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Serrated polyps of the colon: how reproducible is their classification?

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Abstract

For several years, the lack of consensus on definition, nomenclature, natural history, and biology of serrated polyps (SPs) of the colon has created considerable confusion among pathologists. According to the latest WHO classification, the family of SPs comprises hyperplastic polyps (HPs), sessile serrated adenomas/polyps (SSA/Ps), and traditional serrated adenomas (TSAs). The term SSA/P with dysplasia has replaced the category of mixed hyperplastic/adenomatous polyps (MPs). The present study aimed to evaluate the reproducibility of the diagnosis of SPs based on currently available diagnostic criteria and interactive consensus development. In an initial round, H&E slides of 70 cases of SPs were circulated among participating pathologists across Europe. This round was followed by a consensus discussion on diagnostic criteria. A second round was performed on the same 70 cases using the revised criteria and definitions according to the recent WHO classification. Data were evaluated for inter-observer agreement using Kappa statistics. In the initial round, for the total of 70 cases, a fair overall kappa value of 0.318 was reached, while in the second round overall kappa value improved to moderate (kappa = 0.557; p < 0.001). Overall kappa values for each diagnostic category also significantly improved in the final round, reaching 0.977 for HP, 0.912 for SSA/P, and 0.845 for TSA (p < 0.001). The diagnostic reproducibility of SPs improves when strictly defined, standardized diagnostic criteria adopted by consensus are applied.

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References

  1. Snover DC, Ahnen DJ, Burt RW, Odze RD (2010) Serrated polyps of the colon and rectum and serrated polyposis. In: Bosman FT, Carneiro F, Hruban RH, Theise ND (eds) WHO classification of tumours of the digestive system, 4th edn. IARC, Lyon, pp 160–165

    Google Scholar 

  2. Longacre TA, Fenoglio-Preiser CM (1990) Mixed hyperplastic adenomatous polyps/serrated adenomas. A distinct form of colorectal neoplasia. Am J Surg Pathol 14:524–537

    Article  PubMed  CAS  Google Scholar 

  3. Torlakovic E, Skovlund E, Snover DC, Torlakovic G, Nesland JM (2003) Morphologic reappraisal of serrated colorectal polyps. Am J Surg Pathol 27:65–81

    Article  PubMed  Google Scholar 

  4. Higuchi T, Sugihara K, Jass JR (2005) Demographic and pathological characteristics of serrated polyps of colorectum. Histopathology 47:32–40

    Article  PubMed  CAS  Google Scholar 

  5. Snover DC, Jass JR, Fenoglio-Preiser C, Batts KP (2005) Serrated polyps of the large intestine: a morphologic and molecular review of an evolving concept. Am J Clin Pathol 124:380–391

    Article  PubMed  Google Scholar 

  6. Cunningham KS, Riddell RH (2006) Serrated mucosal lesions of the colorectum. Curr Opin Gastroenterol 22:48–53

    Article  PubMed  Google Scholar 

  7. Goldstein NS (2006) Serrated pathway and APC (conventional)-type colorectal polyps: molecular–morphologic correlations, genetic pathways, and implications for classification. Am J Clin Pathol 125:146–153

    PubMed  CAS  Google Scholar 

  8. Torlakovic E, Snover DC (2006) Sessile serrated adenoma: a brief history and current status. Crit Rev Oncog 12:27–39

    Article  PubMed  Google Scholar 

  9. Torlakovic EE, Gomez JD, Driman DK et al (2008) Sessile serrated adenoma (SSA) vs. traditional serrated adenoma (TSA). Am J Surg Pathol 32:21–29

    Article  PubMed  Google Scholar 

  10. Hirano H, Ajioka Y, Watanabe H et al (2004) Bidirectional gastric differentiation in cellular mucin phenotype (foveolar and pyloric) in serrated adenoma and hyperplastic polyp of the colorectum. Pathol Int 54:401–407

    Article  Google Scholar 

  11. Noffsinger AE (2009) Serrated polyps and colorectal cancer: new pathway to malignancy. Annu Rev Pathol 4:343–364

    Article  PubMed  CAS  Google Scholar 

  12. Goldstein NS, Bhanot P, Odish E, Hunter S (2003) Hyperplastic-like colon polyps that preceded microsatellite-unstable adenocarcinomas. Am J Clin Pathol 119:778–796

    Article  PubMed  Google Scholar 

  13. Hirono H, Ajioka Y, Watanabe H, Baba Y, Tozawa E, Nishikura K, Mukai G, Honma T, Aoyagi Y (2004) Bidirectional gastric differentiation in cellular mucin phenotype (foveolar and pyloric) in serrated adenoma and hyperplastic polyp of the colorectum. Pathol Int 54:401–407

    Article  PubMed  CAS  Google Scholar 

  14. Li SC, Burgart L (2007) Histopathology of serrated adenoma, its variants, and differentiation from conventional adenomatous and hyperplastic polyps. Arch Pathol Lab Med 131:440–445

    PubMed  Google Scholar 

  15. Bauer VP, Papaconstantinou HT (2008) Management of serrated adenomas and hyperplastic polyps. Clin Colon Rectal Surg 21:273–279

    Article  PubMed  Google Scholar 

  16. Jass JR, Young J, Leggett BA (2000) Hyperplastic polyps and DNA microsatellite unstable cancers of the colorectum. Histopathology 37:295–301

    Article  PubMed  CAS  Google Scholar 

  17. Jass JR, Young J, Leggett BA (2002) Evolution of colorectal cancer: change of pace and change of direction. J Gastroenterol Hepatol 17:17–26

    Article  PubMed  Google Scholar 

  18. Jass JR (2005) Serrated adenoma of the colorectum and the DNA-methylator phenotype. Nat Clin Pract Oncol 2:398–405

    Article  PubMed  CAS  Google Scholar 

  19. O’Brien MJ, Yang S, Mack C et al (2006) Comparison of microsatellite instability, CpG island methylation phenotype, BRAF and KRAS status in serrated polyps and traditional adenomas indicates separate pathways to distinct colorectal carcinoma end points. Am J Surg Pathol 30:1491–1501

    Article  PubMed  Google Scholar 

  20. Goldstein NS (2006) Small colonic microsatellite unstable adenocarcinomas and high-grade epithelial dysplasias in sessile serrated adenoma polypectomy specimens: a study of eight cases. Am J Clin Pathol 125:132–145

    PubMed  Google Scholar 

  21. Jass JR (2007) Classification of colorectal cancer based on correlation of clinical, morphological and molecular features. Histopathology 50:113–130

    Article  PubMed  CAS  Google Scholar 

  22. Bariol C, Hawkins NJ, Turner JJ, Meagher AP, Williams DB, Ward RL (2003) Histopathological and clinical evaluation of serrated adenomas of the colon and rectum. Mod Pathol 16(5):417–423

    Article  PubMed  Google Scholar 

  23. Farris AB, Misdraji J, Srivastava A, Muzikansky A, Desphande V, Lauwers GY, Mino-Kenudson M (2008) Sessile serrated adenoma. Challenging discrimination from other serrated colonic polyps. Am J Surg Pathol 32:30–35

    Article  PubMed  Google Scholar 

  24. Wong NACS, Hunt LP, Novelli MR, Shepard NA, Warren BF (2009) Observer agreement in the diagnosis of serrated polyps of the large bowel. Histopathology 55:63–66

    Article  PubMed  Google Scholar 

  25. Khalid O, Radaideh S, Cummings OW, O’Brien MJ, Goldblum JR, Rex DK (2009) Reinterpretation of histology of proximal colon polyps called hyperplastic in 2001. World J Gastroenterol 15:3767–3770

    Article  PubMed  Google Scholar 

  26. Glatz K, Pritt B, Glatz D, Harmann A, O’Brien MJ, Blaszyk H (2007) A multinational, internet-based assessment of observer variability in the diagnosis of serrated colorectal polyps. Am J Clin Pathol 127:938–945

    Article  PubMed  Google Scholar 

  27. Sandmeier D, Seelentag W, Bouzourene H (2007) Serrated polyps of the colorectum: is sessile serrated adenoma distinguishable from hyperplastic polyp in daily practice? Virchows Arch 450:613–618

    Article  PubMed  Google Scholar 

  28. Bustamente-Balen M, Bernet L, Cano R, Morell L, Lopez A (2009) Assessing the reproducibility of the microscopic diagnosis of sessile serrated adenoma of the colon. Rev Esp Enferm Dig (Madrid) 101:258–264

    Google Scholar 

  29. Gunia S, Berg T, Gradhand E, Becker S (2011) Knowledge of the anatomical polyp location might bias the pathological classification of histologically equivocal colorectal serrated polyps—a consensus study performed by pathology trainees. Path Res Pract 207:116–120

    Article  PubMed  Google Scholar 

  30. Denis B, Peters C, Chapelain C, Kleinclaus I, Fricker A, Wild R, Auge B, Gendre I, Perrin P, Chatelain D, Flejou JF (2009) Diagnostic accuracy of community pathologists in the interpretation of colorectal polyps. Eur J Gastroenterol Hepatol 21:1153–1160

    Article  PubMed  Google Scholar 

  31. Chung SM, Chen YT, Panczykowski A, Schamberg N, Klimstra DS, Yantiss RK (2008) Serrated polyps with “intermediate features” of sessile serrated polyp and microvesicular hyperplastic polyp: a practical approach to the classification of nondysplastic serrated polyps. Am J Surg Pathol 32:407–412

    Article  PubMed  Google Scholar 

  32. Ensari A, Bosman FT, Offerhaus GJA (2010) The serrated polyp: getting it right! J Clin Pathol 63:665–668

    Article  PubMed  CAS  Google Scholar 

  33. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  PubMed  CAS  Google Scholar 

  34. Aust DE, Baretton GB (2010) Serrated polyps of the colon and rectum (hyperplastic polyps, sessile serrated adenomas, traditional serrated adenomas, and mixed polyps)—proposal for diagnostic criteria. Virchows Arch 457:291–297

    Article  PubMed  Google Scholar 

  35. Sheridan TB, Fenton H, Lewin MR et al (2006) Sessile serrated adenomas with low- and high-grade dysplasia and early carcinomas: an immunohistochemical study of serrated lesions “caught in the act”. Am J Clin Pathol 126:564–571

    Article  PubMed  Google Scholar 

  36. Hamilton SR, Vogelstein B, Kudo S et al (2000) Carcinoma of the colon and rectum. In: Hamilton SR, Aaltonen IA (eds) Tumours of the digestive system. WHO classification of tumours. IARC, Lyon, pp 113–114

    Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Pathology, Ankara University Medical School, Sihhiye, Ankara, Turkey

    Arzu Ensari & Berna Savaş

  2. Department of Pathology, Ankara Guven Hospital, Ankara, Turkey

    Banu Bilezikçi

  3. Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal

    Fatima Carneiro

  4. Medical Faculty and Centro Hospitalar São João, Porto, Portugal

    Fatima Carneiro

  5. Department of Pathology, Group Florence Nightingale Hospitals, Istanbul, Turkey

    Gülen Bülbül Doğusoy

  6. Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands

    Ann Driessen

  7. Department of Pathology, Gazi Medical Faculty, Ankara, Turkey

    Ayşe Dursun

  8. Department of Pathology, Saint-Antoine Hospital, AP-HP, Pierre et Marie Curie Medical School, Paris, France

    Jean-François Flejou

  9. Department of Pathology, KU Leuven, Leuven, Belgium

    Gert de Hertogh

  10. Universiteit Gent, Ghent, Belgium

    Karel Geboes

  11. Department of Pathology, Cliniques Universitaires St Luc, UCL, Brussels, Belgium

    Anne Jouret-Mourin

  12. Institute of Pathology, Medical University of Graz, 8036, Graz, Austria

    Cord Langner

  13. Department of Pathology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands

    Irıs D. Nagtegaal

  14. Department of Pathology, University Medical Center Utrecht, H04.312, PB 85500, 3508 GA, Utrecht, The Netherlands

    Johan Offerhaus

  15. Department of Pathology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland

    Janina Orlowska

  16. Department of Pathology, HUSLAB and Haartman Institute, Helsinki University Central Hospital, Helsinki, Finland

    Ari Ristimäki

  17. Genome-Scale Biology, Research Program Unit, University of Helsinki, Helsinki, Finland

    Ari Ristimäki

  18. Departamento de Anatomia Patologuca, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain

    Julian Sanz-Ortega

  19. Department of Pathology, Alexandra Hospital, Athens, Greece

    Maria Sotiropoulou

  20. Department of Pathology, Spedali Civili Brescia, Brescia, Italy

    Vincenzo Villanacci

  21. Department of Biostatistics, Ankara University Medical School, Ankara, Turkey

    Nazmiye Kurşun

  22. University Institute of Pathology, University of Lausanne Medical Center, Lausanne, Switzerland

    Fred Bosman

Authors
  1. Arzu Ensari
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  2. Banu Bilezikçi
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  3. Fatima Carneiro
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  4. Gülen Bülbül Doğusoy
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  5. Ann Driessen
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  6. Ayşe Dursun
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  7. Jean-François Flejou
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  8. Karel Geboes
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  9. Gert de Hertogh
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  10. Anne Jouret-Mourin
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  11. Cord Langner
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  12. Irıs D. Nagtegaal
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  13. Johan Offerhaus
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  14. Janina Orlowska
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  15. Ari Ristimäki
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  16. Julian Sanz-Ortega
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  17. Berna Savaş
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  18. Maria Sotiropoulou
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  19. Vincenzo Villanacci
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  20. Nazmiye Kurşun
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  21. Fred Bosman
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Corresponding author

Correspondence to Arzu Ensari.

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Ensari, A., Bilezikçi, B., Carneiro, F. et al. Serrated polyps of the colon: how reproducible is their classification?. Virchows Arch 461, 495–504 (2012). https://doi.org/10.1007/s00428-012-1319-7

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  • DOI: https://doi.org/10.1007/s00428-012-1319-7

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