Optical biopsy of sessile serrated adenomas: do these lesions resemble hyperplastic polyps under narrow-band imaging?

Gastrointest Endosc. 2013 Dec;78(6):902-909. doi: 10.1016/j.gie.2013.06.004. Epub 2013 Jul 9.


Background: Serrated colorectal lesions include hyperplastic polyps (HPs) and sessile serrated adenomas (SSAs). Optical biopsy could misclassify SSAs as unimportant if they resemble HPs.

Objective: To explore the narrow-band imaging (NBI) features of SSAs. We hypothesized that SSAs resemble HPs under NBI.

Design: Retrospective analysis of data from our prospective study of NBI in routine practice.

Setting: Single specialty group.

Patients: Patients undergoing colonoscopy.

Intervention: Colonoscopy.

Main outcome measurements: Polyp histology prediction by community gastroenterologists. Features of SSAs versus HPs and adenomas by using the Narrow-Band Imaging International Colorectal Endoscopic (NICE) Classification.

Results: Among 2388 lesions, 141 were diagnosed on pathology as SSAs, 465 as HPs, and 1546 as adenomas. Each individual NICE feature of HPs was found in 38% to 42% of SSAs, 66% to 67% of HPs, and 15% to 20% of adenomas (P < .001 for each). Each individual NICE feature of adenomas was found in 57% to 62% of SSAs, 33% to 34% of HPs, and 80% to 84% of adenomas (P < .001 for each). Compared with HPs, SSAs were less likely (odds ratio [OR] 0.74; 95% confidence interval [CI], 0.69-0.79) and adenomas were even less likely (OR 0.62; 95% CI, 0.59-0.64) to have all 3 NICE features of HPs. SSAs >5 mm were more likely than smaller SSAs to have all 3 NICE features of adenomas. SSA location did not predict NBI features. Analyses restricted to high-confidence lesions showed similar results.

Limitations: The endoscopists were not NBI experts.

Conclusion: Community gastroenterologists observed a profile of NICE features among SSAs that was intermediate to the profiles observed for HPs and adenomas. These results require confirmation by NBI experts.

Keywords: HP; NBI; NBI International Colorectal Endoscopic (classification); NICE; SSA; hyperplastic polyp; narrow-band imaging; sessile serrated adenoma.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenoma / classification
  • Adenoma / pathology*
  • Aged
  • Biopsy
  • Clinical Competence
  • Colon / pathology*
  • Colonic Polyps / pathology*
  • Colonoscopy
  • Colorectal Neoplasms / classification
  • Colorectal Neoplasms / pathology*
  • Female
  • Gastroenterology
  • Humans
  • Hyperplasia / pathology
  • Male
  • Middle Aged
  • Narrow Band Imaging*
  • Retrospective Studies