Prevalence of advanced histological features in diminutive and small colon polyps

• Published in: Gastrointestinal endoscopy Vol. 75; no. 5; pp. 1022 - 1030
• Main Authors: Gupta, Neil, MD, MPH, Bansal, Ajay, MD, Rao, Deepthi, MD, Early, Dayna S., MD, Jonnalagadda, Sreenivasa, MD, Wani, Sachin B., MD, Edmundowicz, Steven A., MD, Sharma, Prateek, MD, Rastogi, Amit, MD
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01-05-2012; Elsevier
• Subjects: Adenoma - pathology; Adenoma, Villous - pathology; Biological and medical sciences; Colonic Neoplasms - pathology; Colonic Polyps - pathology; Colonic Polyps - surgery; Colonoscopy; Digestive system. Abdomen; Endoscopy; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Retrospective Studies; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumor Burden; Tumors; Colonic disease; Colon polyp; Digestive diseases; Prevalence; Epidemiology
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2012.01.020

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.