Abstract
The prevalence of cancer in small and diminutive polyps is relevant to “resect and
discard” and CT colonography reporting recommendations.
We evaluated a prospectively collected colonoscopy polyp database to identify polyps
<10 mm and those with cancer or advanced histology (high-grade dysplasia or villous elements).
Of 32,790 colonoscopies, 15,558 colonoscopies detected 42,630 polyps <10 mm in size. A total of 4790 lesions were excluded as they were not conventional adenomas
or serrated class lesions.
There were 23,524 conventional adenomas <10 mm of which 22,952 were tubular adenomas. There were 14,316 serrated class lesions
of which 13,589 were hyperplastic polyps and the remainder were sessile serrated polyps.
Of all conventional adenomas, 96 had high-grade dysplasia including 0.3% of adenomas
≤5 mm in size and 0.8% of adenomas 6–9 mm in size. Of all conventional adenomas, 2.1% of those ≤5 mm in size and 5.6% of those 6–9 mm in size were advanced. Among 36,107 polyps ≤5 mm in size and 6523 polyps 6–9 mm in size, there were no cancers.
These results support the safety of resect and discard as well as current CT colonography
reporting recommendations for small and diminutive polyps.
Keywords
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References
- The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps.Gastrointestinal Endoscopy. 2011; 73: 419-422
- CT colonography reporting and data system: a consensus proposal.Radiology. 2005; 236: 3-9
- Morphology, anatomic distribution and cancer potential of colonic polyps.Annals of Surgery. 1979; 190: 679-683
- High-grade dysplasia and invasive carcinoma in colorectal adenomas: a multivariate analysis of the impact of adenoma and patient characteristics.European Journal of Gastroenterology and Hepatology. 2002; 14: 183-188
- The rate of adenocarcinoma in endoscopically removed colorectal polyps.American Surgeon. 2005; 71: 1024-1026
- Clinical significance of small colorectal adenoma less than 10 mm: the KASID study.Hepato-Gastroenterology. 2007; 54: 418-421
- Prevalence of clinically important histology in small adenomas.Clinical Gastroenterology and Hepatology. 2006; 4: 343-348
- Characteristics of advanced adenomas detected at CT colonographic screening: implications for appropriate polyp size thresholds for polypectomy versus surveillance.American Journal of Roentgenology. 2007; 188: 940-944
- Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography.Gastroenterology. 2008; 135: 1100-1105
- Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population.Gut. 2009; 58: 241-248
- Yield of high-grade dysplasia based on polyp size detected at colonoscopy: a series of 2295 examinations following a positive fecal occult blood test in a population-based study.Diseases of the Colon and Rectum. 2010; 53: 339-345
- Risk factors for advanced adenomas amongst small and diminutive colorectal polyps: a prospective monocenter study.Digestive and Liver Disease. 2011; 43: 609-612
- Prevalence of advanced adenomas in small and diminutive colon polyps using direct measurement of size.Digestive Diseases and Sciences. 2011; 56: 2384-2388
- Some diminutive colorectal polyps can be removed and discarded without pathologic examination.Endoscopy. 2011; 43: 81-86
- Prevalence of advanced histological features in diminutive and small colon polyps.Gastrointestinal Endoscopy. 2012; 75: 1022-1030
- Nonpolypoid neoplastic lesions of the colorectal mucosa.Gastrointestinal Endoscopy. 2008; 68: S3-S47
- Prevalence of nonpolypoid colorectal neoplasia: an Italian multicenter observational study.Endoscopy. 2010; 42: 279-285
- Flat and depressed colorectal tumours in southern Swedish population: a prospective chromoendoscopic and histopathological study.Gut. 2002; 51: 550-555
- A survey of patient acceptance of resect and discard for diminutive polyps.Gastrointestinal Endoscopy. 2015; 82 (376–80.e1)
- Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas.Gastroenterology. 1990; 98: 371-379
- Diminutive colonic polyps: histopathology, spatial distribution, concomitant significant lesions, and treatment complications.American Journal of Gastroenterology. 1995; 90: 24-28
- Histological assessment of colorectal adenomas by size. Are polyps less than 10 mm in size clinically important?.European Journal of Surgery. 2001; 167: 777-781
- Diminutive polyps of large bowel should be an early target for endoscopic treatment.Digestive and Liver Disease. 2002; 34: 137-140
- Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults.New England Journal of Medicine. 2003; 349: 2191-2200
- Clinical significance of small colorectal polyps.Diseases of the Colon and Rectum. 2004; 47: 481-485
- Prevalence of adenocarcinoma in small adenomas.American Journal of Gastroenterology. 2006; 101: S199
- Real-time optical diagnosis for diminutive colorectal polyps using narrow-band imaging: the VALID randomised clinical trial.Gut. 2015; 64: 1569-1577
- Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions.Gastrointestinal Endoscopy. 2013; 77: 401-407
- Agreement in interpreting villous elements and dysplasia in adenomas less than one centimetre in size.Digestive and Liver Disease. 2013; 45: 1049-1055
- Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002).Gut. 2010; 59: 666-689
- Reinterpretation of histology of proximal colon polyps called hyperplastic in 2001.World Journal of Gastroenterology. 2009; 15: 3767-3770
- Sessile serrated polyp prevalence determined by a colonoscopist with a high lesion detection rate and an experienced pathologist.Gastrointestinal Endoscopy. 2015; 81: 517-524
- Accuracy of pathologic interpretation of colorectal polyps by general pathologists in community practice.Gastrointestinal Endoscopy. 1999; 50: 468-474
Article info
Publication history
Published online: July 18, 2016
Accepted:
June 20,
2016
Received:
April 11,
2016
Footnotes
☆This work was supported by a gift to the Indiana University Foundation in the name of Douglas K. Rex by Scott and Kay Schurz of Bloomington, Indiana, and their children.
Identification
Copyright
© 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
