Back to Search
Start Over
Diminutive Polyps With Advanced Histologic Features Do Not Increase Risk for Metachronous Advanced Colon Neoplasia
- Source :
- Gastroenterology, 156(3), 623-+. W.B. Saunders, Gastroenterology, 156(3), 623-634.e3. W.B. Saunders Ltd
- Publication Year :
- 2019
-
Abstract
- Background & Aims With advances in endoscopic imaging, it is possible to differentiate adenomatous from hyperplastic diminutive (1–5 mm) polyps during endoscopy. With the optical Resect-and-Discard strategy, these polyps are then removed and discarded without histopathology assessment. However, failure to recognize adenomas (vs hyperplastic polyps), or discarding a polyp with advanced histologic features, could result in a patient being considered at low risk for metachronous advanced neoplasia, resulting in an inappropriately long surveillance interval. We collected data from international cohorts of patients undergoing colonoscopy to determine what proportion of patients are high risk because of diminutive polyps advanced histologic features and their risk for metachronous advanced neoplasia. Methods We collected data from 12 cohorts (in the United States or Europe) of patients undergoing colonoscopy after a positive result from a fecal immunochemical test (FIT cohort, n = 34,221) or undergoing colonoscopies for screening, surveillance, or evaluation of symptoms (colonoscopy cohort, n = 30,123). Patients at high risk for metachronous advanced neoplasia were defined as patients with polyps that had advanced histologic features (cancer, high-grade dysplasia, ≥25% villous features), 3 or more diminutive or small (6–9 mm) nonadvanced adenomas, or an adenoma or sessile serrated lesion ≥10 mm. Using an inverse variance random effects model, we calculated the proportion of diminutive polyps with advanced histologic features; the proportion of patients classified as high risk because their diminutive polyps had advanced histologic features; and the risk of these patients for metachronous advanced neoplasia. Results In 51,510 diminutive polyps, advanced histologic features were observed in 7.1% of polyps from the FIT cohort and 1.5% polyps from the colonoscopy cohort (P = .044); however, this difference in prevalence did not produce a significant difference in the proportions of patients assigned to high-risk status (0.8% of patients in the FIT cohort and 0.4% of patients in the colonoscopy cohort) (P = .25). The proportions of high-risk patients because of diminutive polyps with advanced histologic features who were found to have metachronous advanced neoplasia (17.6%) did not differ significantly from the proportion of low-risk patients with metachronous advanced neoplasia (14.6%) (relative risk for high-risk categorization, 1.13; 95% confidence interval 0.79–1.61). Conclusion In a pooled analysis of data from 12 international cohorts of patients undergoing colonoscopy for screening, surveillance, or evaluation of symptoms, we found that diminutive polyps with advanced histologic features do not increase risk for metachronous advanced neoplasia.
- Subjects :
- Male
0301 basic medicine
Risk Stratification
Internationality
Colorectal cancer
Colonoscopy
Cohort Studies
0302 clinical medicine
Cancer Progression
Prospective Studies
Early Detection of Cancer
medicine.diagnostic_test
Colon Cancer
Incidence
Biopsy, Needle
Age Factors
Gastroenterology
Neoplasms, Second Primary
Middle Aged
Prognosis
Immunohistochemistry
Colonic Neoplasms
Cohort
Female
030211 gastroenterology & hepatology
Radiology
medicine.medical_specialty
Adenoma
Colonic Polyps
Prognostic
Risk Assessment
03 medical and health sciences
Sex Factors
Predictive Value of Tests
Confidence Intervals
medicine
Humans
Neoplasm Invasiveness
Aged
Neoplasm Staging
Proportional Hazards Models
Hepatology
business.industry
medicine.disease
Endoscopy
030104 developmental biology
Hyperplastic Polyp
Dysplasia
Relative risk
business
Precancerous Conditions
Subjects
Details
- Language :
- English
- ISSN :
- 00165085
- Database :
- OpenAIRE
- Journal :
- Gastroenterology, 156(3), 623-+. W.B. Saunders, Gastroenterology, 156(3), 623-634.e3. W.B. Saunders Ltd
- Accession number :
- edsair.doi.dedup.....7b9e361d9493ed576a0d1cadee66a4ff