Hyperplastic polyps identified during screening endoscopy: Reevaluated by histological examinations and genetic alterations
Journal
Journal of the Formosan Medical Association
Journal Volume
113
Journal Issue
7
Pages
417-421
Date Issued
2014
Author(s)
Abstract
Background/Purpose: Screening colonoscopy is one of the most effective methods to detect and prevent colorectal cancer by removing neoplastic polyps. The recent discovery of serrated polyps with neoplastic potential has reclassified these polyps into hyperplastic polyps (HPs), sessile serrated adenoma (SSA), and traditional serrated adenoma (TSA) on the basis of macroscopic morphology and microscopic histology. In this study, we aimed to revisit HPs identified during screening endoscopy by histological reevaluation and genetic alterations. Methods: A total of 253 HPs found by screening endoscopy were rechecked by two pathologists, and mutual agreement on the diagnosis of polyps was subjected for further statistical analysis. Direct sequencing for gene mutation at BRAF V600E and KRAS G12D was performed. Results: Among the 253 HPs analyzed, 175 were classified as serrated polyps, while 78 were reclassified into other diagnosis. The concordance among pathologists in diagnosing these serrated polyps was substantial (κ=0.6672). About 11.5% of the reviewed HPs turned out to be with neoplastic potential, including 7 SSAs, 5 TSAs, as well as 17 conventional adenomas. Results of subgroup analyses revealed that polyps >10mm were more likely to be found in proximal colon (. p=0.0006) and tended to harbor neoplastic components. We found that two SSAs and one TSA had BRAF mutation, while one TSA had KRAS mutation. The mean size of these mutated adenomas (9.0mm) was larger than those with wild-type genes (4.9mm). Conclusion: Serrated polyps with neoplastic potential were prone to be overlooked as hyperplastic and innocent ones during screening colonoscopy. Therefore, both endoscopists and pathologists should pay attention to understand the importance of recognizing serrated adenomas, especially for those polyps >10mm, or those that are located in the proximal colon. ? 2012.
SDGs
Other Subjects
B Raf kinase; K ras protein; B Raf kinase; BRAF protein, human; KRAS protein, human; oncoprotein; Ras protein; adenomatous polyp; adult; aged; article; ascending colon; clinical evaluation; colon adenoma; colon polyp; colonoscopy; descending colon; endoscopist; female; gene mutation; genetic disorder; histopathology; human; hyperplastic polyp; major clinical study; male; rectum adenoma; traditional serrated adenoma; tubulovillous adenoma; tumor volume; very elderly; adenoma; colon polyp; colon tumor; colonoscopy; early diagnosis; genetics; hyperplasia; middle aged; mutation; pathology; Adenoma; Adult; Aged; Aged, 80 and over; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Early Detection of Cancer; Female; Humans; Hyperplasia; Male; Middle Aged; Mutation; Proto-Oncogene Proteins; Proto-Oncogene Proteins B-raf; ras Proteins; Tumor Burden
Publisher
Elsevier
Type
journal article