Serrated Lesion Detection in a Population-based Colon Screening Program

Abstract

Background: Serrated lesions give rise to 15% to 30% of all colorectal cancers, driven predominantly by the sessile serrated polyp (SSP). Fecal immunochemical test (FIT), has low sensitivity for SSPs. SSP detection rate (SSPDR) is influenced by performance of both endoscopists and pathologists, as diagnosis can be subtle both on endoscopy and histology.Goals: To evaluate the SSPDR in a population-based screening program, and the influence of subspecialty trained pathologists on provincial reporting practices. Study:The colon screening program database was used to identify all FIT-positive patients that received colonoscopy between January 2014 and June 2017. Patient demographics, colonoscopy quality indicators, pathologic diagnoses, and FIT values were collected. This study received IRB approval.Results: A total of 74,605 colonoscopies were included and 26.6% had at least 1 serrated polyp removed. The SSPDR was 7.0%, with 59% of the SSPs detected having a concurrent conventional adenoma. The mean FIT value for colonoscopies with only serrated lesions was less than that for colonoscopies with a conventional adenoma or colorectal cancer (P < 0.0001). Centers with a gastrointestinal subspecialty pathologist diagnosed proportionally more SSPs (P < 0.0001), and right-sided SSPs than centers without subspecialists.Conclusions: Serrated lesions often occur in conjunction with conventional adenomas and are associated with lower FIT values. Knowledge of the characteristics of SSPs is essential for pathologists to ensure accurate diagnosis of SSPs.

Sessile serrated polyp detection rates after fecal immunochemical test or multitarget stool DNA test: Systematic review and meta-analysis

“…Seventyfive full-length articles were assessed for inclusion and 23 studies were included in the final analysis [19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41]. Sixteen studies reported SSPDR after only FIT testing [19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34], three reported SSPDR on both FIT and FIT-DNA [35,36,37], and three studies reported SSPDR after only FIT-DNA testing (▶ Fig. 1) [38,39,40,41].…”

Efficacy of oral sulfate tablets for bowel preparation and adenoma detection rate

“…A serrated neoplastic pathway in which serrated polyps, including sessile serrated adenomas and traditional serrated adenomas, progress to colorectal cancer has been proposed as an alternative to the adenoma–carcinoma sequence and is considered partially responsible for the risk of interval colorectal cancer, especially in the proximal colon 25–27 . SSPs are difficult to identify endoscopically because they are sessile or flat, similar in color to the surrounding mucosa, and located in the proximal colon 28 . High‐quality bowel preparation is required for the detection of SSPs 29 .…”

“…[25][26][27] SSPs are difficult to identify endoscopically because they are sessile or flat, similar in color to the surrounding mucosa, and located in the proximal colon. 28 High-quality bowel preparation is required for the detection of SSPs. 29 Therefore, the aim of this study was to evaluate the quality indicators of colonoscopy, such as the ADR and SSPDR, as well as the degree of bowel cleansing when using OSTs as a bowel preparation.…”