A multinational, internet-based assessment of observer variability in the diagnosis of serrated colorectal polyps.

This Internet-based quiz (http://kathrin.unibas.ch/polyp/) tested the diagnostic variability of 168 pathologists in the diagnosis of 20 colorectal polyps on 3 representative images, including hyperplastic polyps (HPs), traditional serrated adenomas (TSAs), sessile serrated adenomas (SSAs), and tubulovillous adenomas (TVAs). Interobserver variability for each of the 20 lesions was significant and was most pronounced for SSAs. Correct answers were independent of the participant's experience with TVAs, HPs, and TSAs. Participants with gastrointestinal subspecialty training and those who had read a reference article on serrated polyps gave a significantly higher percentage of correct answers for SSAs. The nomenclature used for serrated polyps was generally inconsistent. Our results suggest significant shortcomings in the routine H&E diagnosis of serrated colorectal polyps. A diagnostically unifying concept for lesions of the serrated neoplasia pathway, standardization of nomenclature, training of pathologists, and possibly development of ancillary techniques are of paramount importance for accurate patient management.

[1]  J. Palazzo,et al.  Neoplastic progression occurs through mutator pathways in hyperplastic polyposis of the colorectum , 2000, Gut.

[2]  M. O'brien,et al.  BRAF and KRAS Mutations in Hyperplastic Polyps and Serrated Adenomas of the Colorectum: Relationship to Histology and CpG Island Methylation Status , 2004, The American journal of surgical pathology.

[3]  C. Fenoglio-Preiser,et al.  Mixed Hyperplastic Adenomatous Polyps/Serrated Adenomas: A Distinct Form of Colorectal Neoplasia , 1990, The American journal of surgical pathology.

[4]  S. Woolf,et al.  Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. , 2003, Gastroenterology.

[5]  A. Rashid,et al.  Phenotypic and molecular characteristics of hyperplastic polyposis. , 2000, Gastroenterology.

[6]  M. O'brien,et al.  Hyperplastic Polyps, Serrated Adenomas, and the Serrated Polyp Neoplasia Pathway , 2004, The American Journal of Gastroenterology.

[7]  N. Goldstein,et al.  Hyperplastic-like colon polyps that preceded microsatellite-unstable adenocarcinomas. , 2003, American journal of clinical pathology.

[8]  J. F. Arthur.  Structure and significance of metaplastic nodules in the rectal mucosa , 1968, Journal of clinical pathology.

[9]  K. Batts,et al.  Serrated polyps of the large intestine: a morphologic and molecular review of an evolving concept. , 2005, American journal of clinical pathology.

[10]  A. Hartmann,et al.  MIB-1 and MCM-2 immunohistochemical analysis does not aid in identification of serrated colorectal polyps with abnormal proliferation. , 2006, American journal of clinical pathology.

[11]  N. Goldstein.  Small colonic microsatellite unstable adenocarcinomas and high-grade epithelial dysplasias in sessile serrated adenoma polypectomy specimens: a study of eight cases. , 2006, American journal of clinical pathology.

[12]  Wei Zhao,et al.  BRAF and KRAS mutations in colorectal hyperplastic polyps and serrated adenomas. , 2003, Cancer research.

[13]  N. Goldstein.  Serrated pathway and APC (conventional)-type colorectal polyps: molecular-morphologic correlations, genetic pathways, and implications for classification. , 2006, American journal of clinical pathology.

[14]  Jahn M. Nesland,et al.  Morphologic Reappraisal of Serrated Colorectal Polyps , 2003, The American journal of surgical pathology.

[15]  R S Weinstein,et al.  Diagnostic accuracy of an international static-imaging telepathology consultation service. , 1997, Human pathology.

[16]  I. Tomlinson,et al.  Colorectal carcinomas arising in the hyperplastic polyposis syndrome progress through the chromosomal instability pathway. , 2000, The American journal of pathology.

[17]  Jeffrey S. Morris,et al.  BRAF mutations in aberrant crypt foci and hyperplastic polyposis. , 2005, The American journal of pathology.

[18]  S Forti,et al.  Robotic telepathology for intraoperative remote diagnosis using a still-imaging-based system. , 2001, American journal of clinical pathology.

[19]  E. Sawyer,et al.  Molecular characteristics of serrated adenomas of the colorectum , 2002, Gut.

[20]  M. O'brien,et al.  Comparison of Microsatellite Instability, CpG Island Methylation Phenotype, BRAF and KRAS Status in Serrated Polyps and Traditional Adenomas Indicates Separate Pathways to Distinct Colorectal Carcinoma End Points , 2006, The American journal of surgical pathology.

[21]  M. O'brien,et al.  Hyperplastic (Serrated) Polyps of the Colorectum: Relationship of CpG Island Methylator Phenotype and K-ras Mutation to Location and Histologic Subtype , 2004, The American journal of surgical pathology.