Virchows Archiv

, Volume 461, Issue 5, pp 495–504 | Cite as

Serrated polyps of the colon: how reproducible is their classification?

  • Arzu EnsariEmail author
  • Banu Bilezikçi
  • Fatima Carneiro
  • Gülen Bülbül Doğusoy
  • Ann Driessen
  • Ayşe Dursun
  • Jean-François Flejou
  • Karel Geboes
  • Gert de Hertogh
  • Anne Jouret-Mourin
  • Cord Langner
  • Irıs D. Nagtegaal
  • Johan Offerhaus
  • Janina Orlowska
  • Ari Ristimäki
  • Julian Sanz-Ortega
  • Berna Savaş
  • Maria Sotiropoulou
  • Vincenzo Villanacci
  • Nazmiye Kurşun
  • Fred Bosman
Original Article


For several years, the lack of consensus on definition, nomenclature, natural history, and biology of serrated polyps (SPs) of the colon has created considerable confusion among pathologists. According to the latest WHO classification, the family of SPs comprises hyperplastic polyps (HPs), sessile serrated adenomas/polyps (SSA/Ps), and traditional serrated adenomas (TSAs). The term SSA/P with dysplasia has replaced the category of mixed hyperplastic/adenomatous polyps (MPs). The present study aimed to evaluate the reproducibility of the diagnosis of SPs based on currently available diagnostic criteria and interactive consensus development. In an initial round, H&E slides of 70 cases of SPs were circulated among participating pathologists across Europe. This round was followed by a consensus discussion on diagnostic criteria. A second round was performed on the same 70 cases using the revised criteria and definitions according to the recent WHO classification. Data were evaluated for inter-observer agreement using Kappa statistics. In the initial round, for the total of 70 cases, a fair overall kappa value of 0.318 was reached, while in the second round overall kappa value improved to moderate (kappa = 0.557; p < 0.001). Overall kappa values for each diagnostic category also significantly improved in the final round, reaching 0.977 for HP, 0.912 for SSA/P, and 0.845 for TSA (p < 0.001). The diagnostic reproducibility of SPs improves when strictly defined, standardized diagnostic criteria adopted by consensus are applied.


Serrated polyp Diagnosis Criteria Kappa statistics 


Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Arzu Ensari
    • 1
    Email author
  • Banu Bilezikçi
    • 2
  • Fatima Carneiro
    • 3
    • 4
  • Gülen Bülbül Doğusoy
    • 5
  • Ann Driessen
    • 6
  • Ayşe Dursun
    • 7
  • Jean-François Flejou
    • 8
  • Karel Geboes
    • 10
  • Gert de Hertogh
    • 9
  • Anne Jouret-Mourin
    • 11
  • Cord Langner
    • 12
  • Irıs D. Nagtegaal
    • 13
  • Johan Offerhaus
    • 14
  • Janina Orlowska
    • 15
  • Ari Ristimäki
    • 16
    • 17
  • Julian Sanz-Ortega
    • 18
  • Berna Savaş
    • 1
  • Maria Sotiropoulou
    • 19
  • Vincenzo Villanacci
    • 20
  • Nazmiye Kurşun
    • 21
  • Fred Bosman
    • 22
  1. 1.Department of PathologyAnkara University Medical SchoolAnkaraTurkey
  2. 2.Department of PathologyAnkara Guven HospitalAnkaraTurkey
  3. 3.Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP)PortoPortugal
  4. 4.Medical Faculty and Centro Hospitalar São JoãoPortoPortugal
  5. 5.Department of PathologyGroup Florence Nightingale HospitalsIstanbulTurkey
  6. 6.Department of PathologyMaastricht University Medical CenterMaastrichtThe Netherlands
  7. 7.Department of PathologyGazi Medical FacultyAnkaraTurkey
  8. 8.Department of Pathology, Saint-Antoine Hospital, AP-HPPierre et Marie Curie Medical SchoolParisFrance
  9. 9.Department of PathologyKU LeuvenLeuvenBelgium
  10. 10.Universiteit GentGhentBelgium
  11. 11.Department of PathologyCliniques Universitaires St Luc, UCLBrusselsBelgium
  12. 12.Institute of PathologyMedical University of GrazGrazAustria
  13. 13.Department of PathologyRadboud University Nijmegen Medical CenterNijmegenThe Netherlands
  14. 14.Department of PathologyUniversity Medical Center UtrechtUtrechtThe Netherlands
  15. 15.Department of PathologyMaria Sklodowska-Curie Memorial Cancer Centre and Institute of OncologyWarsawPoland
  16. 16.Department of Pathology, HUSLAB and Haartman InstituteHelsinki University Central HospitalHelsinkiFinland
  17. 17.Genome-Scale Biology, Research Program UnitUniversity of HelsinkiHelsinkiFinland
  18. 18.Departamento de Anatomia Patologuca, Facultad de MedicinaUniversidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)MadridSpain
  19. 19.Department of PathologyAlexandra HospitalAthensGreece
  20. 20.Department of PathologySpedali Civili BresciaBresciaItaly
  21. 21.Department of BiostatisticsAnkara University Medical SchoolAnkaraTurkey
  22. 22.University Institute of PathologyUniversity of Lausanne Medical CenterLausanneSwitzerland

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