Subscribe to RSS
Evaluation of the optical criteria for sessile serrated lesions of the colon: A prospective study on a colorectal cancer screening population
Background and study aims We aimed to describe the presence and combination of Hazewinkelʼs optical diagnosis (OD) criteria for sessile serrated lesions (SSL), determining which lesion characteristics increase the probability of a correct OD, with a focus on diminutive lesions.
Patients and methods This was a prospective study describing the presence of Hazewinkelʼs OD criteria for SSL in lesions found in consecutive CRC screening colonoscopies. The presence of each OD criterion and their diagnostic combinations in SSL, related to the lesion’s NBI International Colorectal Endoscopic (NICE) classification category, size, and location, were described. The presence of two or more optical criteria was considered diagnostic of SSL. The OD was compared to pathology as the gold standard.
Results Seventy-nine SSLs (5.6 %) were diagnosed. Cloud-like appearance was the most prevalent OD criterion (35, 44.3 %). OD criteria were more frequently identified in NICE type 1, ≥ 10 mm, and proximal lesions. Only 26 SLLs fulfilled the OD criteria (sensitivity 32.9 %, 95 % CI 29.1 %–36.7 %). The sensitivity for diminutive SSL was 14.7 %, (95 % CI 11.9 %–17.6 %). Eighty-five lesions were optically diagnosed as SSL. However, only in 26 SSL was this the definitive diagnosis (positive predictive value 30.6 %, 95 % CI 26.9 %–34.3 %). Size > 5 mm and proximal location increased the probability of a correct diagnosis. The overall accuracy of the optical criteria was 92.0 % (95 % CI, 89.8 %–94.2 %).
Conclusions The Hazewinkelʼs optical criteria are not reliable for a positive diagnosis of SSL, particularly for diminutive lesions.
Received: 02 June 2020
Accepted: 28 September 2020
Article published online:
01 January 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Snover DC. Update on the serrated pathway to colorectal carcinoma. Hum Pathol 2011; 42: 1-10
- 2 Satorres C, Garcia-Campos M, Bustamante-Balen M. Molecular features of the serrated pathway to colorectal cancer: current knowledge and future directions. Gut Liver 2020 DOI: 10.5009/gnl19402.
- 3 Pohl H, Srivastava A, Bensen SP. et al. Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology 2013; 144: 74-80 e71
- 4 Oono Y, Fu K, Nakamura H. et al. Progression of a sessile serrated adenoma to an early invasive cancer within 8 months. Digest Dis Sci 2009; 54: 906-909
- 5 Rex DK, Kahi C, OʼBrien M. et al. The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2011; 73: 419-422
- 6 Ignjatovic A, East JE, Suzuki N. et al. Optical diagnosis of small colorectal polyps at routine colonoscopy (Detect InSpect ChAracterise Resect and Discard; DISCARD trial): a prospective cohort study. Lancet Oncol 2009; 10: 1171-1178
- 7 Terdiman JP, McQuaid KR. Surveillance guidelines should be updated to recognize the importance of serrated polyps. Gastroenterology 2010; 139: 1444-1447
- 8 Hazewinkel Y, Lopez-Ceron M, East JE. et al. Endoscopic features of sessile serrated adenomas: validation by international experts using high-resolution white-light endoscopy and narrow-band imaging. Gastrointest Endosc 2013; 77: 916-924
- 9 JE IJ, Bastiaansen BA, van Leerdam ME. et al. Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps. Gut 2016; 65: 963-970
- 10 Vleugels JLA, Dijkgraaf MGW, Hazewinkel Y. et al. Effects of training and feedback on accuracy of predicting rectosigmoid neoplastic lesions and selection of surveillance intervals by endoscopists performing optical diagnosis of diminutive polyps. Gastroenterology 2018; 154: 1682-1693 e1681
- 11 Bouwens MW, van Herwaarden YJ, Winkens B. et al. Endoscopic characterization of sessile serrated adenomas/polyps with and without dysplasia. Endoscopy 2014; 46: 225-235
- 12 Burgess NG, Pellise M, Nanda KS. et al. Clinical and endoscopic predictors of cytological dysplasia or cancer in a prospective multicentre study of large sessile serrated adenomas/polyps. Gut 2016; 65: 437-446
- 13 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3-43
- 14 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; quiz 1314, 1330
- 15 Yamada M, Sakamoto T, Otake Y. et al. Investigating endoscopic features of sessile serrated adenomas/polyps by using narrow-band imaging with optical magnification. Gastrointest Endosc 2015; 82: 108-117
- 16 Nakao Y, Saito S, Ohya T. et al. Endoscopic features of colorectal serrated lesions using image-enhanced endoscopy with pathological analysis. Eur J Gastroenterol Hepatol 2013; 25: 981-988
- 17 Yamashina T, Takeuchi Y, Uedo N. et al. Diagnostic features of sessile serrated adenoma/polyps on magnifying narrow band imaging: a prospective study of diagnostic accuracy. J Gastroenterol Hepatol 2015; 30: 117-123
- 18 Uraoka T, Higashi R, Horii J. et al. Prospective evaluation of endoscopic criteria characteristic of sessile serrated adenomas/polyps. J Gastroenterol 2015; 50: 555-563
- 19 Singh R, Jayanna M, Navadgi S. et al. Narrow-band imaging with dual focus magnification in differentiating colorectal neoplasia. Digest Endosc 2013; 25 (Suppl. 02) 16-20
- 20 Parikh ND, Chaptini L, Njei B. et al. Diagnosis of sessile serrated adenomas/polyps with image-enhanced endoscopy: a systematic review and meta-analysis. Endoscopy 2016; 48: 731-739
- 21 Bronzwaer MES, Vleugels JLA, van Doorn SC. et al. Are adenoma and serrated polyp detection rates correlated with endoscopists' sensitivity of optical diagnosis?. Endoscopy 2020; DOI: 10.1055/a-1151-8691.
- 22 Vleugels JLA, Hazewinkel Y, Dijkgraaf MGW. et al. Optical diagnosis expanded to small polyps: post-hoc analysis of diagnostic performance in a prospective multicenter study. Endoscopy 2019; 51: 244-252
- 23 Ishigooka S, Nomoto M, Obinata N. et al. Evaluation of magnifying colonoscopy in the diagnosis of serrated polyps. World J Gastroenterol 2012; 18: 4308-4316
- 24 Matsushita HO, Yamano HO. What is type II-open pit pattern?. Digest Endosc 2016; 28: 60
- 25 Atkinson NS, East JE. Optical biopsy and sessile serrated polyps: Is DISCARD dead? Long live DISCARD-lite! . Gastrointestinal endoscopy 2015; 82: 118-121
- 26 Bustamante-Balen M, Bernet L, Cano R. et al. Assessing the reproducibility of the microscopic diagnosis of sessile serrated adenoma of the colon. Rev Esp Enferm Dig 2009; 101: 258-264