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Reclassification of hyperplastic colon polyps influences surveillance

November's Gastrointestinal Endoscopy reports the reassessment of hyperplastic colon polyps in a city-wide pathology practice and the implications for surveillance recommendations.

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Sessile serrated adenomas and hyperplastic polyps are the 2 most common types of serrated colon polyps.

Sessile serrated adenomas are suspected to be the precursor lesions for many colorectal cancers, and hence there is an emphasis on their detection and removal.

On the other hand, recent guidelines such as those from the European Union consider hyperplastic polyps of limited clinical significance.

Dr Harminder Singh and colleagues from Canada evaluated the reclassification rate of recently diagnosed hyperplastic polyps to sessile serrated adenomas and the predictors of such reclassification.

20% of the polyps were reported as serrated colon polyps
Gastrointestinal Endoscopy

The research team searched the provincial pathology database for all colon polyps reported in the 6 pathology laboratories in the city of Winnipeg in 2009.

All retrieved pathology slides for previously reported right-sided hyperplastic polyps, and a 20% random sample of left-sided HPs were reassessed by 2 pathologists with a special interest in GI pathology.

Polyp size, colon location, and age and sex of the study participants were evaluated as potential predictors of reclassification.

A total of 4096 pathology reports by 25 different pathologists were reviewed.

The researchers noted that 20% of the polyps were reported as serrated colon polyps.

The team observed that 17% of right-sided previously reported hyperplastic polyps, and 20% of those more than 5 mm were reclassified as sessile serrated adenomas.

The research team found that size more than 5 mm, and location in the right side of the colon were independent predictors of reclassification.

Dr Singh's team concludes, "A significant proportion of recently reported right-sided hyperplastic polyps may be sessile serrated adenomas."

"Surveillance recommendations for serrated colon polyps should consider the size and location of serrated colon polyps, and not just the reported type."

Gastrointestinal Endoscopy 2012: 76(5): 1003-1008
22 November 2012

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