Endoscopic detection of proximal serrated lesions and pathologic identification of sessile serrated adenomas/polyps vary on the basis of center

Shannon R. Payne, Timothy R. Church, Michael Wandell, Thomas Rösch, Neal Osborn, Dale Snover, Robert W. Day, David F. Ransohoff, Douglas Rex

Research output: Contribution to journalArticle

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Abstract

Background & Aims: We investigated rates of detection of proximal serrated lesions in a cohort of average-risk patients undergoing screening colonoscopies. Methods: We reviewed results from screening colonoscopies performed by attending gastroenterologists at 32 endoscopy centers from 2008-2010. Pathology slides were interpreted at the individual centers. For this analysis, serrated lesions included hyperplastic polyps larger than 10 mm, those interpreted as sessile serrated adenomas (or sessile serrated polyp), and traditional serrated adenomas. Rates of detection for conventional adenomas and serrated lesions were compared among centers. Results: A total of 5778 lesions were detected in 7215 screening colonoscopies. Of the 5548 lesions with pathology results, 3008 (54.2%) were conventional adenomas, 350 (6.3%) were serrated, and 232 (4.2%) were proximal serrated. The proportion of colonoscopies with at least 1 proximal serrated lesion was 2.8% (range among centers, 0%-9.8%). The number of serrated lesions per colonoscopy ranged from 0.00-0.11 (average, 0.05 ± 0.25). Overall lesion detection rates correlated with proximal serrated lesion detection rates (R= 0.91, P < .0001); conventional adenoma and proximal serrated lesion detection rates also correlated (R= .43, P= .025). The detection rate of proximal serrated lesions differed significantly among centers (P < .0001); odds ratios for detection ranged from 0-0.79. Some centers' pathologists never identified proximal serrated lesions as sessile serrated adenomas/polyps. Conclusions: In an average-risk screening cohort, detection of proximal serrated lesions varied greatly among endoscopy centers. There was also substantial variation among pathologists in identification of sessile serrated adenomas/polyps. Nationally, a significant proportion of proximal serrated lesions may be missed during colonoscopy examination or incorrectly identified during pathology assessment. ClinicalTrials.gov Number: NCT00855348.

Original languageEnglish
Pages (from-to)1119-1126
Number of pages8
JournalClinical Gastroenterology and Hepatology
Volume12
Issue number7
DOIs
StatePublished - 2014

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Polyps
Adenoma
Colonoscopy
Pathology
Endoscopy
Odds Ratio

Keywords

  • Cancer screening
  • Colon cancer
  • Early detection
  • Hyperplastic polyp
  • Sessile serrated adenoma
  • Sessile serrated polyp

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Endoscopic detection of proximal serrated lesions and pathologic identification of sessile serrated adenomas/polyps vary on the basis of center. / Payne, Shannon R.; Church, Timothy R.; Wandell, Michael; Rösch, Thomas; Osborn, Neal; Snover, Dale; Day, Robert W.; Ransohoff, David F.; Rex, Douglas.

In: Clinical Gastroenterology and Hepatology, Vol. 12, No. 7, 2014, p. 1119-1126.

Research output: Contribution to journalArticle

Payne, Shannon R. ; Church, Timothy R. ; Wandell, Michael ; Rösch, Thomas ; Osborn, Neal ; Snover, Dale ; Day, Robert W. ; Ransohoff, David F. ; Rex, Douglas. / Endoscopic detection of proximal serrated lesions and pathologic identification of sessile serrated adenomas/polyps vary on the basis of center. In: Clinical Gastroenterology and Hepatology. 2014 ; Vol. 12, No. 7. pp. 1119-1126.
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abstract = "Background & Aims: We investigated rates of detection of proximal serrated lesions in a cohort of average-risk patients undergoing screening colonoscopies. Methods: We reviewed results from screening colonoscopies performed by attending gastroenterologists at 32 endoscopy centers from 2008-2010. Pathology slides were interpreted at the individual centers. For this analysis, serrated lesions included hyperplastic polyps larger than 10 mm, those interpreted as sessile serrated adenomas (or sessile serrated polyp), and traditional serrated adenomas. Rates of detection for conventional adenomas and serrated lesions were compared among centers. Results: A total of 5778 lesions were detected in 7215 screening colonoscopies. Of the 5548 lesions with pathology results, 3008 (54.2{\%}) were conventional adenomas, 350 (6.3{\%}) were serrated, and 232 (4.2{\%}) were proximal serrated. The proportion of colonoscopies with at least 1 proximal serrated lesion was 2.8{\%} (range among centers, 0{\%}-9.8{\%}). The number of serrated lesions per colonoscopy ranged from 0.00-0.11 (average, 0.05 ± 0.25). Overall lesion detection rates correlated with proximal serrated lesion detection rates (R= 0.91, P < .0001); conventional adenoma and proximal serrated lesion detection rates also correlated (R= .43, P= .025). The detection rate of proximal serrated lesions differed significantly among centers (P < .0001); odds ratios for detection ranged from 0-0.79. Some centers' pathologists never identified proximal serrated lesions as sessile serrated adenomas/polyps. Conclusions: In an average-risk screening cohort, detection of proximal serrated lesions varied greatly among endoscopy centers. There was also substantial variation among pathologists in identification of sessile serrated adenomas/polyps. Nationally, a significant proportion of proximal serrated lesions may be missed during colonoscopy examination or incorrectly identified during pathology assessment. ClinicalTrials.gov Number: NCT00855348.",
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T1 - Endoscopic detection of proximal serrated lesions and pathologic identification of sessile serrated adenomas/polyps vary on the basis of center

AU - Payne, Shannon R.

AU - Church, Timothy R.

AU - Wandell, Michael

AU - Rösch, Thomas

AU - Osborn, Neal

AU - Snover, Dale

AU - Day, Robert W.

AU - Ransohoff, David F.

AU - Rex, Douglas

PY - 2014

Y1 - 2014

N2 - Background & Aims: We investigated rates of detection of proximal serrated lesions in a cohort of average-risk patients undergoing screening colonoscopies. Methods: We reviewed results from screening colonoscopies performed by attending gastroenterologists at 32 endoscopy centers from 2008-2010. Pathology slides were interpreted at the individual centers. For this analysis, serrated lesions included hyperplastic polyps larger than 10 mm, those interpreted as sessile serrated adenomas (or sessile serrated polyp), and traditional serrated adenomas. Rates of detection for conventional adenomas and serrated lesions were compared among centers. Results: A total of 5778 lesions were detected in 7215 screening colonoscopies. Of the 5548 lesions with pathology results, 3008 (54.2%) were conventional adenomas, 350 (6.3%) were serrated, and 232 (4.2%) were proximal serrated. The proportion of colonoscopies with at least 1 proximal serrated lesion was 2.8% (range among centers, 0%-9.8%). The number of serrated lesions per colonoscopy ranged from 0.00-0.11 (average, 0.05 ± 0.25). Overall lesion detection rates correlated with proximal serrated lesion detection rates (R= 0.91, P < .0001); conventional adenoma and proximal serrated lesion detection rates also correlated (R= .43, P= .025). The detection rate of proximal serrated lesions differed significantly among centers (P < .0001); odds ratios for detection ranged from 0-0.79. Some centers' pathologists never identified proximal serrated lesions as sessile serrated adenomas/polyps. Conclusions: In an average-risk screening cohort, detection of proximal serrated lesions varied greatly among endoscopy centers. There was also substantial variation among pathologists in identification of sessile serrated adenomas/polyps. Nationally, a significant proportion of proximal serrated lesions may be missed during colonoscopy examination or incorrectly identified during pathology assessment. ClinicalTrials.gov Number: NCT00855348.

AB - Background & Aims: We investigated rates of detection of proximal serrated lesions in a cohort of average-risk patients undergoing screening colonoscopies. Methods: We reviewed results from screening colonoscopies performed by attending gastroenterologists at 32 endoscopy centers from 2008-2010. Pathology slides were interpreted at the individual centers. For this analysis, serrated lesions included hyperplastic polyps larger than 10 mm, those interpreted as sessile serrated adenomas (or sessile serrated polyp), and traditional serrated adenomas. Rates of detection for conventional adenomas and serrated lesions were compared among centers. Results: A total of 5778 lesions were detected in 7215 screening colonoscopies. Of the 5548 lesions with pathology results, 3008 (54.2%) were conventional adenomas, 350 (6.3%) were serrated, and 232 (4.2%) were proximal serrated. The proportion of colonoscopies with at least 1 proximal serrated lesion was 2.8% (range among centers, 0%-9.8%). The number of serrated lesions per colonoscopy ranged from 0.00-0.11 (average, 0.05 ± 0.25). Overall lesion detection rates correlated with proximal serrated lesion detection rates (R= 0.91, P < .0001); conventional adenoma and proximal serrated lesion detection rates also correlated (R= .43, P= .025). The detection rate of proximal serrated lesions differed significantly among centers (P < .0001); odds ratios for detection ranged from 0-0.79. Some centers' pathologists never identified proximal serrated lesions as sessile serrated adenomas/polyps. Conclusions: In an average-risk screening cohort, detection of proximal serrated lesions varied greatly among endoscopy centers. There was also substantial variation among pathologists in identification of sessile serrated adenomas/polyps. Nationally, a significant proportion of proximal serrated lesions may be missed during colonoscopy examination or incorrectly identified during pathology assessment. ClinicalTrials.gov Number: NCT00855348.

KW - Cancer screening

KW - Colon cancer

KW - Early detection

KW - Hyperplastic polyp

KW - Sessile serrated adenoma

KW - Sessile serrated polyp

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