Abstract
Background and study aims Sessile serrated lesions (SSLs) are
precursor lesions in the serrated neoplasia pathway that lead to invasive carcinoma
from
dysplasia arising from SSLs. This study aimed to elucidate the clinicopathological
and
endoscopic features of SSLs with and without dysplasia or carcinoma.
Patients and methods We reviewed the clinicopathological and
endoscopic data from all colorectal lesions pathologically diagnosed as SSLs at Juntendo
University Hospital, Tokyo, Japan, between 2011 and 2022. In addition to conventional
endoscopic findings, we retrospectively evaluated magnifying endoscopic findings with
narrow-band imaging (NBI) or blue laser imaging (BLI) using the Japan NBI Expert Team
system
and analyzed pit patterns using magnified chromoendoscopic images.
Results Of the 2,132 SSLs, 92.5%, 4.7%, 1.8%, and 0.9% had no
dysplasia, low-grade dysplasia, high-grade dysplasia, and submucosal invasive carcinoma,
respectively. Older age, the proximal colon, and larger lesions were more frequently
associated with SSLs with dysplasia or carcinoma. However, 41.3% of the SSLs with
dysplasia or
carcinoma were ≤ 10 mm in size. Endoscopic findings, such as (semi)pedunculated morphology,
double elevation, central depression, and reddishness, were frequently found in SSLs
with
dysplasia or carcinoma. Furthermore, magnifying endoscopy using NBI or BLI and magnifying
chromoendoscopy showed high sensitivity, specificity, and accuracy for diagnosing
dysplasia or
carcinoma within SSLs.
Conclusions SSLs with and without dysplasia or carcinoma exhibit
distinct clinicopathological and endoscopic features. In an SSL series, conventional
endoscopic characteristics in addition to use of magnifying endoscopy may be useful
for
accurately diagnosing advanced histology within an SSL.
Keywords
Endoscopy Lower GI Tract - Polyps / adenomas / ... - Colorectal cancer - Diagnosis
and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE...)
