title: Serrated neoplasia-role in colorectal carcinogenesis and clinical implications.
abstract: Colorectal cancer (CRC) is considered a heterogeneous disease, both regarding pathogenesis and clinical behaviour. Four decades ago, the adenoma-carcinoma pathway was presented as the main pathway towards CRC, a conclusion that was largely based on evidence from observational morphological studies. This concept was later substantiated at the genomic level. Over the past decade, evidence has been generated for alternative routes in which CRC might develop, in particular the serrated neoplasia pathway. Providing indisputable evidence for the neoplastic potential of serrated polyps has been difficult. Reasons include the absence of reliable longitudinal observations on individual serrated lesions that progress to cancer, a shortage of available animal models for serrated lesions and challenging culture conditions when generating organoids of serrated lesions for in vitro studies. However, a growing body of circumstantial evidence has been accumulated, which indicates that ≥15% of CRCs might arise through the serrated neoplasia pathway. An even larger amount of post-colonoscopy colorectal carcinomas (carcinomas occurring within the surveillance interval after a complete colonoscopy) have been suggested to originate from serrated polyps. The aim of this Review is to assess the current status of the serrated neoplasia pathway in CRC and highlight clinical implications.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, Meibergdreef 9, Amsterdam, 1105AZ, Netherlands.
authors.forename: Joep E G
authors.initials: JE
authors.lastname: IJspeert
authors.affiliation: Laboratory for Experimental Oncology and Radiobiology, Center for Experimental Molecular Medicine, Academic Medical Centre, Meibergdreef 9, Amsterdam, 1105AZ, Netherlands.
authors.forename: Louis
authors.initials: L
authors.lastname: Vermeulen
authors.affiliation: Department of Pathology, VU University Medical Center, De Boelelaan 1117, Amsterdam 1081HZ, Netherlands.
authors.forename: Gerrit A
authors.initials: GA
authors.lastname: Meijer
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, Meibergdreef 9, Amsterdam, 1105AZ, Netherlands.
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
mesh_terms: D003111:Colonic Polyps / Q000145:classification / Q000473:pathology*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000378:metabolism / Q000473:pathology*; D018450:Disease Progression; D019317:Evidence-Based Medicine; D006801:Humans; D011230:Precancerous Conditions / Q000145:classification / Q000473:pathology*