title: Optical biopsy of sessile serrated adenomas: do these lesions resemble hyperplastic polyps under narrow-band imaging?
abstract: BACKGROUND
  Serrated colorectal lesions include hyperplastic polyps (HPs) and sessile serrated adenomas (SSAs). Optical biopsy could misclassify SSAs as unimportant if they resemble HPs.
  
  
  OBJECTIVE
  To explore the narrow-band imaging (NBI) features of SSAs. We hypothesized that SSAs resemble HPs under NBI.
  
  
  METHODS
  Retrospective analysis of data from our prospective study of NBI in routine practice.
  
  
  METHODS
  Single specialty group.
  
  
  METHODS
  Patients undergoing colonoscopy.
  
  
  METHODS
  Colonoscopy.
  
  
  METHODS
  Polyp histology prediction by community gastroenterologists. Features of SSAs versus HPs and adenomas by using the Narrow-Band Imaging International Colorectal Endoscopic (NICE) Classification.
  
  
  RESULTS
  Among 2388 lesions, 141 were diagnosed on pathology as SSAs, 465 as HPs, and 1546 as adenomas. Each individual NICE feature of HPs was found in 38% to 42% of SSAs, 66% to 67% of HPs, and 15% to 20% of adenomas (P < .001 for each). Each individual NICE feature of adenomas was found in 57% to 62% of SSAs, 33% to 34% of HPs, and 80% to 84% of adenomas (P < .001 for each). Compared with HPs, SSAs were less likely (odds ratio [OR] 0.74; 95% confidence interval [CI], 0.69-0.79) and adenomas were even less likely (OR 0.62; 95% CI, 0.59-0.64) to have all 3 NICE features of HPs. SSAs >5 mm were more likely than smaller SSAs to have all 3 NICE features of adenomas. SSA location did not predict NBI features. Analyses restricted to high-confidence lesions showed similar results.
  
  
  CONCLUSIONS
  The endoscopists were not NBI experts.
  
  
  CONCLUSIONS
  Community gastroenterologists observed a profile of NICE features among SSAs that was intermediate to the profiles observed for HPs and adenomas. These results require confirmation by NBI experts.
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Sheila
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Huron Gastroenterology Associates, Ann Arbor, Michigan.
authors.forename: Ann
authors.initials: A
authors.lastname: Fioritto
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California; Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California.
authors.forename: Aya
authors.initials: A
authors.lastname: Mitani
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California; Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California.
authors.forename: Manisha
authors.initials: M
authors.lastname: Desai
authors.affiliation: Huron Gastroenterology Associates, Ann Arbor, Michigan.
authors.forename: Naresh
authors.initials: N
authors.lastname: Gunaratnam
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Uri
authors.initials: U
authors.lastname: Ladabaum
mesh_terms: D000236:Adenoma / Q000145:classification / Q000473:pathology*; D000368:Aged; D001706:Biopsy; D002983:Clinical Competence; D003106:Colon / Q000473:pathology*; D003111:Colonic Polyps / Q000473:pathology*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000145:classification / Q000473:pathology*; D005260:Female; D005762:Gastroenterology; D006801:Humans; D006965:Hyperplasia / Q000473:pathology; D008297:Male; D008875:Middle Aged; D062048:Narrow Band Imaging; D012189:Retrospective Studies
keywords: HP; NBI; NBI International Colorectal Endoscopic (classification); NICE; SSA; hyperplastic polyp; narrow-band imaging; sessile serrated adenoma