title: Prospective evaluation of endoscopic criteria characteristic of sessile serrated adenomas/polyps.
abstract: BACKGROUND
  Differentiating sessile serrated adenoma/polyp (SSA/P) from hyperplastic polyp (HP) is clinically important in determining the necessity of endoscopic resection or recommending appropriate surveillance. There are few reports of characterization of SSA/P using narrowband imaging and chromoendoscopy with and without magnification. We aimed to establish imaging criteria to aid real-time diagnosis of SSA/P.
  
  
  METHODS
  Patients with pale sessile or flat lesions of 6 mm or greater were prospectively enrolled in this multicenter trial. Nine endoscopic criteria, determined in real time, were investigated for possible association with SSA/P. Endoscopic mucosal resection was performed; specimens were retrieved and analyzed by histopathological examination.
  
  
  RESULTS
  In 63 patients, 89 lesions were detected, including 41 HP, 38 SSA/P, five mixed polyps, and five other lesions. Right-side colon location, lesion size of 10 mm or greater, excessive mucus, the presence of a varicose microvascular vessel (VMV) noted with high-magnification narrowband imaging, and type III(H) pit pattern were each commonly associated with SSA/P compared with HP. Multivariate analysis substantiated three independent endoscopic criteria for SSA/P: the presence of VMV (p = 0.001), lesion size of 10 mm or greater (p = 0.0017), and right-side location (p = 0.0041), with odds ratios of 8.2, 7.2, and 6.1, respectively. The presence of VMV had a significantly higher specificity (87.8%) than the other two independent endoscopic criteria (p = 0.0007 and p = 0.0008, respectively), but a lower sensitivity (57.9%), whereas a combination of the three criteria (two or more positive) increased the sensitivity significantly (89.5% and p = 0.0033) and had a higher degree of accuracy (82.3%).
  
  
  CONCLUSIONS
  Three endoscopic criteria individually and in combination were effective in predicting a diagnosis of SSA/P without the need for chromoendoscopy.
authors.affiliation: Division for Research and Development of Minor Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo, Japan, turaoka@a3.keio.jp.
authors.forename: Toshio
authors.initials: T
authors.lastname: Uraoka
authors.forename: Reiji
authors.initials: R
authors.lastname: Higashi
authors.forename: Joichiro
authors.initials: J
authors.lastname: Horii
authors.forename: Keita
authors.initials: K
authors.lastname: Harada
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hori
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okada
authors.forename: Motowo
authors.initials: M
authors.lastname: Mizuno
authors.forename: Jun
authors.initials: J
authors.lastname: Tomoda
authors.forename: Nobuya
authors.initials: N
authors.lastname: Ohara
authors.forename: Takehiro
authors.initials: T
authors.lastname: Tanaka
authors.forename: Han-Mo
authors.initials: HM
authors.lastname: Chiu
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yahagi
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000046:Academic Medical Centers; D000236:Adenoma / Q000453:epidemiology / Q000473:pathology*; D018256:Adenomatous Polyps / Q000453:epidemiology / Q000473:pathology*; D000328:Adult; D000368:Aged; D003110:Colonic Neoplasms / Q000453:epidemiology / Q000473:pathology*; D003111:Colonic Polyps / Q000453:epidemiology / Q000473:pathology*; D003113:Colonoscopy / Q000379:methods; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging; D011230:Precancerous Conditions / Q000453:epidemiology / Q000473:pathology*; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012907:Smoking / Q000009:adverse effects