Serrated and non-serrated polyps of the colorectum: their prevalence in an unselected case series and correlation of BRAF mutation analysis with the diagnosis of sessile serrated adenoma

N J Carr; H Mahajan; K L Tan; N J Hawkins; R L Ward

doi:10.1136/jcp.2008.061960

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Serrated and non-serrated polyps of the colorectum: their prevalence in an unselected case series and correlation of BRAF mutation analysis with the diagnosis of sessile serrated adenoma

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Response from Authors
Norman J Carr
Published on: 18 April 2016
Serrated and non-serrated polyps of the colorectum...
Olorunda Rotimi
Published on: 18 April 2016

Published on: 18 April 2016
Response from Authors
- Norman J Carr, Dr
- Other Contributors:
  Nicholas Hawkins, Hema Mahajan, King L Tan, Robyn Ward
Dear Editor
We thank Drs Rotimi and Reall for their comments, but would suggest that their criticisms have been framed by a perspective that is different from our own. Their perspective is the “most striking result” was that sessile serrated adenomas (SSAs) were predominantly right sided. They are welcome to highlight this point, which is readily apparent from the data presented.
Our perspective is t...
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Dear Editor
We thank Drs Rotimi and Reall for their comments, but would suggest that their criticisms have been framed by a perspective that is different from our own. Their perspective is the “most striking result” was that sessile serrated adenomas (SSAs) were predominantly right sided. They are welcome to highlight this point, which is readily apparent from the data presented.
Our perspective is that the right sided predominance of SSAs is well known, and widely reported in the literature. Hence we did not highlight this finding. Their perspective is that a frequency of 4% of all polyps is not “common”. From our perspective, four in every 100 polyps is “common”, and we believe this point is worth emphasising because in many practices SSAs are reported rarely, if ever. Again, the quantitative information is available to readers, who are welcome to interpret it as they see fit.
We would argue that although “common” is a relative and qualitative term, it is misleading to propose that SSAs are not common in routine practice. Finally, Drs Rotimi and Reall are concerned that our statistical tests may have been inappropriate. We have the happy perspective of knowing the age distribution of the groups in question (serrated and non- serrated polyps). We can assure them that these distributions are normal, and that the use of parametric tests is indeed appropriate in this case.
Nicholas J Hawkins, Norman J Carr, King L Tan, Hema Mahajan, Robyn L Ward,
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Conflict of Interest:
None declared.
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Published on: 18 April 2016
Serrated and non-serrated polyps of the colorectum...
- Olorunda Rotimi, Consultant Histopathologist
- Other Contributors:
  Georgina Reall
Dear Editor,
Re: Serrated and non-serrated polyps of the colorectum: their prevalence in an unselected case series and correlation of BRAF mutation analysis with the diagnosis of sessile serrated adenoma
We read with interest the article by Carr NJ et al (J Clin Pathol 2009;62:516-518). The article describes the prevalence of different colorectal polyps in an unselected population with a focus speci...
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Dear Editor,
Re: Serrated and non-serrated polyps of the colorectum: their prevalence in an unselected case series and correlation of BRAF mutation analysis with the diagnosis of sessile serrated adenoma
We read with interest the article by Carr NJ et al (J Clin Pathol 2009;62:516-518). The article describes the prevalence of different colorectal polyps in an unselected population with a focus specifically on sessile serrated adenomas (SSAs) and their correlation with BRAF mutation.
We found the most striking result in this paper presented in Table 1. SSAs (as defined by the authors) were predominantly seen in the right side of the colon (51 on the right and 6 on the left; a ratio of almost 9:1). This result is all the more emphasized by the fact that not all the patients had full colonoscopy. However, the authors failed to highlight this important result and ultimately reported that serrated polyps were more likely to be left-sided. This observation of a right-sided predominance of SSAs is in agreement with many other publications(1, 2). The finding of more right-sided SSAs have been reported to correlate with the higher number of serrated adenocarcinomas found in the right colon in other studies(3).
Also, the authors over-emphasize the prevalence of SSAs, concluding that they are seen ‘commonly in routine endoscopy practice’. The SSAs accounted for 11% of all serrated lesions and only 3.9% of all polyps in this study and such low percentages cannot and should not be reported as being encountered commonly in routine practice.
In addition, use of Student’s t test to analyse the relationship between polyp type and age may have been inappropriate given the most likely non-normal distribution of data, especially with the small numbers in the polyp subgroups. A non-parametric statistical test would have been more appropriate.
Olorunda Rotimi, FRCPath, PGDip Health Research, Georgina Reall, FRCPath
References
1. Higuchi T, Sugihara K, Jass JR. Demographic and pathological characteristics of serrated polyps of colorectum. Histopathology 2005;47:32–40.
2. Amy E. Noffsinger. Serrated Polyps and Colorectal Cancer: New Pathway to Malignancy. Annual Review of Pathology, Mechanisms of Disease 2009;4:343–64.
3. M. J. Makinen, S. M. C. George, P. Jernvall, J. Makela, P. Vihko and T. J. Karttunen. Colorectal carcinoma associated with serrated adenoma - prevalence, histological features, and prognosis. Journal of Pathology 2001; 193: 286-294
Department of Histopathology St James's University Hospital Leeds, UK
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Conflict of Interest:
None declared.
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