Aberrant p53 immunohistochemical staining is uncommon in serrated epithelial change, regardless of association with dysplasia

Although the absence of aberrant, strong p53 staining in most SEC cases, regardless of association with dysplasia, may argue against classifying SEC as a form of dysplasia potentially driven by TP53 alterations, it does not fully exclude a potential precursor role for SEC in a subset of cases. This finding also suggests that p53 immunohistochemistry may have limited clinical value for risk stratification of SEC. However, given its association with neoplasia in the same colonic segment and documented molecular abnormalities in some cases, a careful follow-up colonoscopy may be warranted following a new SEC diagnosis. This may be particularly important for patients with additional risk factors such as older age (>50 years), longer disease duration (>20 years), CD, or multifocal SEC.