Endoscopic analysis of colorectal serrated lesions with cancer

Nagata,Shuichiro; Mitsuyama,Keiichi; Kawano,Hiroshi; Noda,Tetsuhiro; Maeyama,Yasuhiko; Mukasa,Michita; Takedatsu,Hidetoshi; Yoshioka,Shinichiro; Kuwaki,Kotaro; Akiba,Jun; Tsuruta,Osamu; Torimura,Takuji

doi:10.3892/ol.2018.8386

Endoscopic analysis of colorectal serrated lesions with cancer

Authors:
- Shuichiro Nagata
- Keiichi Mitsuyama
- Hiroshi Kawano
- Tetsuhiro Noda
- Yasuhiko Maeyama
- Michita Mukasa
- Hidetoshi Takedatsu
- Shinichiro Yoshioka
- Kotaro Kuwaki
- Jun Akiba
- Osamu Tsuruta
- Takuji Torimura
View Affiliations

Affiliations: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan, Department of Gastroenterology, St. Mary's Hospital, Kurume, Fukuoka 830‑8543, Japan, Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
Published online on: March 29, 2018 https://doi.org/10.3892/ol.2018.8386
Pages: 8655-8662

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Serrated lesions, including hyperplastic polyps (HPs), traditional serrated adenomas (TSAs) and sessile serrated adenomas/polyps (SSA/Ps), are important contributors to colorectal carcinogenesis. The aim of the present study was to analyze the potential of conventional endoscopy and advanced endoscopic imaging techniques to delineate the characteristic features of serrated lesions with cancer. The present study was a retrospective analysis of the data of 168 patients who had undergone colonoscopy, and a total of 228 serrated lesions (77 HPs, 58 TSAs, 84 SSA/Ps, 9 SSA/P plus TSAs) have been identified in these patients. A cancer component was identified in 2.6% of HPs, 13.8% of TSAs and 10.7% of SSA/Ps, but none of SSA/P plus TSAs. Compared with the lesions without cancer, the lesions with cancer exhibited a larger size (HP, TSA and SSA/P), a reddish appearance (SSA/P), a two‑tier raised appearance (HP and SSA/P), a central depression (HP, TSA and SSA/P), the type V pit pattern (HP, TSA and SSA/P), and/or the type III capillary pattern (TSA and SSA/P). Deep invasion was identified in 50.0% of HPs, 12.5% of TSAs and 55.6% of SSA/Ps with cancer. The Ki‑67 proliferative zone was distributed diffusely within the area of the cancer, but partially within the non‑cancer area of HPs, TSAs and SSA/Ps. The lesion types were also analyzed on the basis of mucin phenotype. The present study suggested that a detailed endoscopic analysis of serrated lesions with cancer is useful for delineating characteristic features, and the analysis aids treatment selection.

View Figures

View References

1	Morson BC: Precancerous and early malignant lesions of the large intestine. Br J Surg. 55:725–731. 1968. View Article : Google Scholar : PubMed/NCBI
2	Muto T, Bussey HJ and Morson BC: The evolution of cancer of the colon and rectum. Cancer. 36:2251–2270. 1975. View Article : Google Scholar : PubMed/NCBI
3	Torlakovic E, Skovlund E, Snover DC, Torlakovic G and Nesland JM: Morphologic reappraisal of serrated colorectal polyps. Am J Surg Pathol. 27:65–81. 2003. View Article : Google Scholar : PubMed/NCBI
4	Jass JR: Classification of colorectal cancer based on correlation of clinical, morphological and molecular features. Histopathology. 50:113–30. 2007. View Article : Google Scholar : PubMed/NCBI
5	Cunningham KS and Riddell RH: Serrated mucosal lesions of the colorectum. Curr Opin Gastroenterol. 22:48–53. 2006. View Article : Google Scholar : PubMed/NCBI
6	Snover D, Ahnen D, Burt R, et al: Serrated polyps of the colon and rectum and serrated polyposisWHO Classification of Tumours of the Digestive System. 4th edition. Bosman F, Carneiro F, Hruban R and Theise N: IARC Press; Lyon: pp. 160–165. 2000
7	Kambara T, Simms LA, Whitehall VL, Spring KJ, Wynter CV, Walsh MD, Barker M, Arnold S, McGivern A, Matsubara N, et al: BRAF mutation is associated with DNA methylation in serrated polyps and cancers of the colorectum. Gut. 53:1137–1144. 2004. View Article : Google Scholar : PubMed/NCBI
8	Jass JR: Serrated adenoma of the colorectum and the DNA-methylator phenotype. Nat Clin Pract Oncol. 2:398–405. 2005. View Article : Google Scholar : PubMed/NCBI
9	O'Brien M: Hyperpalastic and serrated polyps of the colorectum. Gastroenterol Clin North Am. 36:947–968. 2007. View Article : Google Scholar : PubMed/NCBI
10	Axelrad AM, Fleischer DE, Geller AJ, Nguyen CC, Lewis JH, Al-Kawas FH, Avigan MI, Montgomery EA and Benjamin SB: High-resolution chromoendoscopy for the diagnosis of diminutive colon polyps: Implications for colon cancer screening. Gastroenterology. 110:1253–1258. 1996. View Article : Google Scholar : PubMed/NCBI
11	Fu KI, Sano Y, Kato S, Fujii T, Nagashima F, Yoshino T, Okuno T, Yoshida S and Fujimori T: Chromoendoscopy using indigo carmine dye spraying with magnifying observation is the most reliable method for differential diagnosis between non-neoplastic and neoplastic colorectal lesions: A prospective study. Endoscopy. 36:1089–1093. 2004. View Article : Google Scholar : PubMed/NCBI
12	Hasegawa S, Mitsuyama K, Kawano H, Arita K, Maeyama Y, Akagi Y, Watanabe Y, Okabe Y, Tsuruta O and Sata M: Endoscopic discrimination of sessile serrated adenomas from other serrated lesions. Oncol Lett. 2:785–789. 2011.PubMed/NCBI
13	Tadepalli US, Feihel D, Miller KM, Itzkowitz SH, Freedman JS, Kornacki S, Cohen LB, Bamji ND, Bodian CA and Aisenberg J: A morphologic analysis of sessile serrated polyps observed during routine colonoscopy (with video). Gastrointest Endosc. 74:1360–1368. 2011. View Article : Google Scholar : PubMed/NCBI
14	Hazewinkel Y, López-Cerón M, East JE, Rastogi A, Pellisé M, Nakajima T, van Eeden S, Tytgat KM, Fockens P and Dekker E: Endoscopic features of sessile serrated adenomas: Validation by international experts using high-resolution white-light endoscopy and narrow-band imaging. Gastrointest Endosc. 77:916–924. 2013. View Article : Google Scholar : PubMed/NCBI
15	Rosty C, Hewett DG, Brown IS, Leggett BA and Whitehall VL: Serrated polyps of the large intestine: Current understanding of diagnosis, pathogenesis, and clinical management. J Gastroenterol. 48:287–302. 2013. View Article : Google Scholar : PubMed/NCBI
16	Buda A, De Bona M, Dotti I, Piselli P, Zabeo E, Barbazza R, Bellumat A, Valiante F, Nardon E, Probert CS, et al: Prevalence of different subtypes of serrated polyps and risk of synchronous advanced colorectal neoplasia in average-risk population undergoing first-time colonoscopy. Clin Transl Gastroenterol. 3:e62012. View Article : Google Scholar : PubMed/NCBI
17	Bouwens MW, van Herwaarden YJ, Winkens B, Rondagh EJ, de Ridder R, Riedl RG, Driessen A, Dekker E, Masclee AA and Sanduleanu S: Endoscopic characterization of sessile serrated adenomas/polyps with and without dysplasia. Endoscopy. 46:225–235. 2014. View Article : Google Scholar : PubMed/NCBI
18	Kudo S, Hirota S, Nakajima T, Hosobe S, Kusaka H, Kobayashi T, Himori M and Yagyuu A: Colorectal tumours and pit pattern. J Clin Pathol. 47:880–885. 1994. View Article : Google Scholar : PubMed/NCBI
19	Kudo S, Tamura S, Nakajima T, Yamano H, Kusaka H and Watanabe H: Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc. 44:8–14. 1996. View Article : Google Scholar : PubMed/NCBI
20	Tobaru T, Mitsuyama K, Tsuruta O, Kawano H and Sata M: Sub-classification of type VI pit patterns in colorectal tumors: Relation to the depth of tumor invasion. Int J Oncol. 33:503–508. 2008.PubMed/NCBI
21	Sano Y, Ikematsu H, Fu KI, Emura F, Katagiri A, Horimatsu T, Kaneko K, Soetikno R and Yoshida S: Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps. Gastrointest Endosc. 69:278–283. 2009. View Article : Google Scholar : PubMed/NCBI
22	Uraoka T, Saito Y, Ikematsu H, Yamamoto K and Sano Y: Sano's capillary pattern classification for narrow-band imaging of early colorectal lesions. Dig Endosc. 1:112–125. 2011. View Article : Google Scholar
23	Soetikno RM, Kaltenbach T, Rouse RV, Park W, Maheshwari A, Sato T, Matsui S and Friedland S: Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA. 299:1027–1035. 2008. View Article : Google Scholar : PubMed/NCBI
24	Schlemper RJ, Riddell RH, Kato Y, Borchard F, Cooper HS, Dawsey SM, Dixon MF, Fenoglio-Preiser CM, Fléjou JF, Geboes K, et al: The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 47:251–255. 2000. View Article : Google Scholar : PubMed/NCBI
25	Shiroshita H, Watanabe H, Ajioka Y, Watanabe G, Nishikura K and Kitano S: Re-evaluation of mucin phenotypes of gastric minute well-differentiated-type adenocarcinomas using a series of HGM, MUC5AC, MUC6, M-GGMC, MUC2 and CD10 stains. Pathol Int. 54:311–321. 2004. View Article : Google Scholar : PubMed/NCBI
26	Fujita K, Hirahashi M, Yamamoto H, Matsumoto T, Gushima M, Oda Y, Kishimoto J, Yao T, Iida M and Tsuneyoshi M: Mucin core protein expression in serrated polyps of the large intestine. Virchows Arch. 457:443–449. 2010. View Article : Google Scholar : PubMed/NCBI
27	Shiroshita H, Watanabe H, Ajioka Y, Watanabe G, Nishikura K and Kitano S: Re-evaluation of mucin phenotypes of gastric minute well-differentiated-type adenocarcinomas using a series of HGM, MUC5AC, MUC6, M-GGMC, MUC2 and CD10 stains. Pathol Int. 54:311–321. 2004. View Article : Google Scholar : PubMed/NCBI
28	Jass JR, Whitehall VL, Young J and Leggett BA: Emerging concepts in colorectal neoplasia. Gastroenterology. 123:862–876. 2002. View Article : Google Scholar : PubMed/NCBI
29	Leggett B and Whitehall V: Role of the serrated pathway in colorectal cancer pathogenesis. Gastroenterology. 138:2088–2100. 2010. View Article : Google Scholar : PubMed/NCBI
30	Oono Y, Fu K, Nakamura H, Iriguchi Y, Yamamura A, Tomino Y, Oda J, Mizutani M, Takayanagi S, Kishi D, et al: Progression of a sessile serrated adenoma to an early invasive cancer within 8 months. Dig Dis Sci. 54:906–909. 2009. View Article : Google Scholar : PubMed/NCBI
31	Horii J, Kato J, Nagasaka T, Hiraoka S, Sun DS, Watanabe K, Fujita I, Toyokawa T, Tomoda J and Yamamoto K: Development of invasive colon cancer with microsatellite instability in a patient with hyperplastic polyposis syndrome. Jpn J Clin Oncol. 42:451–454. 2012. View Article : Google Scholar : PubMed/NCBI
32	Torlakovic EE, Gomez JD, Driman DK, Parfitt JR, Wang C, Benerjee T and Snover DC: Sessile serrated adenoma (SSA) vs. traditional serrated adenoma (TSA). Am J Surg Pathol. 32:21–29. 2008. View Article : Google Scholar : PubMed/NCBI
33	Oue N, Sentani K, Sakamoto N and Yasui W: Clinicopathologic and molecular characteristics of gastric cancer showing gastric and intestinal mucin phenotype. Cancer Sci. 106:951–918. 2015. View Article : Google Scholar : PubMed/NCBI
34	Gibson JA, Hahn HP, Shahsafaei A and Odze RD: MUC expression in hyperplastic and serrated colonic polyps: Lack of specificity of MUC6. Am J Surg Pathol. 35:742–749. 2011. View Article : Google Scholar : PubMed/NCBI