Analysis of the Causes of Misdiagnosis of Sessile Serrated Adenoma/Polyp as Hyperplastic Polyp and Endoscopic Features

ZHANG Zixu; WANG Weiyi; ZHOU Lu; CHENG Jinnian; CHU Yimin; PENG Haixia

doi:10.3969/j.issn.1002-3429.2025.10.001

Abstract：Objective To analyze the causes of misdiagnosis of sessile serrated adenoma/polyp(SSA/P)as hyper-plastic polyp(HP)in clinical endoscopic examination,and to summarize its endoscopic characteristics.Methods The clini-cal data of 17 patients with SSA/P who were misdiagnosed from January 2020 to January 2023 were retrospectively analyzed.Results Twelve patients were misdiagnosed as HP due to the smooth surface of polyps and similar color to the surrounding mucosa on endoscopic examination,and were mainly observed and followed up.Three patients were misdiagnosed as HP due to the small size and atypical morphology of the polyps,which were difficult to distinguish under endoscopy,and local resec-tion treatment was given.Two patients failed to clearly display the serrated features during endoscopic examination due to light or angle issues and were misdiagnosed as HP.Regular reexaminations were recommended.After receiving the initial treat-ment,the above-mentioned patients were diagnosed as SSA/P through pathological examination,and the misdiagnosis period was 1 to 4 weeks.All 17 patients were diagnosed and received endoscopic resection treatment.The postoperative pathology confirmed SSA/P,and no malignant lesions were observed.The patients were followed up for 6 to 12 months after the opera-tion,and no recurrence or canceration was observed.Conclusion SSA/P is easily confused with HP under endoscopy,and especially when the polyp surface is smooth,the morphology is atypical and the examination conditions are limited,it is more likely to be misdiagnosed.Improving physicians'ability to recognize endoscopic features and combining with auxiliary tech-niques such as staining endoscopy or magnifying endoscopy can effectively reduce misdiagnosis and improve diagnostic accura-cy.