Verification of the increase in concomitant dysplasia and cancer with the size of sessile serrated lesions

Abstract

Background and study aims This study aimed to evaluate the relationship between sessile serrated lesion (SSL) size and the comorbidity rate of SSL with dysplasia (SSLD) and cancer in SSL (SSL-cancer).

Patients and methods This retrospective, single-center analysis identified SSL cases that underwent endoscopic resection between January 2015 and December 2022. The prevalence of SSL, SSLD, and SSL-cancer and their annual trends were assessed. The tumor diameter was stratified as 0 to 5 mm, 6 to 9 mm, 10 to 19 mm, and ≥ 20 mm in size. Furthermore, the frequency of SSL-D/SSL-cancer was determined in each group.

Results The prevalence of SSL was 2.9% (1328/45799). This prevalence was 1.8% (112/6192) in 2015 and 4.2% (230/5500) in 2022, indicating an increasing trend over time. A total of 1825 lesions were assessed: 1751 (96.0%), 55 (3.0%), 14 (0.8%), and 5 (0.3%) of lesions were SSL, SSL with low-grade dysplasia, SSL with high-grade dysplasia and SSL-cancer, respectively. Stratifying the SSLs by size: 0 to 5 mm, 5 to 9 mm, 10 to 19 mm, and ≥ 20 mm, SSLD and SSL-cancer rates were 2.3% (10/429), 2.4% (16/674), 5.3% (31/584), and 11.8% (16/136), respectively. SSLD and SSL-cancer were observed in 2.4% (26/1103) of small SSLs < 10 mm.

Conclusions In cases of SSL, the rate of SSLD and SSL-cancer increased as the lesion diameter increased. A certain rate of SSLD and SSL-cancer was observed even in small SSLs less than 5mm.

Keywords

Endoscopy Upper GI Tract - Endoscopic resection (ESD, EMRc, ...) - Endoscopy Lower GI Tract - Polyps / adenomas / ... - Colorectal cancer

Publication History

Received: 21 September 2023

Accepted after revision: 08 January 2024

Accepted Manuscript online:
15 January 2024

Article published online:
28 March 2024

• References

• 1 Rex DK, Ahnen DJ, Baron JA. et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol 2012; 107: 1315-1329
• 2 Snover DC. Update on the serrated pathway to colorectal carcinoma. Hum Pathol 2011; 42: 1-10
• 3 Ahadi M, Sokolova A, Brown I. et al. The 2019 World Health Organization Classification of appendiceal, colorectal and anal canal tumours: an update and critical assessment. Pathology 2021; 53: 454-461
• 4 Zhou MJ, Lebwohl B, Krigel A. Patient and physician factors associated with adenoma and sessile serrated lesion detection rates. Dig Dis Sci 2020; 65: 3123-3131
• 5 Shaukat A, Holub J, Greenwald D. et al. Variation over time and factors associated with detection rates of sessile serrated lesion across the united states: results form a national sample using the GIQuIC Registry. Am J Gastroenterol 2021; 116: 95-99
• 6 Desai M, Anderson JC, Kaminski M. et al. Sessile serrated lesion detection rates during average risk screening colonoscopy: A systematic review and meta-analysis of the published literature. Endosc Int Open 2021; 9: E610-E620
• 7 Shiu SI, Kashida H, Komeda Y. The prevalence of sessile serrated lesion in the colorectum and its relationship to synchronous colorectal advanced neoplasia: a systemic review and meta-analysis. Eur J Gastroenterol Hepatol 2021; 33: 1495-1504
• 8 Edwardson N, Adsul P, Gonzalez Z. et al. Sessile serrated lesion detection rates continue to increase: 2008–2020. Endosc Int Open 2023; 11: E107-E116
• 9 Sano W, Sano Y, Iwatate M. et al. Prospective evaluation of the proportion of sessile serrated adenoma/polyps in endoscopically diagnosed colorectal polyps with hyperplastic features. Endosc Int Open 2015; 3: E354-E358
• 10 Saiki H, Nishida T, Yamamoto M. et al. Frequency of coexistent carcinoma in sessile serrated adenoma/polyps and traditional serrated adenomas removed by endoscopic resection. Endosc Int Open 2016; 4: E451-E458
• 11 Chino A, Yamamoto N, Kato Y. et al. The frequency of early colorectal cancer derived from sessile serrated adenoma/polyps among 1858 serrated polyps from a single institution. Int J Colorectal Dis 2016; 31: 343-349
• 12 Lash RH, Genta RM, Schuler CM. Sessile serrated adenomas: prevalence of dysplasia and carcinoma in 2139 patients. J Clin Pathol 2010; 63: 681-686
• 13 Omori K, Yoshida K, Tamiya S. et al. Endoscopic observation of the growth process of a right-side sessile serrated adenoma/polyp with cytological dysplasia to an invasive submucosal adenocarcinoma. Case Rep Gastrointest Med 2016;
• 14 Oono Y, Fu K, Nakamura H. et al. Progression of a sessile serrated adenoma to an early invasive cancer within 8 months. Dig Dis Sci 2009; 54: 906-909
• 15 Tate DJ, Jayanna M, Awadie H. et al. A standardized imaging protocol for the endoscopic prediction of dysplasia within sessile serrated polyps (with video). Gastrointest Endosc 2018; 87: 222-231
• 16 Tanaka Y, Yamano HO, Yamamoto E. et al. Endoscopic and molecular characterization of colorectal sessile serrated adenoma/polyps with cytologic dysplasia. Gastrointest Endosc 2017; 86: 1131-1138
• 17 Murakami T, Sakamoto N, Ritsuno H. et al. Distinct endoscopic characteristics of sessile serrated adenoma/polyp with and without dysplasia/carcinoma. Gastrointest Endosc 2017; 85: 590-600
• 18 Hirata D, Kashida H, Matsumoto T. et al. A multicenter prospective validation study on selective endoscopic resection of sessile serrated lesions using magnifying colonoscopy in clinical practice. Digestion 2023; 104
• 19 van Hattem WA, Shahidi N, Vosko S. et al. Piecemeal cold snare polypectomy versus conventional endoscopic mucosal resection for large sessile serrated lesions: a retrospective comparison across two successive periods. Gut 2021; 70: 1691-1697
• 20 Kimoto Y, Sakai E, Inamoto R. et al. Safety and efficacy of cold snare polypectomy without submucosal injection for large sessile serrated lesions: a prospective study. Clin Gastroenterol Hepatol 2022; 20: e132-e138
• 21 Gschwantler M, Kriwanek S, Langner E. et al. High-grade dysplasia and invasive carcinoma in colorectal adenomas: a multivariate analysis of the impact of adenoma and patient characteristics. Eur J Gastroenterol Hepatol 2002; 14: 183-188
• 22 Sakamoto T, Matsuda T, Nakajima T. et al. Clinicopathological features of colorectal polyps: evaluation of the “predict, resect and discard” strategies. Colorectal Dis 2013; 15: e295-e300
• 23 Gupta N, Bansal A, Rao D. et al. Prevalence of advanced histological features in diminutive and small colon polyps. Gastrointest Endosc 2012; 75: 1022-1030
• 24 Ohki D, Tsuji Y, Tanaka M. et al. A case of a tiny neuroendocrine carcinoma in a large flat-elevated rectal tumor causing multiple liver metastases. Clin J Gastroenterol 2022; 15: 1078-1082
• 25 Murakami T, Kurosawa T, Fukushima H. et al. Sessile serrated lesions: Clinicopathological characteristics, endoscopic diagnosis, and management. Dig Endosc 2022; 34: 1096-1109
• 26 Matsuda T, Kawano H, Hisabe T. et al. Current status and future perspectives of endoscopic diagnosis and treatment of diminutive colorectal polyps. Dig Endosc 2014; 26: 104-108
• 27 Shimada S, Imai K, Hotta K. Ten-year progression of a diminutive rectosigmoid polyp left in situ at the index colonoscopy. Dig Endosc 2021; 33: 1194
• 28 Zhang Q, Gao P, Han B. et al. Polypectomy for complete endoscopic resection of small colorectal polyps. Gastrointest Endosc 2018; 87: 733-740
• 29 Ito A, Suga T, Ota H. et al. Resection depth and layer of cold snare polypectomy versus endoscopic mucosal resection. J Gastroenterol 2018; 53: 1171-1178
• 30 Kawamura T, Takeuchi Y, Asai S. et al. A comparison of the resection rate for cold and hot snare polypectomy for 4–9 mm colorectal polyps: a multicentre randomised controlled trial (CRESCENT study). Gut 2018; 67: 1950-1957
• 31 Murakami T, Yoshida N, Yasuda R. et al. Local recurrence and its risk factors after cold snare polypectomy of colorectal polyps. Surg Endosc 2020; 34: 2918-2925
• 32 Inoki K, Takamaru H, Furuhashi H. et al. Management of colorectal high-grade dysplasia or cancer resected by cold snare polypectomy: a multicenter exploratory study. J Gastroenterol 2023; 58: 554-564
• 33 Yoshida N, Fukumoto K, Hasegawa D. et al. Recurrence rate and lesions characteristics after cold snare polypectomy of high-grade dysplasia and T1 lesions: A multicenter analysis. J Gastroenterol Hepatol 2021; 36: 3337-3344
• 34 Ohata K, Kobayashi N, Sakai E. et al. Long-term outcomes after endoscopic submucosal dissection for large colorectal epithelial neoplasms: a prospective, multicenter, cohort trial from Japan. Gastroenterology 2022; 163: 1423-1434
• 35 Tate DJ, Awadie H, Bahin FF. et al. Wide-field piecemeal cold snare polypectomy of large sessile serrated polyps without a submucosal injection is safe. Endoscopy 2018; 50: 248-252