Sessile serrated adenomas: prevalence of dysplasia and carcinoma in 2139 patients

J Clin Pathol. 2010 Aug;63(8):681-6. doi: 10.1136/jcp.2010.075507. Epub 2010 Jun 14.

Abstract

Background and aims: Sessile serrated adenomas (SSAs) are recognised as precursors to microsatellite unstable adenocarcinomas. This study attempts to estimate the progression rate of SSAs based upon the epidemiology of a large cohort as well as identify relationships to other colorectal polyps.

Methods: Pathological reports generated at Caris Diagnostics from 290 810 colonoscopic specimens on 179 111 patients were analysed using computerised algorithms.

Results: SSAs with or without dysplasia/carcinoma (SSA+/-) were identified in 2416 specimens from 2139 patients (54% women). The distribution of SSA+/- was: right-sided (81.2%); left-sided (11.2%); both right- and left-sided (3.2%); not specified (4.3%). There were 1816 (85%) patients without dysplasia (SSA-), 257 (12%) with low-grade dysplasia (SSA-LD), 45 (2%) with high-grade dysplasia (SSA-HD) and 21 (1%) with adenocarcinoma (SSA-CA). The difference in median age between almost all groups was significant (SSA-=61 years versus SSA-LD=66 years (p<0.001) vs SSA-HD=72 years (p=0.002) vs SSA-CA=76 years (p=0.07, NS)). Women comprised 53% of the SSA- group (968/1816), 57% of the SSA-LD group (147/257), 69% of the SSA-HD group (31/45) and 76% of the SSA-CA group (16/21), being more likely to have high-grade dysplasia (OR 1.94, 95% CI 1.03 to 3.67) and adenocarcinoma (OR 2.80, 95% CI 1.02 to 7.68).

Conclusions: 1.7% of patients with mucosal polyps had SSAs (with and without dysplasia), more commonly in women and primarily in the right colon. Dysplasia or carcinoma was identified in 15% of patients and significantly disproportionately among women. Based on significant age differences between groups, there appears to be a stepwise progression of dysplasia and carcinoma in SSAs over 10 to 15 years, a period two to three times longer than that for conventional adenomas.

MeSH terms

  • Adenocarcinoma / epidemiology
  • Adenocarcinoma / pathology
  • Adenoma / epidemiology*
  • Adenoma / pathology
  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Biopsy
  • Colonoscopy
  • Colorectal Neoplasms / epidemiology*
  • Colorectal Neoplasms / pathology
  • Disease Progression
  • Female
  • Humans
  • Intestinal Polyps / epidemiology
  • Intestinal Polyps / pathology
  • Male
  • Middle Aged
  • Prevalence
  • United States / epidemiology
  • Young Adult