Critical appraisal of the diagnosis of the sessile serrated adenoma

Bettington, Mark, Walker, Neal, Rosty, Christophe, Brown, Ian, Clouston, Andrew, Wockner, Leesa, Whitehall, Vicki and Leggett, Barbara (2014) Critical appraisal of the diagnosis of the sessile serrated adenoma. American Journal of Surgical Pathology, 38 2: 158-166. doi:10.1097/PAS.0000000000000103

Author Bettington, Mark
Walker, Neal
Rosty, Christophe
Brown, Ian
Clouston, Andrew
Wockner, Leesa
Whitehall, Vicki
Leggett, Barbara
Title Critical appraisal of the diagnosis of the sessile serrated adenoma
Journal name American Journal of Surgical Pathology   Check publisher's open access policy
ISSN 0147-5185
Publication date 2014-02-01
Year available 2014
Sub-type Article (original research)
DOI 10.1097/PAS.0000000000000103
Open Access Status DOI
Volume 38
Issue 2
Start page 158
End page 166
Total pages 9
Place of publication Philadelphia, United States
Publisher Lippincott Williams & Wilkins
Language eng
Subject 2702 Anatomy
2746 Surgery
2734 Pathology and Forensic Medicine
Abstract The sessile serrated adenoma (SSA) is a relatively recently described polyp that can present diagnostic difficulties for the practicing pathologist. The frequency of SSA diagnoses varies dramatically in the reported literature. In addition, the histologic interface between the microvesicular hyperplastic polyp (MVHP) and the SSA continues to be a diagnostic problem. The trend in recent years has been toward a lower threshold for SSA diagnosis. Herein, we have performed a cross-sectional study of 6340 colorectal polyps received at a high-volume community-based pathology practice over a 3-month period. After central review, with strict application of the diagnostic criteria outlined in the 2010 edition of the World Health Organization Classification of Tumours of the Digestive Tract, we found that SSAs represented 12.1% of all polyps. In addition, we developed novel diagnostic subcategories in an attempt to determine the most appropriate cutoff for the interface between the MVHP and the SSA. We found that serrated polyps (MVHPs or SSAs) with any SSA-like crypts had clinical features more in common with the SSA than the MVHP and that this diagnostic cutoff showed good reproducibility between pathologists. This supports the position of a recent consensus publication proposing that polyps with as few as 1 SSA-type crypt should be diagnosed as an SSA. Applying these criteria to our cohort yields an overall SSA rate of 14.7%. In summary, we believe that SSAs continue to be underdiagnosed in pathologic practice and that this may result in inadequate surveillance and thus contribute to interval colorectal carcinomas. Copyright
Keyword Colorectal neoplasms
Colorectal polyps
Microvesicular hyperplastic polyp
Sessile serrated adenoma
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
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