Clinical and endoscopic characteristics of colorectal sessile serrated lesion with dysplasia: a single-center cross-sectional comparative study

Abstract

Background: The precancerous lesion of colorectal cancer (CRC), colorectal sessile serrated lesion (SSL), takes an average of 15 years to germinate from no cell dysplasia to CRC, and 2 years for SSL with dysplasia (SSL-D). To date, the impacts of endoscopic and pathological features of SSL and SSL-D on the development of dysplasia remain unclear. In this study, we explored these impacts, striving to provide reference for its classification, detection, and diagnosis.

Methods: Retrospectively, a cross-sectional analysis was conducted to compare 414 SSL and 59 SSL-D, which had been diagnosed under colonoscopy in the Affiliated Drum Tower Hospital of Nanjing University.

Results: A total of 454 participants were enrolled with a mean age of 58.43±13.94 years and a male-to-female ratio of 0.91:1. There were significant differences between the SSL and SSL-D groups in the gender distribution (P=0.044). The proportion of patients with hypertension (33.33% vs. 17.13%, P=0.004) was higher in the SSL-D group. Significantly higher indexes in lipid metabolism were observed in the SSL-D group. SSL-D had a greater number of lesions ≥10 mm (86.44% vs. 57.00%, P<0.001), 0-IIa morphology (55.93% vs. 41.55%, P=0.049), and kermesinus surface (22.03% vs. 7.49%, P<0.001).

Conclusions: Female SSL patients with a history of hypertension are more prone to developing into dysplasia, whereas morphological discriminations between SSL and SSL-D are vague. Lipid metabolism might have certain impact on the germination of SSL to SSL-D. Studies with larger sample sizes are warranted.

Keywords: Sessile serrated lesion (SSL); colorectal cancer (CRC); dysplasia; endoscopic features; lipid metabolism.

Figure 1

Age and gender distribution of patients with SSL. Totally 454 subjects were collected in this study, including 216 males (47.58%) and 238 females (52.42%). Group aged 51–70 years represented largest proportion, whereas patients ≤50 years are also prominent (26.21%). SSL, sessile serrated lesion.

Figure 2

Age distribution of SSL and SSL-D groups. Of the 454 cases included in the study, 397 were SSL, including 196 males (49.37%) and 201 females (50.63%) with a ratio of 0.98:1. Fifty-seven were SSL-D (12.55%), including 20 men (35.09%) and 37 women (64.91%), with a male-to-female ratio of 0.54:1. Patients older than 50 years shared the largest proportion in both groups. SSL, sessile serrated lesion; SSL-D, sessile serrated lesion with dysplasia.