Prevalence of advanced histological features in diminutive and small colon polyps - 21/04/12
Reprint requests: Amit Rastogi, MD, FASGE, Associate Professor of Medicine, Director of Endoscopy, Division of Gastroenterology, Kansas City Veterans Affairs Medical Center, 4801 E. Linwood Boulevard, Kansas City, MO 64128Riassunto |
Background |
Investigators have proposed “predict, resect, and discard” strategies for diminutive (≤5 mm) or small (6-9 mm) polyps to reduce screening colonoscopy costs. Advanced histological features such as villous histology, high-grade dysplasia, and/or cancer in these polyps could deter adoption of these strategies.
Objective |
Determine the prevalence of advanced histological features in diminutive and small colon polyps.
Design |
Retrospective analysis of data from 3 prospective clinical trials.
Setting |
Two tertiary-care referral centers.
Patients |
This study involved patients undergoing screening or surveillance colonoscopy.
Intervention |
The location, size, and morphology of each polyp detected was documented. Each polyp was then resected, placed in a unique specimen jar, and sent for histopathological evaluation.
Main Outcome Measurements |
Rates of advanced histological features (villous histology, high-grade dysplasia, and cancer).
Results |
A total of 2361 polyps were detected, removed, and retrieved. Both diminutive and small polyps had a lower frequency of any advanced histological features compared with large polyps (0.5% and 1.5%, respectively vs 15.0%; P < .001 for both comparisons). Polyps <10 mm in size had a lower frequency of advanced histology compared with polyps ≥10 mm (0.8% vs 15.0%; P < .001). During sensitivity analysis, the frequency of advanced histological features varied from 0.2% to 0.7% within diminutive polyps, 1.5% to 3.6% within small polyps, and 0.8% to 1.2% within polyps <10 mm.
Limitations |
Retrospective analysis from tertiary-care referral centers; predominantly white, male, veteran patient population resulting in limited generalizability of results.
Conclusion |
The prevalence of advanced histological features in colon polyps ≤5 mm is very low (0.5%). This has important implications for the potential practice of “predicting, resecting, and discarding” diminutive colon polyps.
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| DISCLOSURE: S. Jonnalagadda and S. Edmundowicz are consultants and serve on the advisory board for Olympus America, Inc. P. Sharma and A. Rastogi have received research grants from Olympus America, Inc. A. Rastogi has been supported by the Michael V. Sivak Jr, MD Endoscopic Research Award and Endoscopic Research Career Development Award from the American Society for Gastrointestinal Endoscopy. No other financial relationships relevant to this publication were disclosed. |
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| If you would like to chat with an author of this article, you may contact Dr Rastogi of amitr68@hotmail.com. |
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| See CME section; p. 1068. |
Vol 75 - N° 5
P. 1022-1030 - Maggio 2012 Ritorno al numero
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