title: Endoscopic detection of proximal serrated lesions and pathologic identification of sessile serrated adenomas/polyps vary on the basis of center.
abstract: OBJECTIVE
  We investigated rates of detection of proximal serrated lesions in a cohort of average-risk patients undergoing screening colonoscopies.
  
  
  METHODS
  We reviewed results from screening colonoscopies performed by attending gastroenterologists at 32 endoscopy centers from 2008-2010. Pathology slides were interpreted at the individual centers. For this analysis, serrated lesions included hyperplastic polyps larger than 10 mm, those interpreted as sessile serrated adenomas (or sessile serrated polyp), and traditional serrated adenomas. Rates of detection for conventional adenomas and serrated lesions were compared among centers.
  
  
  RESULTS
  A total of 5778 lesions were detected in 7215 screening colonoscopies. Of the 5548 lesions with pathology results, 3008 (54.2%) were conventional adenomas, 350 (6.3%) were serrated, and 232 (4.2%) were proximal serrated. The proportion of colonoscopies with at least 1 proximal serrated lesion was 2.8% (range among centers, 0%-9.8%). The number of serrated lesions per colonoscopy ranged from 0.00-0.11 (average, 0.05 ± 0.25). Overall lesion detection rates correlated with proximal serrated lesion detection rates (R = 0.91, P < .0001); conventional adenoma and proximal serrated lesion detection rates also correlated (R = .43, P = .025). The detection rate of proximal serrated lesions differed significantly among centers (P < .0001); odds ratios for detection ranged from 0-0.79. Some centers' pathologists never identified proximal serrated lesions as sessile serrated adenomas/polyps.
  
  
  CONCLUSIONS
  In an average-risk screening cohort, detection of proximal serrated lesions varied greatly among endoscopy centers. There was also substantial variation among pathologists in identification of sessile serrated adenomas/polyps. Nationally, a significant proportion of proximal serrated lesions may be missed during colonoscopy examination or incorrectly identified during pathology assessment. ClinicalTrials.gov Number: NCT00855348.
authors: Seattle, Washington.
authors: Shannon R
authors: SR
authors: Payne
authors: University of Minnesota School of Public Health, Minneapolis, Minnesota.
authors: Timothy R
authors: TR
authors: Church
authors: CRQ Insight, LLC, Mercer Island, Washington.
authors: Michael
authors: M
authors: Wandell
authors: Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors: Thomas
authors: T
authors: Rösch
authors: Atlanta Gastroenterology Associates, Atlanta, Georgia.
authors: Neal
authors: N
authors: Osborn
authors: Fairview Southdale Hospital, Minneapolis, Minnesota.
authors: Dale
authors: D
authors: Snover
authors: Fred Hutchinson Cancer Research Center, Seattle, Washington; Epigenomics, Inc, Seattle, Washington.
authors: Robert W
authors: RW
authors: Day
authors: Departments of Medicine and Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: David F
authors: DF
authors: Ransohoff
authors: Indiana University, Indianapolis, Indiana. Electronic address: drex@iupui.edu.
authors: Douglas K
authors: DK
authors: Rex
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D006268:Health Facilities; D006801:Humans; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis*
keywords: Cancer Screening; Colon Cancer; Early Detection; Hyperplastic Polyp; Sessile Serrated Adenoma; Sessile Serrated Polyp