ENDOSCOPIC CHARACTERISTICS DIFFERENTIATING SESSILE SERRATED LESIONS AND MICROVESICULAR HYPERPLASTIC POLYPS FROM GOBLET CELL RICH HYPERPLASTIC POLYPS: A CROSS-SECTIONAL STUDY

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Introduction

Differentiating between colorectal serrated polyps (SPs) on endoscopy can be challenging since sessile serrated lesions (SSLs) and hyperplastic polyps (HPs) tend to have a similar appearance^1-4. Furthermore, the endoscopic differences between the two subtypes of HPs, namely microvesicular HP (MVHP) and goblet cell-rich HP (GCHP), are not well understood^5,6. Therefore, we compared the endoscopic features of SSL, MVHP, and GCHP.

Aims & Methods

This retrospective, cross-sectional study was conducted at the Toyoshima Endoscopy Clinic. We examined the polyp size, location, Paris classification type, mucus cap, indistinct border, expanded crypt opening, varicose microvascular vessels (VMV), and Japan NBI expert team (JNET) classification type. Multivariable analysis was performed to determine the endoscopic finding that predicted SP histology using a binomial logistic regression model. We constructed endoscopic microvesicular goblet (MG) score for differentiating SPs using the endoscopic findings associated with SP histology in the multivariable analysis, and calculated the area under the receiver operating characteristic curve (AUC) and diagnostic accuracy.

Results

A total of 1366 SPs were eligible for this study, including 321 SSLs, 718 MVHPs, and 327 GCHPs. The mean polyp size was 6.24 mm. SPs in the proximal colon accounted for 70.7%. In the comparison between MVHP and GCHP, a mucus cap (partial regression coefficient 1.44, 95% confidence interval [CI] 1.06-1.82), expanded crypt opening (1.92, 1.44-2.40), and VMV (1.04, 0.58-1.49) were more often found in MVHP in contrast to GCHP (Table). comparison of SSL and MVHP showed that SSLs were located in the proximal colon (0.70, 0.30-1.10), were larger (0.21, 0.16-0.25), and had mucus cap (0.54, 0.16-0.93) compared to MVHPs. On comparing the SSL plus MVHP group and GCHP group, larger size (0.12, 0.06-0.19), a mucus cap (1.76, 1.39-2.14), expanded crypt opening (2.04, 1.57-2.52), VMV (1.21, 0.75-1.68), and JNET type 2A (1.17, 0.73-1.61) were more often observed in SSL + MVHP group compared with GCHP. Mucus cap, expanded crypt opening, and VMV were each assigned 1 point and the sum of the points was defined as the endoscopic MG score. In the examination of MVHPs and GCHPs, the AUC of the endoscopic MG score for predicting MVHP was 0.78 (95% CI 0.76-0.81) and the optimal cut-off value was 1; the sensitivity, specificity, and positive predictive value (PPV) were 74.7%, 75.5%, 87.0%, respectively. In the assessment of SSLs, MVHPs, and GCHPs, the AUC of the endoscopic MG score for predicting SSL plus MVHP group was 0.82 (0.79-0.84) and the optimal cut-off value was 1; the sensitivity, specificity, and PPV were 79.4%, 75.5%, and 91.2%, respectively.

Table. Multivariable analysis for comparison of endoscopic appearance between MVHP and GCHP.
	Partial regression coefficient	95% confidence interval	Degree of freedom	P value
Polyp size	0.04	-0.03, 0.11	1	0.23
Mucus cap	1.44	1.06, 1.82	1	<0.001
Indistinct border	0.07	-0.32, 0.46	1	0.73
Expanded crypt opening	1.92	1.44, 2.40	1	<0.001
VMV	1.04	0.58, 1.49	1	<0.001

Conclusion

MVHP and GCHP, while belonging to the same HP category, exhibited different endoscopic appearances such as mucus cap, expanded crypt opening, and VMV. Conversely, SSL and MVHP despite belonging to different histopathological categories, showed similar endoscopic appearances except for mucus cap. Moreover, SSL plus MVHP showed distinct endoscopic appearances compared to GCHP group. Considering MVHP and GCHP as separate entities can aid in the endoscopic diagnosis of SPs.

References

1. Ijspeert JEG, de Wit K, van der Vlugt M, et al. Prevalence, distribution and risk of sessile serrated adenomas/polyps at a center with a high adenoma detection rate and experienced pathologists. Endoscopy. 2016;48(08):740-746.
2. Turner KO, Genta RM, Sonnenberg A. Lesions of All Types Exist in Colon Polyps of All Sizes. Am J Gastroenterol. 2018;113(2):303-306.
3. Zessner-Spitzenberg J, Waldmann E, Jiricka L, et al. Comparison of adenoma detection rate and proximal serrated polyp detection rate and their effect on post-colonoscopy colorectal cancer mortality in screening patients. Endoscopy. 2023;55(5):434-441.
4. Nishizawa T, Yoshida S, Toyoshima A, et al. Endoscopic diagnosis for colorectal sessile serrated lesions. World J Gastroenterol. 2021;27(13):1321-1329.
5. Qazi TM, O'Brien MJ, Farraye FA, et al, 3rd. Epidemiology of goblet cell and microvesicular hyperplastic polyps. Am J Gastroenterol. 2014;109(12):1922-1932.
6. Crockett SD, Barry EL, Mott LA, et l. Predictors of Incident Serrated Polyps: Results from a Large Multicenter Clinical Trial. Cancer Epidemiol Biomarkers Prev. 2022;31(5):1058-1067.

Disclosure

The authors have no COI.