Introduction Endoscopic management of early colonic neoplasia or polyp cancer remains unclear. There are no national guidelines or good quality data to guide clinicians with these difficult lesions. The aim of this study is to identify the incidence of early cancer and variation in practise of managing these lesions
Methods Data was prospectively collected in all patients undergoing screening within the Solent BCSP. The database was interrogated to identify all neoplasia. The endoscopists suspicion of cancer was noted from the reports. MDT outcome was recorded, along with final management of the cancer
Results In total 3976 patients underwent screening colonoscopy between 2007 –2012. N = 5768 neoplastic polyps found giving a mean polyp detection rate of 1.5/patient. Cancer was found in 235/3976 (6%) patients. Mean age was 67yrs. 142/235 (60%) were male. 145/235 (62%) had advanced cancer, confirmed at surgery. 90/235 (38%) patients had polyp cancer. 83% of them in recto-sigmoid.
(1) 13/90 were pedunculated polyps (mean size 23 mm, range 12–35 mm)
(2) 77/90 were flat polyp cancers (mean size 24 mm, range 8–80 mm)
See table 1 below
13/13 pedunculated polyp cancers were endoscopically resected. In 6/13 cases cancer was suspected prior to resection. Histology was reported accurately on 12/13 (92%) polyp cancers using Haggitt classification. 1/13 required surgery due to invasive features on histology.
30/77 (39%) of flat or sessile polyp cancers were endoscopically resected. Endoscopist suspected cancer in only 13/30 (43%) cases prior to resection. Histology was reported confidently by Kukuchi levels in 19/30 (63%) of lesions. 9/19 required surgery due to invasive features on histology. In 11/30 (37%) cases the histology report was inconclusive due to a poor quality EMR specimen. This led to surgery in all 11 patients but no residual disease or LN involvement was found.
The in-vivo endoscopic diagnosis of cancer prior to resection is suboptimal and can be improved
Post EMR histology reporting is inconclusive in a large proportion of flat polyps leading to unnecessary surgery
Clinical care could be improved by optimising in-vivo diagnostic skills and resecting large flat lesions in single piece by ESD.
Disclosure of Interest None Declared
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