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Caught in the act: endoscopic characterization of sessile serrated adenomas with dysplasia

2014; Elsevier BV; Volume: 79; Issue: 5 Linguagem: Inglês

10.1016/j.gie.2014.01.013

1097-6779

Kavinderjit S. Nanda, Nicholas Tutticci, Nicholas G. Burgess, Rebecca Sonson, Duncan McLeod, Michael J. Bourke,

Metastasis and carcinoma case studies

The serrated pathway accounts for up to 30% of colorectal cancers 1 Leggett B. Whitehall V. Role of the serrated pathway in colorectal cancer pathogenesis. Gastroenterology. 2010; 138: 2088-2100 Abstract Full Text Full Text PDF PubMed Scopus (758) Google Scholar , 2 Snover D.C. Update on the serrated pathway to colorectal carcinoma. Hum Pathol. 2011; 42: 1-10 Abstract Full Text Full Text PDF PubMed Scopus (520) Google Scholar and is implicated in the relative failure of colonoscopy to protect against colorectal cancer in the proximal colon. 3 Sawhney M.S. Farrar W.D. Gudiseva S. et al. Microsatellite instability in interval colon cancers. Gastroenterology. 2006; 131: 1700-1705 Abstract Full Text Full Text PDF PubMed Scopus (260) Google Scholar , 4 Arain M.A. Sawhney M. Sheikh S. et al. CIMP status of interval colon cancers: another piece to the puzzle. Am J Gastroenterol. 2010; 105: 1189-1195 Crossref PubMed Scopus (286) Google Scholar The sessile serrated adenoma (SSA) is the major precursor in this pathway. The development of dysplasia (D) within an SSA is a critical event and represents a rapidly accelerated phase in the progression to cancer. 2 Snover D.C. Update on the serrated pathway to colorectal carcinoma. Hum Pathol. 2011; 42: 1-10 Abstract Full Text Full Text PDF PubMed Scopus (520) Google Scholar , 5 Bettington M. Walker N. Clouston A. et al. The serrated pathway to colorectal carcinoma: current concepts and challenges. Histopathology. 2013; 62: 367-386 Crossref PubMed Scopus (355) Google Scholar Improvements in image definition and the evolution of push-button image enhancements, such as narrow-band imaging (NBI), permit accurate endoscopic prediction of polyp histopathology without the requirement for magnification, 6 Henry Z.H. Yeaton P. Shami V.M. et al. Meshed capillary vessels found on narrow-band imaging without optical magnification effectively identifies colorectal neoplasia: a North American validation of the Japanese experience. Gastrointest Endosc. 2010; 72: 118-126 Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar , 7 Hewett D.G. Kaltenbach T. Sano Y. et al. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology. 2012; 143: 599-607.e1 Abstract Full Text Full Text PDF PubMed Scopus (446) Google Scholar allowing implementation in mainstream clinical practice. Moreover, these methods allow accurate real-time endoscopic prediction of advanced histology and early invasive change in conventional adenomas. Recognition of these features is important because a change in the proposed management strategy may be necessary.