Endoscopic analysis of colorectal serrated lesions with cancer

Abstract

Serrated lesions, including hyperplastic polyps (HPs), traditional serrated adenomas (TSAs) and sessile serrated adenomas/polyps (SSA/Ps), are important contributors to colorectal carcinogenesis. The aim of the present study was to analyze the potential of conventional endoscopy and advanced endoscopic imaging techniques to delineate the characteristic features of serrated lesions with cancer. The present study was a retrospective analysis of the data of 168 patients who had undergone colonoscopy, and a total of 228 serrated lesions (77 HPs, 58 TSAs, 84 SSA/Ps, 9 SSA/P plus TSAs) have been identified in these patients. A cancer component was identified in 2.6% of HPs, 13.8% of TSAs and 10.7% of SSA/Ps, but none of SSA/P plus TSAs. Compared with the lesions without cancer, the lesions with cancer exhibited a larger size (HP, TSA and SSA/P), a reddish appearance (SSA/P), a two-tier raised appearance (HP and SSA/P), a central depression (HP, TSA and SSA/P), the type V pit pattern (HP, TSA and SSA/P), and/or the type III capillary pattern (TSA and SSA/P). Deep invasion was identified in 50.0% of HPs, 12.5% of TSAs and 55.6% of SSA/Ps with cancer. The Ki-67 proliferative zone was distributed diffusely within the area of the cancer, but partially within the non-cancer area of HPs, TSAs and SSA/Ps. The lesion types were also analyzed on the basis of mucin phenotype. The present study suggested that a detailed endoscopic analysis of serrated lesions with cancer is useful for delineating characteristic features, and the analysis aids treatment selection.

Which Lesions Are at Higher Risk of Developing Colorectal Carcinomas: Superficially Elevated Serrated Lesions or Depressed Lesions?

“…In an analysis of a large number of carcinomas invading the submucosa, 6% were serrated with the invasion of the submucosa and four SSA with the invasion of the submucosa (1.6% of the total of carcinomas with invasion of the submucosa) 12 . In another publication, invasive carcinomas were diagnosed in 1.3% of resected hyperplastic polyps (one case, already invading the muscularis propria) and 5.9% of SSA (four cases invading the submucosa and one the muscularis propria) 22 .…”

“…In these lesions, dysplasia or carcinomas are more frequently diagnosed in large pediculated or (sub)pediculated lesions, with double elevation (two layers), depressions, and reddish color 21 , and in foci of adenomas that appear on their surfaces 33 . In cases with invasive carcinomas, all had irregular or effaced crypt patterns 21 , 22 . However, histopathological examination of the entire lesion remains the diagnostic gold standard.…”