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CLASSIFICATION
Classification
SPS diagnostic criteria (serrated polyposis syndrome)
WHO 2019 diagnostic criteria for serrated polyposis syndrome (formerly hyperplastic polyposis). Includes 2010 criteria for reference, counting rules, and surveillance pointers. Separate from the WASP SSL morphology classification.
Classification overview
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WHO 2019
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Criterion I · Proximal phenotype (WHO 2019)
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Criterion II · Pancolonic phenotype (WHO 2019)
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WHO 2010
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Type 1 · WHO 2010 (superseded)
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Type 2 · WHO 2010 — family history (removed)
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Type 3 · WHO 2010 (superseded)
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Serrated polyp types
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HP · Hyperplastic polyp
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SSL · Sessile serrated lesion
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TSA · Traditional serrated adenoma
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Application
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Counting rules · What counts toward SPS
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Surveillance · Post-diagnosis follow-up (overview)
WHO 2019
Criterion I
Proximal phenotype (WHO 2019)
Definition
At least five serrated polyps proximal to the rectum, all ≥5 mm in size, with at least two ≥10 mm
Location
Proximal to the rectum (includes sigmoid colon; rectosigmoid and rectum are excluded)
Size
All five (or more) qualifying polyps must be ≥5 mm; at least two must be ≥10 mm
Note: Expanded from 2010 Type 1: now proximal to the rectum (includes sigmoid); all qualifying polyps must be ≥5 mm. Proximal-predominant phenotype.
Criterion II
Pancolonic phenotype (WHO 2019)
Definition
More than 20 serrated polyps of any size distributed throughout the large bowel, with at least five proximal to the rectum
Location
Throughout the colon and rectum; ≥5 must be proximal to the rectum
Size
Any size (diminutive polyps count toward the total of >20)
Note: Corresponds to 2010 Type 3 with an added requirement of ≥5 polyps proximal to the rectum. Pancolonic phenotype.
WHO 2010
Type 1
WHO 2010 (superseded)
Definition
At least five serrated polyps proximal to the sigmoid colon, with at least two >10 mm in size
2019 change
Expanded to proximal to the rectum; all qualifying polyps must be ≥5 mm (not only the two ≥10 mm)
Note: 2019 Criterion I predecessor. Kept for reference when reading older literature.
Type 2
WHO 2010 — family history (removed)
Definition
Any number of serrated polyps proximal to the sigmoid colon in an individual with a first-degree relative with SPS
2019 change
Removed from WHO 2019 criteria
Note: Removed in WHO 2019. Family history is handled in genetic-counseling context.
Type 3
WHO 2010 (superseded)
Definition
More than 20 serrated polyps of any size distributed throughout the colon
2019 change
Requires ≥5 serrated polyps proximal to the rectum (Criterion II)
Note: 2019 Criterion II adds ≥5 proximal polyps to the 2010 Type 3 definition.
Serrated polyp types
HP
Hyperplastic polyp
Abbreviation
HP
Counting
Included in SPS polyp counts when histologically confirmed
SSL
Sessile serrated lesion
Abbreviation
SSL (formerly SSA/P — sessile serrated adenoma/polyp)
Counting
Included in SPS polyp counts; endoscopic detection quality matters
Note: WHO 2019 term is SSL; pathology and endoscopy reports may still use SSA/P.
TSA
Traditional serrated adenoma
Abbreviation
TSA
Counting
Included in SPS polyp counts when histologically confirmed
Application
Counting rules
What counts toward SPS
Cumulative
Polyp counts are cumulative over a lifetime and across multiple colonoscopies
Histology
Only histologically confirmed serrated polyps (HP, SSL, TSA) count
Exclusions
Conventional adenomas, non-serrated lesions, and unconfirmed endoscopic impressions do not count
Resection
Removed polyps count if pathology confirms a serrated subtype
Note: Cumulative over a lifetime and multiple procedures. Conventional adenomas do not count.
Surveillance
Post-diagnosis follow-up (overview)
ESGE 2019
European Society of Gastrointestinal Endoscopy guideline on colorectal polyposis syndromes
US MSTF 2020
Gupta S et al. Recommendations for follow-up after colonoscopy and polypectomy. Gastrointest Endosc 2020 — serrated polyposis surveillance intervals
Principle
Clear the colon of significant serrated polyps and assign shortened surveillance based on polyp burden and dysplasia
Note: Follow ESGE 2019 polyposis and US MSTF 2020 (Gupta GIE 2020); use local protocols.
McWhinney 2023, Table 1, Not original, CC BY-NC-ND
Dekker 2020, Original
Reference
Original article
WHO Classification of Digestive System Tumours, 5th ed. 2019
Review
Dekker E et al. Gastroenterology 2020;158:1520-1523
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Decision support only. Follow current guidelines and local protocols. Classification definitions and terminology follow the original publication language.