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Risk factors for advanced neoplasia within subcentimetric polyps: implications for diagnostic imaging
  1. Frank Thomas Kolligs1,
  2. Alexander Crispin2,
  3. Anno Graser3,
  4. Axel Munte4,
  5. Ulrich Mansmann2,
  6. Burkhard Göke1
  1. 1Department of Medicine II, University of Munich, Munich, Germany
  2. 2Institute of Medical Informatics, Biometry, and Epidemiology, University of Munich, Munich, Germany
  3. 3Institute of Clinical Radiology, University of Munich, Munich, Germany
  4. 4Bavarian Association of Compulsory Health Insurance Physicians, Munich, Germany
  1. Correspondence to Dr Frank Thomas Kolligs, Department of Medicine II, University of Munich, Marchioninistr 15, 81377 Munich, Germany; fkolligs{at}


Objective Diagnostic imaging by CT colonography and capsule endoscopy is used to detect colonic lesions. Controversy exists regarding the work-up of subcentimetric lesions. The aim of this study was to identify risk indicators for advanced neoplasia (AN) in subcentimetric polyps.

Design Colonoscopies were classified on the basis of the largest lesion found. AN was defined as high-grade dysplasia, villous histology, or cancer. Logistic regression models were developed to identify risk factors for AN, and validated on separate datasets. A risk index based on the logistic regression was generated, and the number needed to screen (NNS) to detect AN was determined.

Results 1 077 956 colonoscopies identified 106 270 intermediate (5–9 mm) and 198 954 diminutive (≤4 mm) lesions; 13% of intermediate and 3.7% of diminutive lesions contained AN. The risk of AN was higher in intermediate than in diminutive lesions (OR 3.1; 95% CI 3.0 to 3.3). Age ≥85 versus <45 years was associated with ORs of 2.4 (95% CI 1.8 to 3.1) for intermediate polyps and 3.2 (95% CI 2.3 to 4.5) for diminutive polyps. Pedunculated versus sessile morphology was associated with a higher risk of AN in intermediate (OR 2.0; 95% CI 1.9 to 2.2) and diminutive (OR 3.5; 95% CI 2.9 to 4.1) lesions. In the combined analysis for subcentimetric lesions, ORs were 2.7 (95% CI 2.2 to 3.3) for age ≥85 versus <45 years, 1.1 (95% CI 1.1 to 1.2) for male sex, 1.6 (95% CI 1.4 to 1.7) for occult blood, 1.3 (95% CI 1.2 to 1.5) for overt blood in stool, 1.3 (95% CI 1.2 to 1.4) for more than four lesions, and 2.2 (95% CI 2.1 to 2.3) for pedunculated versus sessile lesions. At median risk index values, the NNS was 9.3 (95% CI 9.1 to 9.5) in individuals with intermediate lesions and 29.4 (95% CI 28.5 to 30.2) in those with diminutive lesions. Compared with the NNS of 15 of the whole cohort, the majority of intermediate, but a minority of diminutive, lesions were deemed at high risk of AN.

Conclusion This study successfully identified risk factors and established a risk index for subcentimetric lesions. This has implications for the work-up of patients with subcentimetric lesions identified on diagnostic imaging.

  • Colorectal cancer
  • virtual colonoscopy
  • capsule colonoscopy
  • colonoscopy

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  • Competing interests None.

  • Ethics approval Bavarian governmental authority for data protection.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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