Serrated Lesions of the Colorectum: Review and Recommendations From an Expert Panel

By Douglas Rex, D. Ahnen, J. Baron, K. Batts, C. Burke, R. Burt, J. Goldblum, J. Guillem, Charles J. Kahi, M. Kalady and 9 more. American Journal of Gastroenterology, 2012

1,035 citations recorded by the source corpus.

Serrated lesions of the colorectum are the precursors of perhaps one-third of colorectal cancers (CRCs). Cancers arising in serrated lesions are usually in the proximal colon, and account for a disproportionate fraction of cancer identified after colonoscopy. We sought to provide guidance for the clinical management of serrated colorectal lesions based on current evidence and expert opinion regarding definitions, classification, and significance of serrated lesions. A consensus conference was held over 2 days reviewing the topic of serrated lesions from the perspectives of histology, molecular biology, epidemiology, clinical aspects, and serrated polyposis. Serrated lesions should be classified pathologically according to the World Health Organization criteria as hyperplastic polyp, sessile serrated adenoma/polyp (SSA/P) with or without cytological dysplasia, or traditional serrated adenoma (TSA). SSA/P and TSA are premalignant lesions, but SSA/P is the principal serrated precursor of CRCs. Serrated lesions have a distinct endoscopic appearance, and several lines of evidence suggest that on average they are more difficult to detect than conventional adenomatous polyps. Effective colonoscopy requires an endoscopist trained in the endoscopic appearance of serrated lesions. We recommend that all serrated lesions proximal to the sigmoid colon and all serrated lesions in the rectosigmoid >5 mm in size, be completely removed. Recommendations are made for post-polypectomy surveillance of serrated lesions and for surveillance of serrated polyposis patients and their relatives.

Subfields: Oncology, Pathology and Forensic Medicine, Pulmonary and Respiratory Medicine

View Paper: https://www.semanticscholar.org/paper/10721c59278c0138ad3e59920ad43baf79239844

How researchers see this paper

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In Oncology

1. R. Siegel
2. A. Jemal
3. Douglas Rex
4. K. Miller
5. F. Bray
6. J. Ferlay

In Pathology and Forensic Medicine

1. A. Jemal
2. R. Siegel
3. Douglas Rex

In Pulmonary and Respiratory Medicine

1. A. Jemal
2. R. Siegel
3. Douglas Rex

Citations in the corpus

• Colorectal cancer statistics, 2023 (2023, background): “Multitarget stool DNA testing is also more sensitive than fecal immunochemical testing or colonoscopy alone for serrated polyps,(142) which are precursors for 15%–30% of all CRCs, including many interval cancers.(143,144) However, although the 3‐year screening schedule for multitarget stool DNA test”
• ACG Clinical Guidelines: Colorectal Cancer Screening 2021. (2021, background): “Although it is proposed that some PCCRCs may arise from neoplastic lesions that harbor genetic features that are associated with a more rapid progression to cancer, as well as lesions that are not visualized or may have been incompletely resected, multiple studies have reported the association betwe”
• Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline (2017, background): “Sessile serrated adenomas/polyps are more likely to be located in the right colon (75%), accounting for approximately 5%–25% of all serrated lesions [213, 216].”