Pathological reassessment of hyperplastic colon polyps in a city-wide pathology practice: implications for polyp surveillance recommendations.
BACKGROUND
Sessile serrated adenomas (SSAs) and hyperplastic polyps (HP) are the two most common types of serrated colon polyps (SCPs). SSAs are suspected to be the precursor lesions for many colorectal cancers, and hence there is an emphasis on their detection and removal. On the other hand, recent guidelines such as those from the European Union consider HPs of limited clinical significance.


OBJECTIVE
Evaluate the reclassification rate of recently diagnosed HPs to SSAs and the predictors of such reclassification. DESIGN, SETTING, INTERVENTION, MAIN OUTCOME MEASUREMENTS: The provincial pathology database was searched for all colon polyps reported in the 6 pathology laboratories in the city of Winnipeg in 2009. All retrieved pathology slides for previously reported right-sided HPs and a 20% random sample of left-sided HPs were reassessed by two pathologists with a special interest in GI pathology. Polyp size, colon location, and age and sex of the study participants were evaluated as potential predictors of reclassification.


RESULTS
A total of 4096 pathology reports by 25 different pathologists were reviewed. Twenty percent of the polyps were reported as SCPs. Seventeen percent of right-sided previously reported HPs and 20% of those >5 mm were reclassified as SSAs. Size >5 mm (odds ratio [OR] 4.2; 95% confidence interval [CI], 1.5-11.4) and location in the right side of the colon (OR 4.7; 95% CI, 1.4-15.4) were independent predictors of reclassification.


CONCLUSIONS
Retrospective review.


CONCLUSIONS
A significant proportion of recently reported right-sided HPs may be SSAs. Surveillance recommendations for SCPs should consider the size and location of SCPs and not just the reported type.
Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Harminder
H
Singh
Diane
D
Bay
Stephen
S
Ip
Charles N
CN
Bernstein
Zoann
Z
Nugent
Rodica
R
Gheorghe
Robert
R
Wightman
D000236:Adenoma / Q000145:classification / Q000473:pathology*; D000368:Aged; D044682:Colon, Ascending / Q000473:pathology; D044683:Colon, Descending / Q000473:pathology; D003110:Colonic Neoplasms / Q000145:classification / Q000473:pathology*; D003111:Colonic Polyps / Q000145:classification / Q000473:pathology*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D008350:Manitoba; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011159:Population Surveillance; D012189:Retrospective Studies; D019037:Urban Health Services