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Factors associated with reclassification of hyperplastic polyps after pathological reassessment from screening and surveillance colonoscopies

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction

A substantial interobserver variation in the differential diagnosis of hyperplastic polyps (HPs) and sessile or traditional serrated adenomas (SSAs/TSAs) has been described.

Methods

The aim of this study is to determine the magnitude of reclassification of HPs and associated factors after pathological reassessment of specimens from screening and surveillance colonoscopies, and to estimate its consequences for follow-up recommendations.

Results

Among 1694 screening and surveillance colonoscopies, a total of 536 polyps were initially diagnosed as HPs and remained unchanged in 88.5 % (n = 474), whereas 7.6 (n = 41) and 1.1 % (n = 6) were reclassified as SSA and TSA, respectively. Compared to definite HPs, SSAs were found more frequently in men than in women (82.9 vs. 61.2 %, p < 0.05), and in individuals ≥65.0 years (51.2 vs. 31.6 %, p = 0.05). Also, more SSAs were >5 mm in size (36.6 vs. 6.3 %, p < 0.05) and were localized in the proximal colon (31.7 vs. 11.8 %, p < 0.05). In a mixed model analysis, age ≥65.0 years (OR 4.13, 95 % CI 1.22–14.2), snare polypectomy (OR 23.6, 95 % CI 4.86–115), and coincident advanced adenomas (OR 7.56, 95 % CI 1.31–43.5) were significantly (p < 0.05) associated with reclassification to SSAs. Only 0.53 % of patients had received false recommendations for follow-up visits based on the incorrect HP diagnosis. A c.1799T>A, p.V600E BRAF mutation was detected in 21.9 % (n = 9) of reclassified SSAs.

Conclusion

Considering these factors may be helpful in serrated lesions that are difficult to allocate. Incorrect recommendations regarding control colonoscopy intervals due to misdiagnosed HPs can explain only a small fraction of interval colorectal cancers.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    Christoph Schramm, Moritz Kaiser, Fabian Kuetting, Andrea Bowe, Vera Hoffmann, Ulrich Toex & Hans-Michael Steffen

  2. Center for Pathology, University Hospital of Cologne, Cologne, Germany

    Uta Drebber & Sebastian Gatzke

  3. Institute for Pathology, University Hospital of Muenster, Muenster, Germany

    Inga Gruenewald

  4. Institute for Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany

    Jeremy Franklin

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  1. Christoph Schramm
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  2. Moritz Kaiser
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  3. Uta Drebber
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Correspondence to Hans-Michael Steffen.

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Schramm, C., Kaiser, M., Drebber, U. et al. Factors associated with reclassification of hyperplastic polyps after pathological reassessment from screening and surveillance colonoscopies. Int J Colorectal Dis 31, 319–325 (2016). https://doi.org/10.1007/s00384-015-2404-6

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  • DOI: https://doi.org/10.1007/s00384-015-2404-6

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