Association of large serrated polyps with synchronous advanced colorectal neoplasia

Dan Li, Chengshi Jin, Charles McCulloch, Sanjay Kakar, Barry M. Berger, Thomas Imperiale, Jonathan P. Terdiman

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

OBJECTIVES: Serrated polyps of the colorectum are a histologically and genetically heterogeneous group of lesions, which include classic hyperplasic polyps, sessile serrated adenomas (SSAs), and traditional serrated adenomas. Accumulating evidence suggests that they may have different malignancy potentials. This study sought to determine the association between the presence of large serrated colorectal polyps and synchronous advanced colorectal neoplasia. METHODS: Among 4,714 asymptomatic subjects who underwent screening colonoscopy, cases of advanced colorectal neoplasia (tubular adenoma ≥1 cm, adenoma with any villous histology, adenoma with carcinoma in situ / high-grade dysplasia, or invasive adenocarcinoma) were compared with controls without advanced neoplasia with respect to candidate predictors, including age, sex, family history of colorectal cancer, body mass index, the presence and number of small tubular adenomas (<1 cm), the presence of multiple small serrated polyps (<1 cm), and the presence of large serrated polyps (≥1 cm). Independent predictors of advanced neoplasia were determined by multivariate logistic regression analysis. RESULTS: Among 467 cases and 4,247 controls, independent predictors of advanced colorectal neoplasia were increasing age (odds ratio (OR)=4.51; 95% confidence interval (CI), 1.43-14.3; P=0.01 for subjects ≥80 years vs. 50-54 years of age); non-advanced tubular adenomas (OR=2.33; 95% CI 1.37-3.96, P=0.0017 for 3 or more); and large serrated polyps (OR=3.24; 95% CI 2.05-5.13, P<0.0001). In total, 109 subjects (2.3% of the study population) had large serrated polyps. Right- and left-sided large serrated polyps had a similar association with advanced colorectal neoplasia (OR=3.38 vs. 2.66, P=0.62). CONCLUSIONS: Large serrated polyps are strongly and independently associated with synchronous advanced colorectal neoplasia. Our results suggest that large serrated polyps may be a marker for advanced colorectal neoplasia. Further studies are needed to determine whether the association with advanced neoplasia differs among subsets of serrated polyps, particularly SSAs and classic hyperplastic polyps.

Original languageEnglish
Pages (from-to)695-702
Number of pages8
JournalAmerican Journal of Gastroenterology
Volume104
Issue number3
DOIs
StatePublished - Mar 2009

Fingerprint

Polyps
Adenoma
Neoplasms
Odds Ratio
Confidence Intervals
Villous Adenoma
Carcinoma in Situ
Colonoscopy
Colorectal Neoplasms
Histology
Adenocarcinoma
Body Mass Index
Logistic Models
Regression Analysis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Association of large serrated polyps with synchronous advanced colorectal neoplasia. / Li, Dan; Jin, Chengshi; McCulloch, Charles; Kakar, Sanjay; Berger, Barry M.; Imperiale, Thomas; Terdiman, Jonathan P.

In: American Journal of Gastroenterology, Vol. 104, No. 3, 03.2009, p. 695-702.

Research output: Contribution to journalArticle

Li, Dan ; Jin, Chengshi ; McCulloch, Charles ; Kakar, Sanjay ; Berger, Barry M. ; Imperiale, Thomas ; Terdiman, Jonathan P. / Association of large serrated polyps with synchronous advanced colorectal neoplasia. In: American Journal of Gastroenterology. 2009 ; Vol. 104, No. 3. pp. 695-702.
@article{da8166ba727f4416bd95ba5f4246e176,
title = "Association of large serrated polyps with synchronous advanced colorectal neoplasia",
abstract = "OBJECTIVES: Serrated polyps of the colorectum are a histologically and genetically heterogeneous group of lesions, which include classic hyperplasic polyps, sessile serrated adenomas (SSAs), and traditional serrated adenomas. Accumulating evidence suggests that they may have different malignancy potentials. This study sought to determine the association between the presence of large serrated colorectal polyps and synchronous advanced colorectal neoplasia. METHODS: Among 4,714 asymptomatic subjects who underwent screening colonoscopy, cases of advanced colorectal neoplasia (tubular adenoma ≥1 cm, adenoma with any villous histology, adenoma with carcinoma in situ / high-grade dysplasia, or invasive adenocarcinoma) were compared with controls without advanced neoplasia with respect to candidate predictors, including age, sex, family history of colorectal cancer, body mass index, the presence and number of small tubular adenomas (<1 cm), the presence of multiple small serrated polyps (<1 cm), and the presence of large serrated polyps (≥1 cm). Independent predictors of advanced neoplasia were determined by multivariate logistic regression analysis. RESULTS: Among 467 cases and 4,247 controls, independent predictors of advanced colorectal neoplasia were increasing age (odds ratio (OR)=4.51; 95{\%} confidence interval (CI), 1.43-14.3; P=0.01 for subjects ≥80 years vs. 50-54 years of age); non-advanced tubular adenomas (OR=2.33; 95{\%} CI 1.37-3.96, P=0.0017 for 3 or more); and large serrated polyps (OR=3.24; 95{\%} CI 2.05-5.13, P<0.0001). In total, 109 subjects (2.3{\%} of the study population) had large serrated polyps. Right- and left-sided large serrated polyps had a similar association with advanced colorectal neoplasia (OR=3.38 vs. 2.66, P=0.62). CONCLUSIONS: Large serrated polyps are strongly and independently associated with synchronous advanced colorectal neoplasia. Our results suggest that large serrated polyps may be a marker for advanced colorectal neoplasia. Further studies are needed to determine whether the association with advanced neoplasia differs among subsets of serrated polyps, particularly SSAs and classic hyperplastic polyps.",
author = "Dan Li and Chengshi Jin and Charles McCulloch and Sanjay Kakar and Berger, {Barry M.} and Thomas Imperiale and Terdiman, {Jonathan P.}",
year = "2009",
month = "3",
doi = "10.1038/ajg.2008.166",
language = "English",
volume = "104",
pages = "695--702",
journal = "American Journal of Gastroenterology",
issn = "0002-9270",
publisher = "Nature Publishing Group",
number = "3",

}

TY - JOUR

T1 - Association of large serrated polyps with synchronous advanced colorectal neoplasia

AU - Li, Dan

AU - Jin, Chengshi

AU - McCulloch, Charles

AU - Kakar, Sanjay

AU - Berger, Barry M.

AU - Imperiale, Thomas

AU - Terdiman, Jonathan P.

PY - 2009/3

Y1 - 2009/3

N2 - OBJECTIVES: Serrated polyps of the colorectum are a histologically and genetically heterogeneous group of lesions, which include classic hyperplasic polyps, sessile serrated adenomas (SSAs), and traditional serrated adenomas. Accumulating evidence suggests that they may have different malignancy potentials. This study sought to determine the association between the presence of large serrated colorectal polyps and synchronous advanced colorectal neoplasia. METHODS: Among 4,714 asymptomatic subjects who underwent screening colonoscopy, cases of advanced colorectal neoplasia (tubular adenoma ≥1 cm, adenoma with any villous histology, adenoma with carcinoma in situ / high-grade dysplasia, or invasive adenocarcinoma) were compared with controls without advanced neoplasia with respect to candidate predictors, including age, sex, family history of colorectal cancer, body mass index, the presence and number of small tubular adenomas (<1 cm), the presence of multiple small serrated polyps (<1 cm), and the presence of large serrated polyps (≥1 cm). Independent predictors of advanced neoplasia were determined by multivariate logistic regression analysis. RESULTS: Among 467 cases and 4,247 controls, independent predictors of advanced colorectal neoplasia were increasing age (odds ratio (OR)=4.51; 95% confidence interval (CI), 1.43-14.3; P=0.01 for subjects ≥80 years vs. 50-54 years of age); non-advanced tubular adenomas (OR=2.33; 95% CI 1.37-3.96, P=0.0017 for 3 or more); and large serrated polyps (OR=3.24; 95% CI 2.05-5.13, P<0.0001). In total, 109 subjects (2.3% of the study population) had large serrated polyps. Right- and left-sided large serrated polyps had a similar association with advanced colorectal neoplasia (OR=3.38 vs. 2.66, P=0.62). CONCLUSIONS: Large serrated polyps are strongly and independently associated with synchronous advanced colorectal neoplasia. Our results suggest that large serrated polyps may be a marker for advanced colorectal neoplasia. Further studies are needed to determine whether the association with advanced neoplasia differs among subsets of serrated polyps, particularly SSAs and classic hyperplastic polyps.

AB - OBJECTIVES: Serrated polyps of the colorectum are a histologically and genetically heterogeneous group of lesions, which include classic hyperplasic polyps, sessile serrated adenomas (SSAs), and traditional serrated adenomas. Accumulating evidence suggests that they may have different malignancy potentials. This study sought to determine the association between the presence of large serrated colorectal polyps and synchronous advanced colorectal neoplasia. METHODS: Among 4,714 asymptomatic subjects who underwent screening colonoscopy, cases of advanced colorectal neoplasia (tubular adenoma ≥1 cm, adenoma with any villous histology, adenoma with carcinoma in situ / high-grade dysplasia, or invasive adenocarcinoma) were compared with controls without advanced neoplasia with respect to candidate predictors, including age, sex, family history of colorectal cancer, body mass index, the presence and number of small tubular adenomas (<1 cm), the presence of multiple small serrated polyps (<1 cm), and the presence of large serrated polyps (≥1 cm). Independent predictors of advanced neoplasia were determined by multivariate logistic regression analysis. RESULTS: Among 467 cases and 4,247 controls, independent predictors of advanced colorectal neoplasia were increasing age (odds ratio (OR)=4.51; 95% confidence interval (CI), 1.43-14.3; P=0.01 for subjects ≥80 years vs. 50-54 years of age); non-advanced tubular adenomas (OR=2.33; 95% CI 1.37-3.96, P=0.0017 for 3 or more); and large serrated polyps (OR=3.24; 95% CI 2.05-5.13, P<0.0001). In total, 109 subjects (2.3% of the study population) had large serrated polyps. Right- and left-sided large serrated polyps had a similar association with advanced colorectal neoplasia (OR=3.38 vs. 2.66, P=0.62). CONCLUSIONS: Large serrated polyps are strongly and independently associated with synchronous advanced colorectal neoplasia. Our results suggest that large serrated polyps may be a marker for advanced colorectal neoplasia. Further studies are needed to determine whether the association with advanced neoplasia differs among subsets of serrated polyps, particularly SSAs and classic hyperplastic polyps.

UR - http://www.scopus.com/inward/record.url?scp=62049084040&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=62049084040&partnerID=8YFLogxK

U2 - 10.1038/ajg.2008.166

DO - 10.1038/ajg.2008.166

M3 - Article

VL - 104

SP - 695

EP - 702

JO - American Journal of Gastroenterology

JF - American Journal of Gastroenterology

SN - 0002-9270

IS - 3

ER -