Aims:
Sessile serrated adenoma/polyp (SSA/P) are considered to develop dysplasia by the
serrated neoplasia pathway. Dysplastic portions in SSA/P can be difficult to detect
and are often incompletely resected. We aimed to evaluate the clinical and endoscopic
findings associated with dysplasia in SSA/P.
Methods:
Among patients with endoscopic resection from 2015 to 2018 in PNUYH, patients with
SSA/P in pathologic diagnosis and ≥10 mm in size were enrolled. We retrospectively
evaluated clinical and endoscopic findings, pathologic diagnosis in these patients.
Results:
A total of 59 SSA/Ps were assessed in 51 patients. Median size was 15.0 mm (interquartile
range 10 – 25), and 79.7% were in the right side of the colon. Thirty of 59 SSA/Ps
(50.9%) had dysplasia at histopathology (21 low-grades, 8 high-grades, 1 carcinoma
in situ). SSA/P with dysplasia was significantly different in age (p < 0.0001), size
(p < 0.0001), NICE type (p < 0.0001) and Kudo pit pattern (p < 0.0001), but not location,
morphology, surface patterns and ≥2 WASP criteria compared to SSA/P without dysplasia.
In multivariate analysis, dysplasia was significantly associated with age (OR 1.123,
p < 0.005), size (OR 1.188, p < 0.008) and shape (OR 0.138, p < 0.05).
Conclusions:
Dysplasia in SSA/P was frequently combined, especially old age and large size, and
SSA/P with IIb morphology was inversely correlated with dysplasia. Therefore, SSA/P
with these clinical and endoscopic findings should be completely resected for the
prevention of local recurrence and interval cancer.
