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Serrated Lesion Detection in a Population-based Colon Screening Program.

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Sessile serrated polyps (SSPs) are a significant cause of colorectal cancer, but fecal immunochemical tests (FITs) have low sensitivity for them. Subspecialty pathologists improve SSP detection rates in screening programs.

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Area of Science:

  • Gastroenterology
  • Oncology
  • Pathology

Background:

  • Serrated lesions, particularly sessile serrated polyps (SSPs), account for 15-30% of colorectal cancers.
  • Fecal immunochemical tests (FITs) exhibit low sensitivity for detecting SSPs.
  • Accurate diagnosis of SSPs depends on both endoscopic and histologic expertise.

Purpose of the Study:

  • To assess the sessile serrated polyp detection rate (SSPDR) within a population-based colon cancer screening program.
  • To investigate the impact of subspecialty-trained pathologists on SSP detection and reporting.

Main Methods:

  • Analysis of a colon screening program database from January 2014 to June 2017.
  • Inclusion of FIT-positive patients who underwent colonoscopy.
  • Collection of data on demographics, colonoscopy quality, pathology, and FIT values.

Main Results:

  • Out of 74,605 colonoscopies, 26.6% revealed serrated polyps, with an SSPDR of 7.0%.
  • 59% of detected SSPs were found concurrently with conventional adenomas.
  • Centers with gastrointestinal subspecialty pathologists demonstrated higher SSP detection rates and identified more right-sided SSPs.

Conclusions:

  • Serrated lesions frequently coexist with conventional adenomas and are linked to lower FIT values.
  • Accurate SSP diagnosis is crucial and influenced by pathologist expertise.
  • Subspecialty pathology training enhances the detection of SSPs in screening settings.