Prevalence of different subtypes of serrated polyps and risk of synchronous advanced colorectal neoplasia in average-risk population undergoing first-time colonoscopy

Andrea Buda, Manuela De Bona, Isabella Dotti, Pierluca Piselli, Eva Zabeo, Renzo Barbazza, Angelo Bellumat, Flavio Valiante, Ermanno Nardon, Chris S. Probert, Massimo Pignatelli, Giorgio Stanta, GiacomoCarlo Sturniolo, Michele De Boni

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Abstract

OBJECTIVES: A growing body of evidence indicates that patients with sessile serrated adenoma/polyp (SSA/P) and traditional serrated adenoma (TSA) are at risk for subsequent malignancy. Despite increasing knowledge on histological categorization of serrated polyps (SPs) data are lacking on the actual prevalence and the association of each SP subtype with advanced colorectal neoplasia. METHODS: We prospectively determined the prevalence of different SP subtypes and evaluate the association with synchronous advanced neoplasia in asymptomatic average-risk subjects undergoing first-time colonoscopy. All retrieved polyps were examined by two independent pathologists. Serrated lesions were classified into hyperplastic polyps (HP), SSA/P (without and with cytological dysplasia, SSA/P/DIS), and TSA, and were screened for BRAF and K-ras mutations. RESULTS: Among 258 polyps detected in 985 subjects, the proportion of SSA/P and TSA was 8.9% and 1.9% with an overall prevalence of 2.3% and 0.6%, respectively. SSA/Ps were small without significant difference in their location between proximal and distal colon; TSA were predominantly left-sided. BRAF mutation was common in SSA/Ps and K-ras mutation was present in all TSA. Independent predictors of advanced neoplasia were male sex (odds ratio (OR)=2.0, 95% confidence interval (CI) 1.0-4.0), increasing age (OR=4.5, 95% CI 1.5-13.4 for 50-69 years and OR=9.9, 95% CI 3.1-31.5 for >70 years), current smoking (OR=2.0, 95% CI 1.3-6.8), >3 tubular adenoma (OR=3.6, 95% CI 1.9-6.4), and SSA/P (OR=6.0, 95% CI 1.9-19.5). CONCLUSIONS: The substantial prevalence of BRAF-mutated SSA/P and the independent association with synchronous advanced colorectal neoplasia in asymptomatic average-risk subjects support the overall impact of the serrated pathway on colorectal cancer (CRC) risk in general population. The endoscopic characteristics of SSA/P emphasize the need of high-quality colonoscopy as a key factor for an effective CRC screening program. & 2012 the American College of Gastroenterology All rights reserved.

Original languageEnglish
JournalClinical and Translational Gastroenterology
Volume3
DOIs
Publication statusPublished - 2012
Externally publishedYes

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Colonoscopy
Polyps
Adenoma
Population
Neoplasms
Odds Ratio
Confidence Intervals
Mutation
Colorectal Neoplasms
Sex Ratio
Early Detection of Cancer
Colon
Smoking

ASJC Scopus subject areas

  • Gastroenterology

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Prevalence of different subtypes of serrated polyps and risk of synchronous advanced colorectal neoplasia in average-risk population undergoing first-time colonoscopy. / Buda, Andrea; De Bona, Manuela; Dotti, Isabella; Piselli, Pierluca; Zabeo, Eva; Barbazza, Renzo; Bellumat, Angelo; Valiante, Flavio; Nardon, Ermanno; Probert, Chris S.; Pignatelli, Massimo; Stanta, Giorgio; Sturniolo, GiacomoCarlo; De Boni, Michele.

In: Clinical and Translational Gastroenterology, Vol. 3, 2012.

Research output: Contribution to journalArticle

Buda, A, De Bona, M, Dotti, I, Piselli, P, Zabeo, E, Barbazza, R, Bellumat, A, Valiante, F, Nardon, E, Probert, CS, Pignatelli, M, Stanta, G, Sturniolo, G & De Boni, M 2012, 'Prevalence of different subtypes of serrated polyps and risk of synchronous advanced colorectal neoplasia in average-risk population undergoing first-time colonoscopy', Clinical and Translational Gastroenterology, vol. 3. https://doi.org/10.1038/ctg.2011.5
Buda, Andrea ; De Bona, Manuela ; Dotti, Isabella ; Piselli, Pierluca ; Zabeo, Eva ; Barbazza, Renzo ; Bellumat, Angelo ; Valiante, Flavio ; Nardon, Ermanno ; Probert, Chris S. ; Pignatelli, Massimo ; Stanta, Giorgio ; Sturniolo, GiacomoCarlo ; De Boni, Michele. / Prevalence of different subtypes of serrated polyps and risk of synchronous advanced colorectal neoplasia in average-risk population undergoing first-time colonoscopy. In: Clinical and Translational Gastroenterology. 2012 ; Vol. 3.
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abstract = "OBJECTIVES: A growing body of evidence indicates that patients with sessile serrated adenoma/polyp (SSA/P) and traditional serrated adenoma (TSA) are at risk for subsequent malignancy. Despite increasing knowledge on histological categorization of serrated polyps (SPs) data are lacking on the actual prevalence and the association of each SP subtype with advanced colorectal neoplasia. METHODS: We prospectively determined the prevalence of different SP subtypes and evaluate the association with synchronous advanced neoplasia in asymptomatic average-risk subjects undergoing first-time colonoscopy. All retrieved polyps were examined by two independent pathologists. Serrated lesions were classified into hyperplastic polyps (HP), SSA/P (without and with cytological dysplasia, SSA/P/DIS), and TSA, and were screened for BRAF and K-ras mutations. RESULTS: Among 258 polyps detected in 985 subjects, the proportion of SSA/P and TSA was 8.9{\%} and 1.9{\%} with an overall prevalence of 2.3{\%} and 0.6{\%}, respectively. SSA/Ps were small without significant difference in their location between proximal and distal colon; TSA were predominantly left-sided. BRAF mutation was common in SSA/Ps and K-ras mutation was present in all TSA. Independent predictors of advanced neoplasia were male sex (odds ratio (OR)=2.0, 95{\%} confidence interval (CI) 1.0-4.0), increasing age (OR=4.5, 95{\%} CI 1.5-13.4 for 50-69 years and OR=9.9, 95{\%} CI 3.1-31.5 for >70 years), current smoking (OR=2.0, 95{\%} CI 1.3-6.8), >3 tubular adenoma (OR=3.6, 95{\%} CI 1.9-6.4), and SSA/P (OR=6.0, 95{\%} CI 1.9-19.5). CONCLUSIONS: The substantial prevalence of BRAF-mutated SSA/P and the independent association with synchronous advanced colorectal neoplasia in asymptomatic average-risk subjects support the overall impact of the serrated pathway on colorectal cancer (CRC) risk in general population. The endoscopic characteristics of SSA/P emphasize the need of high-quality colonoscopy as a key factor for an effective CRC screening program. & 2012 the American College of Gastroenterology All rights reserved.",
author = "Andrea Buda and {De Bona}, Manuela and Isabella Dotti and Pierluca Piselli and Eva Zabeo and Renzo Barbazza and Angelo Bellumat and Flavio Valiante and Ermanno Nardon and Probert, {Chris S.} and Massimo Pignatelli and Giorgio Stanta and GiacomoCarlo Sturniolo and {De Boni}, Michele",
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T1 - Prevalence of different subtypes of serrated polyps and risk of synchronous advanced colorectal neoplasia in average-risk population undergoing first-time colonoscopy

AU - Buda, Andrea

AU - De Bona, Manuela

AU - Dotti, Isabella

AU - Piselli, Pierluca

AU - Zabeo, Eva

AU - Barbazza, Renzo

AU - Bellumat, Angelo

AU - Valiante, Flavio

AU - Nardon, Ermanno

AU - Probert, Chris S.

AU - Pignatelli, Massimo

AU - Stanta, Giorgio

AU - Sturniolo, GiacomoCarlo

AU - De Boni, Michele

PY - 2012

Y1 - 2012

N2 - OBJECTIVES: A growing body of evidence indicates that patients with sessile serrated adenoma/polyp (SSA/P) and traditional serrated adenoma (TSA) are at risk for subsequent malignancy. Despite increasing knowledge on histological categorization of serrated polyps (SPs) data are lacking on the actual prevalence and the association of each SP subtype with advanced colorectal neoplasia. METHODS: We prospectively determined the prevalence of different SP subtypes and evaluate the association with synchronous advanced neoplasia in asymptomatic average-risk subjects undergoing first-time colonoscopy. All retrieved polyps were examined by two independent pathologists. Serrated lesions were classified into hyperplastic polyps (HP), SSA/P (without and with cytological dysplasia, SSA/P/DIS), and TSA, and were screened for BRAF and K-ras mutations. RESULTS: Among 258 polyps detected in 985 subjects, the proportion of SSA/P and TSA was 8.9% and 1.9% with an overall prevalence of 2.3% and 0.6%, respectively. SSA/Ps were small without significant difference in their location between proximal and distal colon; TSA were predominantly left-sided. BRAF mutation was common in SSA/Ps and K-ras mutation was present in all TSA. Independent predictors of advanced neoplasia were male sex (odds ratio (OR)=2.0, 95% confidence interval (CI) 1.0-4.0), increasing age (OR=4.5, 95% CI 1.5-13.4 for 50-69 years and OR=9.9, 95% CI 3.1-31.5 for >70 years), current smoking (OR=2.0, 95% CI 1.3-6.8), >3 tubular adenoma (OR=3.6, 95% CI 1.9-6.4), and SSA/P (OR=6.0, 95% CI 1.9-19.5). CONCLUSIONS: The substantial prevalence of BRAF-mutated SSA/P and the independent association with synchronous advanced colorectal neoplasia in asymptomatic average-risk subjects support the overall impact of the serrated pathway on colorectal cancer (CRC) risk in general population. The endoscopic characteristics of SSA/P emphasize the need of high-quality colonoscopy as a key factor for an effective CRC screening program. & 2012 the American College of Gastroenterology All rights reserved.

AB - OBJECTIVES: A growing body of evidence indicates that patients with sessile serrated adenoma/polyp (SSA/P) and traditional serrated adenoma (TSA) are at risk for subsequent malignancy. Despite increasing knowledge on histological categorization of serrated polyps (SPs) data are lacking on the actual prevalence and the association of each SP subtype with advanced colorectal neoplasia. METHODS: We prospectively determined the prevalence of different SP subtypes and evaluate the association with synchronous advanced neoplasia in asymptomatic average-risk subjects undergoing first-time colonoscopy. All retrieved polyps were examined by two independent pathologists. Serrated lesions were classified into hyperplastic polyps (HP), SSA/P (without and with cytological dysplasia, SSA/P/DIS), and TSA, and were screened for BRAF and K-ras mutations. RESULTS: Among 258 polyps detected in 985 subjects, the proportion of SSA/P and TSA was 8.9% and 1.9% with an overall prevalence of 2.3% and 0.6%, respectively. SSA/Ps were small without significant difference in their location between proximal and distal colon; TSA were predominantly left-sided. BRAF mutation was common in SSA/Ps and K-ras mutation was present in all TSA. Independent predictors of advanced neoplasia were male sex (odds ratio (OR)=2.0, 95% confidence interval (CI) 1.0-4.0), increasing age (OR=4.5, 95% CI 1.5-13.4 for 50-69 years and OR=9.9, 95% CI 3.1-31.5 for >70 years), current smoking (OR=2.0, 95% CI 1.3-6.8), >3 tubular adenoma (OR=3.6, 95% CI 1.9-6.4), and SSA/P (OR=6.0, 95% CI 1.9-19.5). CONCLUSIONS: The substantial prevalence of BRAF-mutated SSA/P and the independent association with synchronous advanced colorectal neoplasia in asymptomatic average-risk subjects support the overall impact of the serrated pathway on colorectal cancer (CRC) risk in general population. The endoscopic characteristics of SSA/P emphasize the need of high-quality colonoscopy as a key factor for an effective CRC screening program. & 2012 the American College of Gastroenterology All rights reserved.

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