Flat neoplastic lesions of the colon and rectum detected by high-resolution video endoscopy and chromoscopy

Jaramillo, Edgar; Watanabe, Makoto; Slezak, P; Rubio, Carlos A.

doi:10.1016/s0016-5107(95)70066-8

Cited by 235 publications

(125 citation statements)

References 39 publications

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“…As a strength, all endoscopists were familiarized with the recognition of nonpolypoid colorectal lesions before commencing this study. This was essential, as nearly half of the serrated polyps have a nonpolypoid appearance (5,6). We used a standardized endoscopic reporting system, including quality benchmarking, and applied the WHO histologic classification of serrated polyps.…”

Section: Discussionmentioning

confidence: 99%

“…The serrated neoplastic pathway may contribute to the occurrence of some postcolonoscopy cancers, as some precursor lesions, especially sessile serrated adenomas/polyps (SSA/P), are easily overlooked during colonoscopy (5,6) and are more challenging to remove endoscopically (7). It is generally accepted that large, proximal, or dysplastic (LPD) serrated polyps (SP) purport significant risk for malignant transformation, whereas nondysplastic small distal serrated polyps do not (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

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Simple Clinical Risk Score Identifies Patients with Serrated Polyps in Routine Practice

Bouwens

Winkens

Rondagh

et al. 2013

Cancer Prevention Research

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Large, proximal, or dysplastic (LPD) serrated polyps (SP) need accurate endoscopic recognition and removal as these might progress to colorectal cancer. Herewith, we examined the risk factors for having 1 LPD SP. We developed and validated a simple SP risk score as a potential tool for improving their detection. We reviewed clinical, endoscopic, and histologic features of serrated polyps in a study of patients undergoing elective colonoscopy (derivation cohort). A self-administered questionnaire was obtained. We conducted logistic regression analyses to identify independent risk factors for having 1 LPD SP and incorporated significant variables into a clinical score. We subsequently tested the performance of the SP score in a validation cohort. We examined 2,244 patients in the derivation and 2,402 patients in the validation cohort; 6.3% and 8.2% had 1 LPD SP, respectively. Independent risk factors for LPD SPs were age of more than 50 years [OR 2.2; 95% confidence interval (CI), 1.3-3.8; P ¼ 0.004], personal history of serrated polyps (OR 2.6; 95% CI, 1.3-4.9; P ¼ 0.005), current smoking (OR 2.2; 95% CI, 1.4-3.6; P ¼ 0.001), and nondaily/no aspirin use (OR 1.8; 95% CI, 1.1-3.0; P ¼ 0.016). In the validation cohort, a SP score 5 points was associated with a 3.0-fold increased odds for LPD SPs, compared with patients with a score <5 points. In the present study, age of more than 50 years, a personal history of serrated polyps, current smoking, and nondaily/no aspirin use were independent risk factors for having LPD SPs. The SP score might aid the endoscopist in the detection of such lesions. Cancer Prev Res; 6(8); 855-63. Ó2013 AACR.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Simple Clinical Risk Score Identifies Patients with Serrated Polyps in Routine Practice

Bouwens

Winkens

Rondagh

et al. 2013

Cancer Prevention Research

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“…[2][3][4] Nonpolypoid colorectal neoplasias exhibit histological features that differ from those of polypoid adenomas, being mainly tubular structures that may show high-grade dysplasia at an early stage. [5][6][7] The grade of dysplasia in nonpolypoid colorectal neoplasias may not necessarily be related to size or to a villous component.…”

mentioning

confidence: 99%

“…It has been reported that there may be a different clinical behavior and histopathological character between nonpolypoid and polypoid adenomas, [2][3][4][5][6][7] suggesting an alternative pathway in the genesis of colorectal cancer. 9,10 However, the clinical and molecular genetic dignity of nonpolypoid neoplastic lesions still remain rather unclear.…”

mentioning

confidence: 99%

Distinct Chromosomal Imbalances in Nonpolypoid and Polypoid Colorectal Adenomas Indicate Different Genetic Pathways in the Development of Colorectal Neoplasms

Richter¹,

Slezak

Walch

et al. 2003

The American Journal of Pathology

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Cytogenetic changes are widely unknown for nonpolypoid (synonymously termed as "flat" or "depressed") colorectal adenomas. A comparison with polypoid adenomas will contribute to the discussion whether different genetic pathways for colorectal tumorigenesis depending on its origin from nonpolypoid or polypoid adenomas exist. Tissue samples of nonpolypoid (n ‫؍‬ 22), polypoid (n ‫؍‬ 28) adenomas, carcinomas ex-nonpolypoid adenomas (n ‫؍‬ 9), carcinomas ex-polypoid adenomas (n ‫؍‬ 14), and normal colonic mucosa (n ‫؍‬ 9) were investigated by comparative genomic hybridization of whole genomic DNA. Chromosomal imbalances were detected from average comparative genomic hybridization profiles for each entity. Nonpolypoid adenomas show recurrent chromosomal losses on chromosomes 16, 17p, 18, 20, and 22 and gains on chromosomes 2q, 4q, 5, 6, 8q, 12q, and 13q. In polypoid adenomas losses of whole chromosomes 16, 18, and 22 and gains of chromosomes 7q and 13 were detected. The frequency of copy number changes was higher in nonpolypoid compared to polypoid adenomas and early onset of chromosomal changes became apparent in low-grade dysplasias of nonpolypoid adenomas. Gains on chromosomes 2q, 5, 6, 8q, and 12q and losses on chromosomes 17p and 20 occurred exclusively in nonpolypoid adenomas, whereas 16p dele-

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“…In our study, we subclassified the FAs as completely flat adenomas (CFAs), depressed adenomas (DAs), and superficially elevated adenomas (SEAs), depending on their low microscopic shape, as described in several reports (1,(6)(7)(8) (Figure 1a-d). Since the SEAs, which are slightly elevated although not polypoid, have similar endoscopic features of a typical small polypoid TA (pTA), we also investigated the clinicopathological differences between them.…”

Section: Methodsmentioning

confidence: 99%

Comparison of the clinicopathological features of flat and polypoid colorectal adenomas that are smaller than or equal to five millimeters

Mıdı²,

C³

2014

Turk J Gastroenterol

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Background/Aims: Colorectal flat adenomas (FAs) may represent a different histogenesis, since their malignant potential is thought to be higher than polypoid adenomas of the same size. In this study, we classified FAs of ≤5 mm into three subgroups-superficially elevated adenomas (SEAs), completely flat adenomas (CFAs), and depressed adenomas (DAs)-based on their low microscopic shapes and compared their clinicopathological features with polypoid tubular adenomas (pTAs) with the same size. Materials and Methods: One hundred one pTAs and 46 FAs with tubular morphology with the same size (≤5 mm) were studied. Results: The percentages of high-grade dysplasia in FAs and pTAs were 19.56% and 12.87%, respectively. The percentages of the high-grade dysplasia were 28.57%, 13.63%, and 20.00% in the DA, SEA, and CFA subgroups, respectively. FAs had a significantly higher number of normal epithelium at the basal crypts of the lesion than the pTAs (p=0.001). The presence of pericryptal mesenchymal cells was higher in pTAs than the FAs (78.21% vs 10.86%) (p<0.001). Conclusion: Flat adenoma represents a distinct type of colorectal adenoma with special histopathological properties-existence of a normal epithelium at the basal crypts, lack of pericryptal mesenchymal cells, and a high percentage of highgrade dysplasia-especially when it has a depressed shape at low magnification.

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Flat neoplastic lesions of the colon and rectum detected by high-resolution video endoscopy and chromoscopy

Cited by 235 publications

References 39 publications

Simple Clinical Risk Score Identifies Patients with Serrated Polyps in Routine Practice

Simple Clinical Risk Score Identifies Patients with Serrated Polyps in Routine Practice

Distinct Chromosomal Imbalances in Nonpolypoid and Polypoid Colorectal Adenomas Indicate Different Genetic Pathways in the Development of Colorectal Neoplasms

Comparison of the clinicopathological features of flat and polypoid colorectal adenomas that are smaller than or equal to five millimeters

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