Lesions with a tufted appearance are described as having a serrated architecture.
Hyperplastic polyps – Benign polyps with a serrated architecture – No follow up required.
Adenomas – Tubular, Villous and Tubular-Villous. Show low grade dysplasia. Follow up as per protocol.
- Mixed Polyps – Hyperplastic polyps with dysplasia – FU as per adenoma
- Traditional serrated Adenoma – Adenomas with a serrated architecture.
Sessile serrated lesions (polyps & adenomas) – Serrated lesions with an unusual architecture. 1) Horizontally orientated, boot shaped deep crypts, 2) Serration down to crypt base. Usually right sided, Large sessile poorly defined lesions, Assoc with MLH1. Sessile serrated lesions – FU for recurrence 3 yearly. Sessile serrated adenomas – as for Adenomas
Serrated Adenocarcinoma – Majority arise in traditional serrated adenomas and have a poor prognosis. 20% arise in sessile serrated lesions have a good prognosis.
New guidelines (2012) for polypectomy surveillance after colonoscopy, see: http://gastroenterology.jwatch.org/cgi/content/full/2012/928/6
“A new set of recommendations for surveillance intervals after resection of serrated lesions. In these recommendations, patients with a small sessile serrated polyp (<10 mm) with no dysplasia should have repeat colonoscopy in 5 years. Patients with a sessile serrated polyp 10 mm, a sessile serrated polyp with dysplasia, or a traditional serrated adenoma should undergo repeat colonoscopy in 3 years. Serrated polyposis syndrome should be followed at 1 year, though subsequent examinations that identify a decreasing polyp burden can be followed by expanded intervals.”
Williams G., Serrated lesions. BSCP presentation
Bettington et al. The serrated pathway to colorectal carcinoma: current concepts and challenges. Histopathology 2013. 62, 367-386.
Atkin et al. Surveillance guidelines after removal of colorectal adenomatous polyps. Gut. 2002; 51 (supplement V): V6-v9.
Lieberman DA et al. Guidelines for colonoscopy surveillance after screening and polypectomy: A consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012 Sep; 143:844.