title: Histology subtypes and polyp size are associated with synchronous colorectal carcinoma of colorectal serrated polyps: a study of 499 serrated polyps.
abstract: Sessile serrated adenomas (SSA) and traditional serrated adenomas (TSA) are considered as precursors of colorectal cancer, and are often diagnostic challenges. Their true prevalence is masked by significant inter-observer variations. To investigate the true prevalence and synchronous colorectal carcinoma (sCRC) of colorectal serrated polyps (CSP) and their associated factors, we first retrospectively identified all colorectal polyps collected at our institution between June 1995 and May 2013. After centrally reclassifying all CSP to reduce inter-observer variations, Chi-square tests and logistic regression analyses were used to analyze the potential factors. Among the included 5501 colorectal polyps, 499 CSP of 428 patients were identified and studied, including 353 hyperplastic polyps (HP, 70.7%), 80 SSA (16.0%), 61 TSA (12.2%) and 5 mixed polyp (1.0%). Diagnostic disagreements were found in 68 CSP (13.63% of CSP). SSA and TSA were more often larger than 5 mm and in proximal colon than HP. SSA were also more likely associated with older age (p=0.005), size ≥5 mm (p<0.001) and ≥3 polyps (p=0.004) than HP in distal colon, but only more likely associated with older age (p=0.006) in proximal colon. Multivariate regression analysis demonstrated that CSP with sCRC, compared with CSP without sCRC, were linked to CSP size ≥1 cm (vs <1 cm, odds ratio [OR] 4.412, 95% confidence interval [CI] 1.684-11.556, P=0.003) and a diagnosis of SSA or TSA (vs HP, OR 6.194, 95% CI 1.870-20.513, P=0.003 and OR 6.754, 95% CI 1.981-23.028, P=0.002, respectively), but not age, gender, polyp number and polyp shape. SSA and TSA are similarly often associated with sCRC (P=0.460). In conclusion, histology subtypes and polyp size may serve as markers for sCRC of CSP. SSA and TSA may warrant careful endoscopic examinations and similar follow-up intervals.
authors: Department of Pathology, Tongji Hospital, Tongji University School of Medicine Shanghai, China.
authors: Hailong
authors: H
authors: Zhu
authors: Department of General Surgery, Tongji Hospital, Tongji University School of Medicine Shanghai, China.
authors: Guofeng
authors: G
authors: Zhang
authors: Department of Pathology, Tongji Hospital, Tongji University School of Medicine Shanghai, China.
authors: Xianghua
authors: X
authors: Yi
authors: Department of Pathology, Tongji Hospital, Tongji University School of Medicine Shanghai, China.
authors: Xuyou
authors: X
authors: Zhu
authors: Department of Pathology, Tongji Hospital, Tongji University School of Medicine Shanghai, China.
authors: Yunjin
authors: Y
authors: Wu
authors: Department of Pathology, Tongji Hospital, Tongji University School of Medicine Shanghai, China.
authors: Jun
authors: J
authors: Liang
authors: Department of Pathology, Tongji Hospital, Tongji University School of Medicine Shanghai, China.
authors: Suxia
authors: S
authors: Zhang
authors: Department of Pathology, Tongji Hospital, Tongji University School of Medicine Shanghai, China.
authors: Yu
authors: Y
authors: Zeng
authors: Department of Pathology, Tongji Hospital, Tongji University School of Medicine Shanghai, China.
authors: Desheng
authors: D
authors: Fan
authors: Department of Pathology, Tongji Hospital, Tongji University School of Medicine Shanghai, China.
authors: Xiaoting
authors: X
authors: Yu
authors: Department of Pathology, Tongji Hospital, Tongji University School of Medicine Shanghai, China.
authors: Jian
authors: J
authors: He
authors: Institute of Health Sciences, Kunming Medical University Kunming, China.
authors: Guozhong
authors: G
authors: He
authors: J-star Research Inc. South Plainfield, NJ, USA.
authors: Zheng
authors: Z
authors: Chen
authors: Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences Shanghai, China.
authors: Shengzhong
authors: S
authors: Duan
authors: Department of Pathology, University Medical Center of Princeton Plainsboro, NJ, USA ; Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers University Piscataway, NJ, USA ; Department of Pathology, Robert Wood Johnson Medical School, Rutgers University Piscataway, NJ, USA ; Cancer Institute of New Jersey, Rutgers University Piscataway, NJ, USA.
authors: Lanjing
authors: L
authors: Zhang
keywords: Conventional adenoma; colon; hyperplastic polyp; sessile serrated adenoma; traditional serrated adenoma
references: J Gastroenterol Hepatol. 2013 Apr;28(4):608-12
references: 23278321
references: Histopathology. 2010 Apr;56(5):581-8
references: 20459568
references: Am J Gastroenterol. 2012 Sep;107(9):1315-29; quiz 1314, 1330
references: 22710576
references: Virchows Arch. 2007 Jun;450(6):613-8
references: 17450379
references: Am J Gastroenterol. 2008 Mar;103(3):788-97
references: 18341497
references: Gastroenterology. 2012 Sep;143(3):844-57
references: 22763141
references: Scand J Gastroenterol. 2012 Feb;47(2):178-83
references: 22229626
references: Clin Transl Gastroenterol. 2012 Jan 05;3:e6
references: 23238028
references: N Engl J Med. 2013 Sep 19;369(12):1106-14
references: 24047060
references: Gut. 2014 Jan;63(1):7-42
references: 24165758
references: Am J Surg Pathol. 2013 Nov;37(11):1660-70
references: 23887157
references: Histopathology. 2009 Aug;55(2):206-13
references: 19694828
references: Gastroenterology. 2010 Nov;139(5):1497-502
references: 20633561
references: Gut. 2010 May;59(5):666-89
references: 20427401
references: Virchows Arch. 2010 Sep;457(3):291-7
references: 20617338
references: World J Gastroenterol. 2010 Jul 21;16(27):3402-5
references: 20632442
references: Gastroenterology. 2006 Nov;131(5):1400-7
references: 17101316
references: Hum Pathol. 2010 Oct;41(10):1359-68
references: 20594582
references: N Engl J Med. 1993 Dec 30;329(27):1977-81
references: 8247072
references: J Clin Pathol. 2012 Oct;65(10):924-7
references: 22782936
references: Hum Pathol. 2011 Jan;42(1):1-10
references: 20869746
references: J Gastroenterol. 2013 Mar;48(3):287-302
references: 23208018
references: Am J Gastroenterol. 2009 Mar;104(3):695-702
references: 19223889
references: Gastroenterology. 2014 Jan;146(1):305-6
references: 24269291
references: BMC Gastroenterol. 2014 Apr 28;14:82
references: 24775268
references: Am J Clin Pathol. 2007 Jun;127(6):938-45
references: 17509991
references: J Clin Pathol. 2014 Jun;67(6):491-8
references: 24570042
references: CA Cancer J Clin. 2013 Jan;63(1):11-30
references: 23335087
references: Am J Surg Pathol. 2004 Apr;28(4):423-34
references: 15087661
references: World J Gastroenterol. 2009 Aug 14;15(30):3767-70
references: 19673017
references: Endoscopy. 2007 Sep;39(9):840-2
references: 17703397
references: Gut. 2006 Dec;55(12 ):1821-2
references: 17124164
references: Gut Liver. 2013 Sep;7(5):524-31
references: 24073309
references: Endoscopy. 2013 Oct;45(10):842-51
references: 24030244
references: Am J Surg Pathol. 2008 Jan;32(1):30-5
references: 18162767
references: Am J Gastroenterol. 2010 Dec;105(12):2656-64
references: 20717107
references: J Clin Pathol. 2009 Jun;62(6):516-8
references: 19126563
references: Dis Colon Rectum. 2011 Oct;54(10):1216-23
references: 21904135
references: World J Gastroenterol. 2013 Aug 28;19(32):5271-7
references: 23983429
references: Gut. 2014 Jun;63(6):957-63
references: 23744612
references: Int J Clin Exp Pathol. 2014 Mar 15;7(4):1635-43
references: 24817960
references: Gastrointest Endosc. 2013 Aug;78(2):333-341.e1
references: 23623039
references: Virchows Arch. 2013 Nov;463(5):633-6
references: 23982168
references: J Clin Pathol. 2010 Aug;63(8):681-6
references: 20547691
references: Endoscopy. 2014 Mar;46(3):219-24
references: 24254386