Current sessile serrated lesion incidence: implications for future clinical practice.
colon cancer screening
colorectal cancer
sessile serrated lesion
sessile serrated polyp
Journal
ANZ journal of surgery
ISSN: 1445-2197
Titre abrégé: ANZ J Surg
Pays: Australia
ID NLM: 101086634
Informations de publication
Date de publication:
03 Sep 2024
03 Sep 2024
Historique:
revised:
25
07
2024
received:
07
04
2024
accepted:
01
08
2024
medline:
3
9
2024
pubmed:
3
9
2024
entrez:
3
9
2024
Statut:
aheadofprint
Résumé
Sessile serrated lesions (SSL) account for up to 30% of colorectal carcinoma pathogenesis. With multiple classification changes and improvements in colonoscopy equipment and technique, historical reporting may have underestimated the true incidence of SSLs. This study aimed to determine the incidence of SSLs in patients undergoing colonoscopic investigation in Canterbury, New Zealand over a 1-year period and describe their clinical and pathological characteristics. Electronic records were searched to identify all lower endoscopy procedures with polypectomy performed from 1 January 2022 to 1 December 2022 (inclusive). Patients' electronic records were used to collect histological classification, location and size of each polyp removed during their procedure. The primary outcome was the number of procedures that had one or more SSL, adenoma or hyperplastic polyp identified. Secondary outcomes included histological classification, location and size of each polyp removed. There were 4346 procedures completed during the study period. Of these, 64.1% (2786) had a polypectomy and 18.6% (808) had at least one SSL excised. Individual polyp analysis was completed on 9166 polyps and found that 24.0% of polyps removed were SSLs and they were found predominately in the right colon (65.1% right colon, 32.6% left colon, 2.3% rectum). SSLs were typically <10 mm (84.8%). This study found a higher incidence of SSLs compared to previous research. These results raise questions regarding whether SLL rates have been historically underestimated, whether SSL detection rate should be included as a key performance indicator and raises further concerns regarding the use of computed tomography colonography as a screening tool.
Sections du résumé
BACKGROUND
BACKGROUND
Sessile serrated lesions (SSL) account for up to 30% of colorectal carcinoma pathogenesis. With multiple classification changes and improvements in colonoscopy equipment and technique, historical reporting may have underestimated the true incidence of SSLs. This study aimed to determine the incidence of SSLs in patients undergoing colonoscopic investigation in Canterbury, New Zealand over a 1-year period and describe their clinical and pathological characteristics.
METHODS
METHODS
Electronic records were searched to identify all lower endoscopy procedures with polypectomy performed from 1 January 2022 to 1 December 2022 (inclusive). Patients' electronic records were used to collect histological classification, location and size of each polyp removed during their procedure. The primary outcome was the number of procedures that had one or more SSL, adenoma or hyperplastic polyp identified. Secondary outcomes included histological classification, location and size of each polyp removed.
RESULTS
RESULTS
There were 4346 procedures completed during the study period. Of these, 64.1% (2786) had a polypectomy and 18.6% (808) had at least one SSL excised. Individual polyp analysis was completed on 9166 polyps and found that 24.0% of polyps removed were SSLs and they were found predominately in the right colon (65.1% right colon, 32.6% left colon, 2.3% rectum). SSLs were typically <10 mm (84.8%).
CONCLUSION
CONCLUSIONS
This study found a higher incidence of SSLs compared to previous research. These results raise questions regarding whether SLL rates have been historically underestimated, whether SSL detection rate should be included as a key performance indicator and raises further concerns regarding the use of computed tomography colonography as a screening tool.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Maurice and Phyllis Paykel Trust
ID : Future Health Researcher Programme 2022/23
Informations de copyright
© 2024 The Author(s). ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.
Références
Ministry of Health NZ. Selected Cancers 2015, 2016, 2017. [Cited 6 Dec 2022]. Available from: https://www.health.govt.nz/publication/selected-cancers-2015-2016-2017
Atkin W, Wooldrage K, Brenner A et al. Adenoma surveillance and colorectal cancer incidence: a retrospective, multicentre, cohort study. Lancet Oncol. 2017; 18: 823–834.
Crockett SD, Nagtegaal ID. Terminology, molecular features, epidemiology, and management of serrated colorectal neoplasia. Gastroenterology 2019; 157: 949–966.e4.
Soeder M, Turshudzhyan A, Rosenberg L, Tadros M. High‐quality colonoscopy: a review of quality indicators and best practices. Gastroenterol. Insights 2022; 13: 162–172.
Meester RGS, van Herk MMAGC, Lansdorp‐Vogelaar I, Ladabaum U. Prevalence and clinical features of sessile serrated polyps: a systematic review. Gastroenterology 2020; 159: 105–118.e25.
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.
Andrea M, Jepsen RK, Klein MF, Gögenur I, Kuhlmann TP. Colorectal serrated lesions and polyps in the Danish population: a large nationwide register‐based cohort study. Endosc. Int. Open 2023; 11: E1116–E1122.
Board WC of TE. Digestive System Tumours. [Cited 11 Mar 2023]. Available from: https://publications.iarc.fr/Book-And-Report-Series/Who-Classification-Of-Tumours/Digestive-System-Tumours-2019
Fraser AG, Rose T, Wong P, Lane M, Frankish P. Improved detection of adenomas and sessile serrated polyps is maintained with continuous audit of colonoscopy. BMJ Open Gastroenterol. 2020; 7: e000425.
Lee SZ, Schubert JP, Prowse SJB, Bryant RV. Are we underutilising computer tomography colonography in Australia? Intern. Med. J. 2022; 52: 864–867.
Singla M, Kemp JD, Goldberg ME et al. Almost one‐third of large sessile serrated polyps are missed on CT colonography. Turk. J. Gastroenterol. 2021; 32: 837–842.
Kim DH, Matkowskyj KA, Pickhardt PJ. Serrated polyps are detected at CT colonography: clinical observations over the past decade and results from CTC‐based screening of average risk adults. Abdom. Radiol. 2016; 41: 1445–1447.
IJspeert JEG, Nolthenius CJT, Kuipers EJ et al. CT‐colonography vs. colonoscopy for detection of high‐risk sessile serrated polyps. J. Am. Coll. Gastroenterol. 2016; 111: 516.
Eabha R, Nally F, John C et al. SSL detection rate‐ the latest KPI? In: Endoscopy. Stuttgart, Germany: Georg Thieme Verlag KG, 2023; eP757 [Cited 2 Jul 2023]. Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-1766034.
Obuch JC, Pigott CM, Ahnen DJ. Sessile serrated polyps: detection, eradication, and prevention of the evil twin. Curr. Treat. Options Gastroenterol. 2015; 13: 156–170.