Distinct endoscopic characteristics of sessile serrated adenoma/polyp with and without dysplasia/carcinoma.
OBJECTIVE
Sessile serrated adenoma/polyp (SSA/P) is a colorectal polyp that has malignant potential. However, the dysplastic components within an SSA/P can be difficult to detect. This study aimed to clarify the endoscopic characteristics of SSA/P with advanced histology.


METHODS
We examined 462 endoscopically or surgically resected lesions that were pathologically diagnosed as SSA/P, including 414 without and 41 with cytologic dysplasia, and 7 with invasive carcinoma. We retrospectively studied the clinicopathologic and endoscopic characteristics and performed pit pattern analysis.


RESULTS
A stepwise increase in the size of the SSA/P series was identified along with their dysplastic progression, although 19 of 48 (39.6%) SSA/Ps with dysplasia/carcinoma were ≤10 mm in size. Most lesions were covered with a mucus cap. Macroscopically, (semi)pedunculated morphology, double elevation, central depression, and reddishness were found more frequently in SSA/P with cytologic dysplasia and invasive carcinoma ([semi]pedunculated morphology, 17.1%/28.6%; double elevation, 63.4%/57.1%; central depression, 9.8%/28.6%; reddishness, 39.0%/85.7%) than in those without dysplasia (4.6%, 4.6%, 3.9%, and 3.4%, respectively). Furthermore, the presence of at least 1 of these 4 markers had high sensitivity (91.7%) for identifying the dysplasia/carcinoma within a SSA/P, with a specificity of 85.3%. In the pit pattern analysis, all SSA/Ps without dysplasia exhibited type II pit pattern only, whereas 94.4% of SSA/Ps with dysplasia/carcinoma showed type II in addition to type IIIL, IV, VI, or VNpit patterns.


CONCLUSIONS
In an SSA/P series, endoscopic characteristics, including (semi)pedunculated morphology, double elevation, central depression, and reddishness, in addition to the use of magnifying endoscopy, may be useful to accurately diagnose advanced histology within an SSA/P.
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan; Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan.
Takashi
T
Murakami
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Naoto
N
Sakamoto
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Hideaki
H
Ritsuno
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Tomoyoshi
T
Shibuya
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Taro
T
Osada
Department of Pathology, Japan Labor Health and Welfare Organization, Kanto Rosai Hospital, Kanagawa, Japan.
Hiroyuki
H
Mitomi
Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan.
Takashi
T
Yao
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Sumio
S
Watanabe
D000236:Adenoma / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D003111:Colonic Polyps / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D047368:Tumor Burden