In this podcast we discuss Serrated Polyps with Prof Neil Shepherd. There is much more to these lesions than Size and Number!   Did you know that there appears to be two distinct syndromes and it's the Site of the lesions which distinguishes the two?  That is just the start.  It gets weirder !  


We cover a huge amount of ground and headings include (in chronological order):

• Serrated polyps - one or two distinct syndromes?
• Can you tell histologically?
• How does the Serrated Polyposis Syndrome fit ?
• What matters the most when deciding on the significance of a serrated polyp?
• Dysplasia inside a serrated polyp? - Well it's complicated ! 
• The heterogeneity of serrated lesions is also problematic
• Could AI help the Pathologist in the future?
• How can we identify patients with serrated polyposis syndrome ?
• Can we explain finding both serrated and adenomatous polyps in serrate polyposis syndrome?
• Why should I refer patient with serrated polyposis syndrome to geneticists?
• Can we tell which cancer has developed from a serrated precursor?
• What is the link between serrated polyps and colitis?
• The weird issue of stromal changes below serrated polyps
• 'Mixed polyp' or 'collision polyp'?
• How can we as endoscopist help the pathologist?
• Do you believe in DISCARD?
• What remains the remit of the pathologist to diagnose?

The UK is standing on the brink of the Bright New World of molecular screening for occult cancer!  This summer, the NHS starts screening for more than 50 cancers using the “Galleri blood test”, developed by an American company called ‘GRAIL’ !  

However, Bjorn has concerns, and after an unsuccessful search for any declared ‘study aims’, of the above NHS/GRAIL initiative asks - Does finding the early signature of cancer always mean that the cancer is treatable?  

Furthermore, as the test will generate just as many true positives as false positive results, HOW do you confirm that the positive result was a 'false positive'?  He is trying to look at this 'trial' through the lens of the Wilson and Jungner criteria.  

Finally, we are standing up for the effectiveness of CTC and wonder why an American study, published in GUT report such shockingly poor results of the technology. 

References
Liu MC. multi-cancer detection using methylation signatures. Ann Onc 2020;31(6);745-59reader.elsevier.com/reader/sd/pii/S0923753420360580?token=F3C7F7E4DB0EA9F4057F53898B77091477DBA3B9DC1A316BA21393EB8FF6466B5CDDC4F38A0F49C9673C7400EB558C2C

Wilson JMG, Jungner G. Principles and practice of screening for disease. Geneva: WHO; 1968www.who.int/bulletin/volumes/86/4/07-050112BP.pdf