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Screening Relevance of Sessile Serrated Polyps

Conventional adenomas have historically been considered to be the only screening-relevant colorectal cancer (CRC) precursor lesion. The prevailing paradigm was that most CRCs arise along the chromosomal instability pathway, where adenomas accumulate incremental genetic alterations over time, leading...

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Autor principal: Kahi, Charles J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Gastrointestinal Endoscopy 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547343/
https://www.ncbi.nlm.nih.gov/pubmed/30625264
http://dx.doi.org/10.5946/ce.2018.112
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author Kahi, Charles J.
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description Conventional adenomas have historically been considered to be the only screening-relevant colorectal cancer (CRC) precursor lesion. The prevailing paradigm was that most CRCs arise along the chromosomal instability pathway, where adenomas accumulate incremental genetic alterations over time, leading eventually to malignancy. However, it is now recognized that this “conventional” pathway accounts for only about two-thirds of CRCs. The serrated pathway is responsible for most of the remainder, and is a disproportionate contributor to postcolonoscopy CRC. Hallmarks of the serrated pathway are mutations in the BRAF gene, high levels of methylation of promoter CpG islands, and the sessile serrated polyp (SSP). Accumulating evidence shows that SSPs can be considered adenoma-equivalent from the standpoint of CRC screening. SSPs have a higher prevalence than previously thought, and appear to have a relatively long dwell time similar to that of conventional adenomas. In addition, SSPs, whether sporadic or as part of the serrated polyposis syndrome, are associated with increased risk of synchronous and metachronous neoplasia. These features collectively support that SSPs are highly relevant to CRC prevention.
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spelling pubmed-65473432019-06-17 Screening Relevance of Sessile Serrated Polyps Kahi, Charles J. Clin Endosc Review Conventional adenomas have historically been considered to be the only screening-relevant colorectal cancer (CRC) precursor lesion. The prevailing paradigm was that most CRCs arise along the chromosomal instability pathway, where adenomas accumulate incremental genetic alterations over time, leading eventually to malignancy. However, it is now recognized that this “conventional” pathway accounts for only about two-thirds of CRCs. The serrated pathway is responsible for most of the remainder, and is a disproportionate contributor to postcolonoscopy CRC. Hallmarks of the serrated pathway are mutations in the BRAF gene, high levels of methylation of promoter CpG islands, and the sessile serrated polyp (SSP). Accumulating evidence shows that SSPs can be considered adenoma-equivalent from the standpoint of CRC screening. SSPs have a higher prevalence than previously thought, and appear to have a relatively long dwell time similar to that of conventional adenomas. In addition, SSPs, whether sporadic or as part of the serrated polyposis syndrome, are associated with increased risk of synchronous and metachronous neoplasia. These features collectively support that SSPs are highly relevant to CRC prevention. Korean Society of Gastrointestinal Endoscopy 2019-05 2019-01-08 /pmc/articles/PMC6547343/ /pubmed/30625264 http://dx.doi.org/10.5946/ce.2018.112 Text en Copyright © 2019 Korean Society of Gastrointestinal Endoscopy This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review
Kahi, Charles J.
Screening Relevance of Sessile Serrated Polyps
title Screening Relevance of Sessile Serrated Polyps
title_full Screening Relevance of Sessile Serrated Polyps
title_fullStr Screening Relevance of Sessile Serrated Polyps
title_full_unstemmed Screening Relevance of Sessile Serrated Polyps
title_short Screening Relevance of Sessile Serrated Polyps
title_sort screening relevance of sessile serrated polyps
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547343/
https://www.ncbi.nlm.nih.gov/pubmed/30625264
http://dx.doi.org/10.5946/ce.2018.112
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