Mark Bettington1,2,3, Ian Brown1,4, Christophe Rosty1,2,5, Neal Walker1,2, Cheng Liu2,3, John Croese6,7, Tony Rahman6, Sally-Ann Pearson3, Diane McKeone3, Barbara Leggett2,3,8, Vicki Whitehall2,3,9. 1. Envoi Specialist Pathologists. 2. School of Medicine, University of Queensland. 3. The Conjoint Gastroenterology Laboratory, QIMR Berghofer Medical Research Institute. 4. Department of Anatomical Pathology, Central Laboratory, Pathology Queensland. 5. Department of Pathology, University of Melbourne, Melbourne, Vic., Australia. 6. Department of Gastroenterology and Hepatology, The Prince Charles Hospital. 7. The Centre for Biodiscovery and Molecular Developmental Therapeutics, James Cook University, Cairns, Qld. 8. Department of Gastroenterology and Hepatology, The Royal Brisbane and Women's Hospital. 9. Department of Chemical Pathology, Pathology Queensland, Brisbane.
Abstract
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.
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.
Authors: Arne G C Bleijenberg; Joep E G IJspeert; Daniel Rodríguez-Alcalde; Sabela Carballal; Maurits R Visser; Maria Pellise; Jan Jacob Koornstra; Salman A Rana; Andrew Latchford; Francesc Balaguer; Evelien Dekker Journal: Fam Cancer Date: 2020-04 Impact factor: 2.375
Authors: Cheng Liu; Lochlan J Fennell; Mark L Bettington; Neal I Walker; Joel Dwine; Barbara A Leggett; Vicki L J Whitehall Journal: Clin Epigenetics Date: 2019-06-14 Impact factor: 6.551
Authors: Arne G C Bleijenberg; Monique E van Leerdam; Marloes Bargeman; Jan Jacob Koornstra; Yasmijn J van Herwaarden; Manon Cw Spaander; Silvia Sanduleanu; Barbara A J Bastiaansen; Erik J Schoon; Niels van Lelyveld; Evelien Dekker; Joep E G IJspeert Journal: Gut Date: 2020-03-05 Impact factor: 23.059