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DOI: 10.1055/a-1333-1776
Rate of detection of serrated lesions at colonoscopy in an average-risk population: a meta-analysis of 129,001 individuals
Abstract
Background and study aims Serrated lesions are precursors of approximately one-third of colorectal cancers (CRCs). Information on their detection rate was lacking as an important reference for CRC screening. This study was a systematic review and meta-analysis to determine the overall detection rate for serrated lesions and their subtypes in average-risk populations undergoing CRC screening with colonoscopy.
Patient and methods MEDLINE and Embase were searched to identify population-based studies that reported the detection rate for serrated lesions. Studies on average-risk populations using colonoscopy as a screening tool were included. Metaprop was applied to model within-study variability by binomial distribution, and Freeman-Tukey Double Arcsine Transformation was adopted to stabilise the variances. The detection rate was presented in proportions using random-effects models.
Results In total, 17 studies involving 129,001 average-risk individuals were included. The overall detection rates for serrated lesions (19.0 %, 95 % CI = 15.3 %–23.0 %), sessile serrated polyps (2.5 %, 95 % CI = 1.5 %–3.8 %), and traditional serrated adenomas (0.3 %, 95 % CI = 0.1 %–0.8 %) were estimated. Subgroup analysis indicated a higher detection rate for serrated lesions among males (22.0 %) than females (14.0 %), and Caucasians (25.9 %) than Asians (14.6 %). The detection rate for sessile serrated polyps was also higher among Caucasians (2.9 %) than Asians (0.7 %).
Conclusions This study determined the overall detection rate for serrated lesions and their different subtypes. The pooled detection rate estimates can be used as a reference for establishing CRC screening programs. Future studies may evaluate the independent factors associated with the presence of serrated lesions during colonoscopy to enhance their rate of detection.
Publication History
Received: 14 August 2020
Accepted: 02 November 2020
Article published online:
19 February 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
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Reference
- 1 World Health Organization. Cancer. 2018. Available at (Accessed April 15, 2019): https://www.who.int/news-room/fact-sheets/detail/cancer
- 2 Zauber AG, Winawer SJ, O'Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
- 3 Harewood GC, Lieberman DA. Colonoscopy practice patterns since introduction of medicare coverage for average-risk screening. Clin Gastroenterol Hepatol 2004; 2: 72-77
- 4 Lieberman DA, Weiss DG, Harford WV. et al. Five-year colon surveillance after screening colonoscopy. Gastroenterology 2007; 133: 1077-1085
- 5 Robertson DJ, Greenberg ER, Beach M. et al. Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology 2005; 129: 34-41
- 6 Arain MA, Sawhney M, Sheikh S. et al. CIMP status of interval colon cancers: another piece to the puzzle. Am J Gastroenterol 2010; 105: 1189-1195
- 7 Leggett B, Whitehall V. Role of the serrated pathway in colorectal cancer pathogenesis. Gastroenterology 2010; 138: 2088-2100
- 8 Bosman FT, Carneiro F, Hruban RH. et al. WHO Classification of digestive tumors: the fourth edition. World Health Organization; 2010
- 9 World Health Organisation. Classification of Tumours of the Digestive Tract. Lyon: IARC Press; 2019
- 10 Hetzel JT, Huang CS, Coukos JA. et al. Variation in the detection of serrated polyps in an average risk colorectal cancer screening cohort. Am J Gastroenterol 2010; 105: 2656-2664
- 11 de Wijkerslooth TR, Stoop EM, Bossuyt PM. et al. Differences in proximal serrated polyp detection among endoscopists are associated with variability in withdrawal time. Gastrointest Endosc 2013; 77: 617-623
- 12 Je IJ, van Doorn SC, van der Brug YM. et al. The proximal serrated polyp detection rate is an easy-to-measure proxy for the detection rate for clinically relevant serrated polyps. Gastrointest Endosc 2015; 82: 870-877
- 13 Kahi CJ, Hewett DG, Norton DL. et al. Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy. Clin Gastroenterol Hepatol 2011; 9: 42-46
- 14 Buda A, De Bona M, Dotti I. et al. Prevalence of different subtypes of serrated polyps and risk of synchronous advanced colorectal neoplasia in average-risk population undergoing first-time colonoscopy. Clin Transl Gastroenterol 2012; 3: e6
- 15 Abdeljawad K, Vemulapalli KC, Kahi CJ. et al. Sessile serrated polyp prevalence determined by a colonoscopist with a high lesion detection rate and an experienced pathologist. Gastrointest Endosc 2015; 81: 517-524
- 16 Moher D, Shamseer L, Clarke M. et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4: 1
- 17 Wells GA, Peterson J, Welch V. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. In: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
- 18 Wong MC, Huang J, Huang JL. et al. Global prevalence of colorectal neoplasia: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2019;
- 19 Huang JLW, Wang YH, Jiang JY. et al. The association between distal findings and proximal colorectal neoplasia: a systematic review and meta-Analysis. Am J Gastroenterol 2017; 112: 1234-1245
- 20 Nyaga VN, Arbyn M, Aerts M. Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Health 2014; 72: 39
- 21 Grobbee EJ, Wieten E, Hansen BE. et al. Fecal immunochemical test-based colorectal cancer screening: The gender dilemma. United European Gastroenterol J 2017; 5: 448-454
- 22 Min YW, Lee JH, Lee SH. et al. Prevalence of proximal colon serrated polyps in a population at average risk undergoing screening colonoscopy: a multicenter study. Clin Res Hepatol Gastroenterol 2012; 36: 604-608
- 23 Liang J, Kalady MF, Appau K. et al. Serrated polyp detection rate during screening colonoscopy. Colorectal Dis 2012; 14: 1323-1327
- 24 Chang LC, Shun CT, Hsu WF. et al. Fecal immunochemical test detects sessile serrated adenomas and polyps with a low level of sensitivity. Clin Gastroenterol Hepatol 2017; 15: 872-879 e871
- 25 Hazewinkel Y, de Wijkerslooth TR, Stoop EM. et al. Prevalence of serrated polyps and association with synchronous advanced neoplasia in screening colonoscopy. Endoscopy 2014; 46: 219-224
- 26 JEG IJ, Bevan R, Senore C. et al. Detection rate for serrated polyps and serrated polyposis syndrome in colorectal cancer screening cohorts: a European overview. Gut 2017; 66: 1225-1232
- 27 Ross WA, Thirumurthi S, Lynch PM. et al. Detection rates of premalignant polyps during screening colonoscopy: time to revise quality standards?. Gastrointest Endosc 2015; 81: 567-574
- 28 Sanaka MR, Gohel T, Podugu A. et al. Adenoma and sessile serrated polyp detection rates: variation by patient sex and colonic segment but not specialty of the endoscopist. Dis Colon Rectum 2014; 57: 1113-1119
- 29 Pyo JH, Ha SY, Hong SN. et al. Identification of risk factors for sessile and traditional serrated adenomas of the colon by using big data analysis. J Gastroenterol Hepatol 2018; 33: 1039-1046
- 30 Kim HY, Kim SM, Seo JH. et al. Age-specific prevalence of serrated lesions and their subtypes by screening colonoscopy: a retrospective study. BMC Gastroenterol 2014; 14: 82
- 31 Lee CK, Kim YW, Shim JJ. et al. Prevalence of proximal serrated polyps and conventional adenomas in an asymptomatic average-risk screening population. Gut Liver 2013; 7: 524-531
- 32 Leung WK, Tang V, Lui PC. Detection rates of proximal or large serrated polyps in Chinese patients undergoing screening colonoscopy. J Dig Dis 2012; 13: 466-471
- 33 Rex DK. Serrated Polyps in the Colon. Gastroenterol Hepatol (N Y) 2014; 10: 671-674
- 34 Schramm C, Janhsen K, Hofer JH. et al. Detection of clinically relevant serrated polyps during screening colonoscopy: results from seven cooperating centers within the German colorectal screening program. Endoscopy 2018; 50: 993-1000
- 35 Wong NA, Hunt LP, Novelli MR. et al. Observer agreement in the diagnosis of serrated polyps of the large bowel. Histopathology 2009; 55: 63-66
- 36 Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 2012; 70: 3-21
- 37 He X, Wu K, Ogino S. et al. Association between risk factors for colorectal cancer and risk of serrated polyps and conventional adenomas. Gastroenterology 2018; 155: 355-373 e318
- 38 Bailie L, Loughrey MB, Coleman HG. Lifestyle risk factors for serrated colorectal polyps: a systematic review and meta-analysis. Gastroenterology 2017; 152: 92-104
- 39 Sonnenberg A, Turner KO, Genta RM. The ethnic distribution of sessile serrated polyps in the United States is inversely associated with Helicobacter pylori prevalence. Colorectal Dis 2017; 19: 996-1002
- 40 Jass JR, Baker K, Zlobec I. et al. Advanced colorectal polyps with the molecular and morphological features of serrated polyps and adenomas: concept of a ‛fusion’ pathway to colorectal cancer. Histopathology 2006; 49: 121-131
- 41 Rosenberg DW, Yang S, Pleau DC. et al. Mutations in BRAF and KRAS differentially distinguish serrated versus non-serrated hyperplastic aberrant crypt foci in humans. Cancer Res 2007; 67: 3551-3554
- 42 Mohammadi M, Kristensen MH, Nielsen HJ. et al. Qualities of sessile serrated adenoma/polyp/lesion and its borderline variant in the context of synchronous colorectal carcinoma. J Clin Pathol 2012; 65: 924-927
- 43 Fu B, Yachida S, Morgan R. et al. Clinicopathologic and genetic characterization of traditional serrated adenomas of the colon. Am J Clin Pathol 2012; 138: 356-366
- 44 Qiu Y, Fu X, Zhang W. et al. Prevalence and molecular characterisation of the sessile serrated adenoma in a subset of the Chinese population. J Clin Pathol 2014; 67: 491-498
- 45 Kim MJ, Lee EJ, Suh JP. et al. Traditional serrated adenoma of the colorectum: clinicopathologic implications and endoscopic findings of the precursor lesions. Am J Clin Pathol 2013; 140: 898-911
- 46 Rajagopalan H, Bardelli A, Lengauer C. et al. Tumorigenesis: RAF/RAS oncogenes and mismatch-repair status. Nature 2002; 418: 934
- 47 O'Brien MJ, Yang S, Clebanoff JL. et al. Hyperplastic (serrated) polyps of the colorectum: relationship of CpG island methylator phenotype and K-ras mutation to location and histologic subtype. Am J Surg Pathol 2004; 28: 423-434
- 48 Slattery ML, Potter JD, Curtin K. et al. Estrogens reduce and withdrawal of estrogens increase risk of microsatellite instability-positive colon cancer. Cancer Res 2001; 61: 126-130
- 49 Lee YM, Huh KC. Clinical and biological features of interval colorectal cancer. Clin Endosc 2017; 50: 254-260
- 50 Saunders BP, Fukumoto M, Halligan S. et al. Why is colonoscopy more difficult in women?. Gastrointest Endosc 1996; 43: 124-126