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Impact of reassessment of colonic hyperplastic polyps by expert GI pathologists

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Recommended follow-up intervals after endoscopic removal of hyperplastic polyps (HP) and sessile serrated adenomas (SSA) differ because of assumed differences in biological behaviour. However, histopathologic differentiation is difficult, with higher SSA rates reported from specialist GI histopathologists.

Objective

The objective of this study was to clarify the relevance of histologic reassessment of HP.

Design and setting

From a prospective screening colonoscopy study relevant serrated lesions (excluding distal small HP ≤5 mm) diagnosed by private practice pathologists were reassessed by four specialized GI pathologists

Patients

One thousand sixty-nine screening colonoscopies were performed in patients.

Main outcome measurements

In terms of main outcome measurements, there is a likelihood of changes of the HP diagnosis on reassessment, as well as interrater variability.

Results

SSA were initially diagnosed in 7 cases (0.7 %) and relevant HP in 83 (7.8 %; 101 lesions). Of the latter, the chance of a change in diagnosis from HP to SSA by any of the four specialist histopathologists was higher for larger (>5 mm) and right-sided lesions (19.1 vs 1.3 %, OR 18.4, p = 0.04) including a higher likelihood to change recommended follow-up intervals (32.1 vs 3.3 %, p < 0.01). However, follow-up intervals were determined by concomitant adenomas in 41 %. Interrater variability was also higher for these lesions (p = 0.04), with an overall kappa value of 0.48. However, this issue related to only 1.2 % of the 1069 study cases.

Limitation

The limitations this study are the limited case number as well as limited retrospective assessment.

Conclusions

Right-sided HP >5 mm had a higher chance of change in diagnosis to SSA; therefore, they should probably be treated like adenomas and be removed. However, reliable data for recommendations on follow-up intervals of HP or SSA will require follow-up studies.

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Contribution of authors

Guido Schachschal was responsible for designing and conducting the analysis, data collection and writing of the paper; Matthias Choschzcik, Daniela Aust, Lydia Brand and Michael Vieth did the histopathological reassessment; finally Susanne Sehner and Karl Wegscheider carried out the statistical analysis. Gustavo Baretton, Thomas Kirchner and Guido Sauter were involved in advising on the classification system and especially in paper revision. Daniel von Renteln, Guido Schachschal and Tania Noder contributed to data collection. Jan Kersten was responsible for the statistical analysis. Thomas Rösch was responsible for designing and conducting the study, data collection, data analysis and writing and revising of the manuscript. All authors revised and approved the final manuscript.

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Authors and Affiliations

  1. Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany

    Guido Schachschal & Thomas Rösch

  2. Department of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Susanne Sehner & Karl Wegscheider

  3. Department of Pathology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Matthias Choschzick & Guido Sauter

  4. Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland

    Matthias Choschzick

  5. Department of Pathology, University Hospital Carl Gustav Carus, Dresden, Germany

    Daniela Aust & Gustavo B. Baretton

  6. Institute of Pathology, Ludwig-Maximilian University, Munich, Germany

    Lydia Brandl & Thomas Kirchner

  7. Institute of Pathology, Bayreuth Hospital, Bayreuth, Germany

    Michael Vieth

Authors
  1. Guido Schachschal
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  2. Susanne Sehner
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  3. Matthias Choschzick
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  4. Daniela Aust
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  5. Lydia Brandl
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  7. Karl Wegscheider
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  8. Gustavo B. Baretton
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  9. Thomas Kirchner
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  10. Guido Sauter
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  11. Thomas Rösch
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Corresponding author

Correspondence to Thomas Rösch.

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Conflict of interest

All authors state that they have no conflict of interest or financial ties relevant to this study to disclose.

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Schachschal, G., Sehner, S., Choschzick, M. et al. Impact of reassessment of colonic hyperplastic polyps by expert GI pathologists. Int J Colorectal Dis 31, 675–683 (2016). https://doi.org/10.1007/s00384-016-2523-8

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  • DOI: https://doi.org/10.1007/s00384-016-2523-8

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