WASP Optical Classification Criteria Are Not So Good for Diminutive Sessile Serrated Lesions
Douglas K. Rex, MD, MASGE, reviewing Bustamante-Balén M, et al. Endosc Int Open 2021 Jan 1.
The optical features of sessile serrated lesions (SSLs) identified in narrow-band imaging are a cloud-like surface, indistinct borders, irregular shape, and dark spots. In a study by 5 experienced endoscopists in which a pathologic diagnosis of SSL was reached in 79 of 1396 lesions (5.7%), the cloud-like appearance was identified in 44.3% of SSLs, indistinct borders in 29.1% of SSLs, irregular shapes in 26.6% of SSLs, and black dots in 12.7% of SSLs. Among diminutive SSLs, 29.4% had a cloud-like appearance, 14.7% had indistinct borders or irregular shapes, and 5.9% had black dots. Overall, the criteria also lacked specificity with a positive predictive value for SSLs based on optical features of 30.6%.
COMMENTThe endoscopic inability to differentiate SSLs from hyperplastic polyps (HPs) is the main reason that the resect-and-discard policy, when enacted, might only apply to conventional adenomas. These data suggest that additional research is needed to identify ways to differentiate SSLs from HPs in diminutive lesions.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Bustamante-Balen M, Satorres C, Ramos-Soler D, et al. Evaluation of the optical criteria for sessile serrated lesions of the colon: a prospective study on a colorectal cancer screening population. Endosc Int Open 2021;9:E14-E21. (https://dx.doi.org/10.1055%2Fa-1293-7086)
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