found in SSA or HP, but was evident in about half of traditional SA and all AD (P < 0.001). Decrease of EphB2 expression was more prominent in SA than HP or AD (P ≤ 0.005). Loss of hMLH1 and MGMT expression were most frequent in SSA (P < 0.001). Loss of hMSH2 showed more pronounced in SA and HP than AD (P ≤ 0.004). Methylations of PTCH and EphB2 were rare in all categories. BRAF mutation harbored frequently in SA, but not AD; only AD harbored Kras mutation. CONCLUSIONS This work provides evidence of similarity of HIF1α, EphB2 or DNA repair proteins expression, and BRAF mutation in serrated CRCs and their precursors, especially SSA, compared with AD and HP.
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Affiliation(s)
- Takashi Morimoto
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan; Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
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Defined morphological criteria allow reliable diagnosis of colorectal serrated polyps and predict polyp genetics. Virchows Arch 2014; 464:663-72. [PMID: 24728704 DOI: 10.1007/s00428-014-1569-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 02/08/2023]
Abstract
Criteria for the diagnosis of serrated colorectal lesions (hyperplastic polyp, sessile serrated adenoma without or with dysplasia--which we called mixed polyp--and traditional serrated adenoma) for which consensus has been reached should be validated for applicability in daily practice in terms of inter-observer reproducibility and their association with clinical features and (epi)genetic events. A study set was created from a consecutive series of colorectal polyps (n = 1,926) by selecting all sessile serrated adenomas, traditional serrated adenomas and mixed polyps. We added consecutive series of hyperplastic polyps, classical adenomas and normal mucosa samples for a total of 200 specimens. With this series, we conducted an inter-observer study, encompassing ten pathologists with gastrointestinal pathology experience from five European countries, in three rounds in which all cases were microscopically evaluated. An assessment of single morphological criteria was included, and these were correlated with clinical parameters and the mutation status of KRAS, BRAF and PIK3CA and the methylation status of MLH1. Gender, age and localisation were significantly associated with certain types of lesions. Kappa statistics revealed moderate to good inter-observer agreement for polyp classification (κ = 0.56 to 0.63), but for single criteria, this varied considerably (κ = 0.06 to 0.82). BRAF mutations were frequently found in hyperplastic polyps (86 %, 62/72) and sessile serrated adenomas (80 %, 41/51). KRAS mutations occurred more frequently in traditional serrated adenomas (78 %, 7/9) and less so in classical adenomas (20 %, 10/51). Single morphological criteria for sessile serrated adenomas showed significant correlation with BRAF mutation (all p ≤ 0.001), and those for classical adenomas or traditional serrated adenoma correlated significantly with KRAS mutation (all p < 0.001). Therefore, single well-defined morphological criteria are predictive for genetic alterations in colorectal polyps.
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Abstract
The sessile serrated adenoma (SSA) is a relatively recently described polyp that can present diagnostic difficulties for the practicing pathologist. The frequency of SSA diagnoses varies dramatically in the reported literature. In addition, the histologic interface between the microvesicular hyperplastic polyp (MVHP) and the SSA continues to be a diagnostic problem. The trend in recent years has been toward a lower threshold for SSA diagnosis. Herein, we have performed a cross-sectional study of 6340 colorectal polyps received at a high-volume community-based pathology practice over a 3-month period. After central review, with strict application of the diagnostic criteria outlined in the 2010 edition of the World Health Organization Classification of Tumours of the Digestive Tract, we found that SSAs represented 12.1% of all polyps. In addition, we developed novel diagnostic subcategories in an attempt to determine the most appropriate cutoff for the interface between the MVHP and the SSA. We found that serrated polyps (MVHPs or SSAs) with any SSA-like crypts had clinical features more in common with the SSA than the MVHP and that this diagnostic cutoff showed good reproducibility between pathologists. This supports the position of a recent consensus publication proposing that polyps with as few as 1 SSA-type crypt should be diagnosed as an SSA. Applying these criteria to our cohort yields an overall SSA rate of 14.7%. In summary, we believe that SSAs continue to be underdiagnosed in pathologic practice and that this may result in inadequate surveillance and thus contribute to interval colorectal carcinomas.
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Delker DA, McGettigan BM, Kanth P, Pop S, Neklason DW, Bronner MP, Burt RW, Hagedorn CH. RNA sequencing of sessile serrated colon polyps identifies differentially expressed genes and immunohistochemical markers. PLoS One 2014; 9:e88367. [PMID: 24533081 PMCID: PMC3922809 DOI: 10.1371/journal.pone.0088367] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/06/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sessile serrated adenomas/polyps (SSA/Ps) may account for 20-30% of colon cancers. Although large SSA/Ps are generally recognized phenotypically, small (<1 cm) or dysplastic SSA/Ps are difficult to differentiate from hyperplastic or small adenomatous polyps by endoscopy and histopathology. Our aim was to define the comprehensive gene expression phenotype of SSA/Ps to better define this cancer precursor. RESULTS RNA sequencing was performed on 5' capped RNA from seven SSA/Ps collected from patients with the serrated polyposis syndrome (SPS) versus eight controls. Highly expressed genes were analyzed by qPCR in additional SSA/Ps, adenomas and controls. The cellular localization and level of gene products were examined by immunohistochemistry in syndromic and sporadic SSA/Ps, adenomatous and hyperplastic polyps and controls. We identified 1,294 differentially expressed annotated genes, with 106 increased ≥10-fold, in SSA/Ps compared to controls. Comparing these genes with an array dataset for adenomatous polyps identified 30 protein coding genes uniquely expressed ≥10-fold in SSA/Ps. Biological pathways altered in SSA/Ps included mucosal integrity, cell adhesion, and cell development. Marked increased expression of MUC17, the cell junction protein genes VSIG1 and GJB5, and the antiapoptotic gene REG4 were found in SSA/Ps, relative to controls and adenomas, were verified by qPCR analysis of additional SSA/Ps (n = 21) and adenomas (n = 10). Immunohistochemical staining of syndromic (n≥11) and sporadic SSA/Ps (n≥17), adenomatous (n≥13) and hyperplastic (n≥10) polyps plus controls (n≥16) identified unique expression patterns for VSIG1 and MUC17 in SSA/Ps. CONCLUSION A subset of genes and pathways are uniquely increased in SSA/Ps, compared to adenomatous polyps, thus supporting the concept that cancer develops by different pathways in these phenotypically distinct polyps with markedly different gene expression profiles. Immunostaining for a subset of these genes differentiates both syndromic and sporadic SSA/Ps from adenomatous and hyperplastic polyps.
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Affiliation(s)
- Don A. Delker
- Department of Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Brett M. McGettigan
- Department of Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Priyanka Kanth
- Department of Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Stelian Pop
- Department of Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Deborah W. Neklason
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States of America
| | - Mary P. Bronner
- Department of Pathology, University of Utah, Salt Lake City, Utah, United States of America
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States of America
| | - Randall W. Burt
- Department of Medicine, University of Utah, Salt Lake City, Utah, United States of America
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States of America
| | - Curt H. Hagedorn
- Department of Medicine, University of Utah, Salt Lake City, Utah, United States of America
- Department of Pathology, University of Utah, Salt Lake City, Utah, United States of America
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States of America
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
- The Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, United States of America
- * E-mail:
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Improved molecular classification of serrated lesions of the colon by immunohistochemical detection of BRAF V600E. Mod Pathol 2014; 27:135-44. [PMID: 23887306 DOI: 10.1038/modpathol.2013.126] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 06/03/2013] [Indexed: 01/12/2023]
Abstract
BRAF V600E mutation in serrated lesions of the colon has been implicated as an important mutation and as a specific marker for the serrated carcinogenic pathway. Recent findings point to microvesicular hyperplastic polyps that have similar histologic and molecular features to sessile serrated adenomas/polyps, as potential colorectal carcinoma precursors. The aim of this study was to evaluate BRAF V600E mutation status by immunohistochemistry in serrated lesions of the colon with regard to histomorphology. We investigated 194 serrated lesions of the colon, comprising 42 sessile serrated adenomas/polyps, 16 traditional serrated adenomas, 136 hyperplastic polyps and 20 tubular/tubulovillous adenomas (conventional adenomas) with the novel BRAF V600E mutation-specific antibody VE1. In addition, BRAF exon 15 and KRAS exon 2 status was investigated by capillary sequencing in selected cases. All sessile serrated adenomas/polyps (42/42, 100%), 15/16 (94%) traditional serrated adenomas and 84/136 (62%) hyperplastic polyps were VE1+. None of the VE1- serrated lesions showed BRAF V600E mutation. Forty out of 42 (95%) sessile serrated adenomas/polyps displayed areas with microvesicular hyperplastic polyp-like features. In microvesicular hyperplastic polyps, VE1 positivity was significantly associated with nuclear atypia (P=0.003); however, nuclear atypia was also present in VE1- cases. Immunostaining with VE1 allows not only the detection of BRAF V600E mutation but also the correlation with histomorphology on a cellular level in serrated lesions. VE1 enables a subclassification of microvesicular hyperplastic polyps according to the mutation status. This improved classification of serrated lesions including immunohistochemical evaluation of BRAF V600E mutation may be the key to identify lesions with higher potential to progression into sessile serrated adenoma/polyp, and further to BRAF V600E-mutated colorectal cancer.
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Turner JK, Williams GT, Morgan M, Wright M, Dolwani S. Interobserver agreement in the reporting of colorectal polyp pathology among bowel cancer screening pathologists in Wales. Histopathology 2013; 62:916-24. [PMID: 23611360 DOI: 10.1111/his.12110] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 02/06/2013] [Indexed: 12/27/2022]
Abstract
AIMS To assess the interobserver agreement in the reporting of colorectal polyps among histopathologists participating in the Welsh Bowel Cancer Screening (BCS) programme. METHODS AND RESULTS Twelve benign polyps representative of BCS cases were identified from pathology files and reported by 28 BCS histopathologists using proforma sheets. The level of agreement between the participants and a gold standard was determined using kappa (κ) statistics. A moderate level of agreement was achieved in the reporting of polyp type [κ = 0.45; 95% confidence interval (CI) 0.34-0.59] and adenomatous lesions were distinguished from non-adenomatous lesions in 96% of cases. Substantial agreement was obtained in distinguishing low- and high-grade dysplasias (κ = 0.67; 95% CI 0.50-0.86), but there was only fair agreement in reporting excision margin status (κ = 0.24; 95% CI 0.07-0.43) with frequent use of the 'uncertain' category. Significant issues included categorizing serrated lesions, recognizing focal high-grade dysplasia and epithelial misplacement, and apparent overdiagnosis of villous change in adenomas. CONCLUSIONS Interobserver variability in some aspects of reporting colorectal polyps by BCS pathologists is suboptimal, with a potential impact upon patient management and the efficient running of the screening service. Approaches to addressing this are discussed.
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Affiliation(s)
- Jeff K Turner
- Department of Gastroenterology, University Hospital Llandough, Cardiff, UK
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Mohammadi M, Bzorek M, Bonde JH, Nielsen HJ, Holck S. The stem cell marker CD133 is highly expressed in sessile serrated adenoma and its borderline variant compared with hyperplastic polyp. J Clin Pathol 2013; 66:403-8. [PMID: 23436931 DOI: 10.1136/jclinpath-2012-201192] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Non-dysplastic serrated polyps (ND-SP) represent a heterogeneous group of colorectal lesions that comprise hyperplastic polyp (HP) and the non-dysplastic subset of sessile serrated adenoma/polyp/lesion (SSA/P/L) and its borderline variant (BSSA/P/L). Given the observer variation in their histological typing, the identification of reliable markers that assist in the characterisation is warranted. Most important is the identification of polyp qualities that may reflect the patients' risk of developing colorectal cancer. To address these issues, CD133 may represent a potential adjunct. Here we studied the discriminatory value of CD133 expression in the classification of ND-SPs and its distribution pattern in relation to synchronous colorectal carcinoma (SCRC). 39 SSA/P/Ls, 27 BSSA/P/Ls and 21 matched HPs were immunostained for CD133. The data were further correlated to the presence of SCRC and to polyp site and size. Ignoring SCRC status, CD133 was expressed more prominently in SSA/P/Ls than in HPs. The values for BSSA/P/Ls fell in between, yet closer to the SSA/P/L scorings. This observation was retained in the context of SCRC and for SSA/P/Ls not associated with SCRC. Right-sidedness and large size of the polyps more commonly associated with increased CD133 expression. CD133 expression was not a significant discriminator as to the SCRC status. BSSA/P/Ls are more closely aligned to SSA/P/L and further that SSA/P/L and BSSA/P/Ls fundamentally differ from HP by their CD133 immunoprofile, a notion that can be exploited in the diagnostic routine practice. Recorded data further indirectly support the idea that SSA/P/Ls are more prone to neoplastic progression than are HPs.
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