Serrated Lesions in Inflammatory Bowel Disease: Genotype-Phenotype Correlation

Area of Science:

• Gastroenterology
• Oncology
• Pathology

Background:

• Patients with inflammatory bowel disease (IBD) face an elevated risk of colorectal cancer, particularly those with hyperplastic/serrated polyposis.
• Understanding the nature of serrated lesions in IBD is crucial for risk stratification and management.

Purpose of the Study:

• To investigate the characteristics and molecular profiles of serrated lesions found in adult patients with inflammatory bowel disease.
• To differentiate true serrated polyps from reactive changes in the context of IBD.

Main Methods:

• Analysis of 65 serrated morphology lesions from 39 adult IBD patients.
• Classification of lesions using WHO 2019 criteria and molecular analysis (KRAS, BRAF mutations).

Main Results:

• Serrated lesions included hyperplastic polyps, sessile serrated lesions, and traditional serrated adenomas; 5 were inflammatory pseudopolyps.
• KRAS and BRAF mutations were identified in true serrated lesions, with distinct patterns in the right vs. left colon.
• One patient with traditional serrated adenomas progressed to adenocarcinoma within 61 months.

Conclusions:

• Molecular analysis can effectively differentiate true serrated lesions from reactive pseudopolyps in IBD patients.
• Accurate classification of serrated lesions is essential for improved patient management and cancer surveillance.