Original article
Clinical endoscopy
Prevalence of advanced histological features in diminutive and small colon polyps

Presented at Digestive Disease Week, May 5-8, 2011, Chicago, Illinois (Gastrointest Endosc 2011;73:AB159-60).
https://doi.org/10.1016/j.gie.2012.01.020Get rights and content

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.

Section snippets

Methods

This was a retrospective analysis of data from 3 prospective clinical trials, which investigated the impact of novel imaging techniques on polyp detection and/or polyp histology prediction.1, 2, 15 From November 2007 to October 2010, patients were enrolled at two tertiary-care referral centers (Veterans Affairs Medical Center in Kansas City, Missouri and Washington University in St. Louis, Missouri) in 1 of 3 clinical trials. All data from the 3 clinical trials were stored in a centralized

Results

A total of 1150 patients underwent colonoscopy, and 756 (65.7%) were found to have 1 or more colon polyps (Fig. 1). Patients with at least 1 polyp had a mean age of 61.8 years (standard deviation 8.2). A total of 648 (85.7%) were male, 571 (75.5%) were white, 604 (79.9%) were veterans, and 286 (37.8%) had a history of colon polyps. A total of 117 patients (15.5%) underwent colonoscopy with standard definition white light, 134 (17.7%) with narrow-band imaging, 328 (43.4%) with high-definition

Discussion

Currently, the standard practice during colonoscopy is to resect all polyps and send them for histopathological examination. Clinically, this serves two purposes: (1) determine future surveillance colonoscopy intervals based on the size and number of adenomas as well the presence of advanced histological features in the adenomas and (2) ensure the absence of invasive cancer. Recently, there has been a rising interest in applying “predict, resect, and discard” strategies during colonoscopy

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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.

    If you would like to chat with an author of this article, you may contact Dr Rastogi of [email protected].

    See CME section; p. 1068.

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    Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.