Traditional serrated adenomas (TSA) and the company they keep: TSA presence predicts advanced neoplasm states
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Traditional serrated adenomas (TSA) and the company they keep: TSA presence predicts advanced neoplasm states Erica Duh 1 & Piotr Sowa 2 & Mary B. Roberts 3 & William Karnes 2 Accepted: 4 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background The association of TSAs with metachronous neoplasms is well established and suggests that TSAs would also have an association with synchronous neoplasms. Methods We compared odds ratios and rates of synchronous neoplasms found in colonoscopies with and without TSAs. Results There was a mean of 2.44 neoplasms among TSA cases in comparison with 1.72 in non-TSA cases. The odds ratio for advanced neoplasia was highest among cases with one or more TSAs relative to cases with one or more HPs (7.54 [CI, 4.23– 13.44]) when compared with adenomas (1.95 [CI, 1.75–2.17]) and SSPs (2.98 [CI, 2.54–3.5]). Conclusions In this study population, there is a 7-fold higher risk of synchronous advanced neoplasms among cases with one or more TSAs. Keywords Traditional serrated adenoma . Sessile serrated polyp . Colonic polyps . Colorectal neoplasms
Background Colorectal carcinoma (CRC) is the most common malignancy within the gastrointestinal system [1]. Almost all cases arise from precursor polyps, making it vital that endoscopists be familiar with polyp subtypes and their natural history. Polyps are classified into conventional adenomas and serrated Study highlights What is known • TSAs are associated with metachronous colorectal advanced neoplasms. What is new here • TSAs are associated with synchronous precancerous and advanced neoplasms. Our data contributes to existing data supporting a strong link between TSA and risk of current and future advanced neoplasms. We aim to add to the already existing efforts to elucidate the biological genesis of TSAs and to support adjustments of guideline surveillance recommendations for patients with TSAs. * Erica Duh [email protected] 1
Department of Internal Medicine, University of California Irvine Medical Center, 101 The City Drive, City Tower, Suite 400, Orange, CA 92806, USA
polyps (SPs), with adenomatous polyps being the most common precancerous polyps. There are three major subtypes of serrated polyps: hyperplastic polyps (HP), sessile serrated polyps (SSPs), and traditional serrated adenomas (TSAs). Non-precancerous hyperplastic polyps are most often found in the distal colon. Precancerous SSPs are flat and often proximal to the splenic flexure, making them challenging to resect. The malignant pathway of SSPs involves BRAF mutations causing inhibition of apoptosis, microsatellite instability, and uncontrolled cellular proliferation [2]. TSAs typically occur in the left colon and make up 1–3% of all polyps [2, 3]. They typically involve KRAS mutations which lead to the development of microsatellite stable cancers, but can be associated with other molecular mechanisms in its neoplastic pathway [3, 4]. While there are several studies that detail metachronous polyps associated with TSAs [5, 6], on
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