Sessile serrated adenomas in young patients may have limited risk of malignant progression

Bettington, Mark, Brown, Ian, Rosty, Christophe, Walker, Neal, Liu, Cheng, Croese, John, Rahman, Tony, Pearson, Sally-Ann, McKeone, Diane, Leggett, Barbara, and Whitehall, Vicki (2019) Sessile serrated adenomas in young patients may have limited risk of malignant progression. Journal of Clinical Gastroenterology, 53 (3). e113-e116.

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Goals: To provide preliminary evidence that sessile serrated adenomas (SSA) are low-risk polyps in young patients.

Background: SSAs are the dominant polyp of the serrated neoplasia pathway and as such are the precursor of up to 20% of colorectal carcinomas (CRC). Up to 90% of these cancers are expected to harbor a BRAF mutation. SSAs are being diagnosed with increasing frequency in young patients, placing a significant burden on colonoscopic services. Evidence to direct the surveillance intervals for these young patients is not available.

Study: We utilized 2 patient cohorts comprising (1) a consecutive series of patients who underwent outpatient colonoscopy through a tertiary hospital and (2) a consecutive series of resection specimens for CRC processed through a gastrointestinal pathology service. The prevalence of SSAs by age was determined in the patients undergoing colonoscopy and compared with the ages of patients with BRAF mutated CRC in the pathology series.

Results: The prevalence of SSAs was similar irrespective of age. By comparison, BRAF mutated CRCs were very rare (3.8% of cases) in patients younger than 50 years of age and uncommon (9.3% of cases) in patients younger than 60 years of age, but increased to 39.8% in patients older than 80 years of age.

Conclusions: These results suggest that SSAs develop at a young age, but have a prolonged dwell time and are unlikely to develop into cancer in patients younger than 60 years of age. These findings highlight the need for further targeted research to determine the most appropriate surveillance intervals for young patients with sporadic SSAs.

Item ID: 57407
Item Type: Article (Research - C1)
ISSN: 1539-2031
Keywords: sessile serrated adenoma, colorectal carcinoma, colonoscopy, surveillance
Copyright Information: Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Date Deposited: 13 Mar 2019 07:31
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3211 Oncology and carcinogenesis > 321199 Oncology and carcinogenesis not elsewhere classified @ 50%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320209 Gastroenterology and hepatology @ 50%
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