BACKGROUND & AIMS: Observational screening of the colon with subsequent referral for colonoscopy raises questions about the threshold of polyp size that necessitates referral. To examine the yield at colonoscopy when a given size lesion is observed, we assessed the yield of advanced adenoma and cancer at colonoscopy based on the size of the abnormality detected at flexible sigmoidoscopy (FSG). METHODS: We used data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, a randomized, controlled, community-based study of FSG. RESULTS: Subsequent colonoscopy was performed on 10,850 subjects (60.4% male; mean age, 62.9 years) with a polyp visualized on screening FSG. For women with a polyp 0.5-0.9 cm on FSG (n = 1426), the yield in the distal colon on colonoscopy was 0.6% for cancer (number needed to screen [NNS] = 166) and 14.5% for advanced adenoma (NNS = 7). In men (n = 2183), the yield was 0.7% (NNS = 142) for cancer and 15.9% (NNS = 6) for advanced adenoma. Among persons with polyps 0.5-0.9 cm identified on FSG, 5.5% (198/3609) had distal advanced adenomas that measured <1.0 cm but had villous histology or high-grade dysplasia, and 9.9% (357/3609) had adenomas > or =1 cm. CONCLUSIONS: The yield for a distal advanced adenomatous lesion when a polyp 0.5-0.9 cm is observed at FSG is substantial and is due to the presence of advanced histology in polyps <1 cm and to detection of polyps that measure > or =1.0 cm on colonoscopy. Establishing thresholds for observation versus evaluation will require careful assessment of the overall yield.
BACKGROUND & AIMS: Observational screening of the colon with subsequent referral for colonoscopy raises questions about the threshold of polyp size that necessitates referral. To examine the yield at colonoscopy when a given size lesion is observed, we assessed the yield of advanced adenoma and cancer at colonoscopy based on the size of the abnormality detected at flexible sigmoidoscopy (FSG). METHODS: We used data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, a randomized, controlled, community-based study of FSG. RESULTS: Subsequent colonoscopy was performed on 10,850 subjects (60.4% male; mean age, 62.9 years) with a polyp visualized on screening FSG. For women with a polyp 0.5-0.9 cm on FSG (n = 1426), the yield in the distal colon on colonoscopy was 0.6% for cancer (number needed to screen [NNS] = 166) and 14.5% for advanced adenoma (NNS = 7). In men (n = 2183), the yield was 0.7% (NNS = 142) for cancer and 15.9% (NNS = 6) for advanced adenoma. Among persons with polyps 0.5-0.9 cm identified on FSG, 5.5% (198/3609) had distal advanced adenomas that measured <1.0 cm but had villous histology or high-grade dysplasia, and 9.9% (357/3609) had adenomas > or =1 cm. CONCLUSIONS: The yield for a distal advanced adenomatous lesion when a polyp 0.5-0.9 cm is observed at FSG is substantial and is due to the presence of advanced histology in polyps <1 cm and to detection of polyps that measure > or =1.0 cm on colonoscopy. Establishing thresholds for observation versus evaluation will require careful assessment of the overall yield.
Authors: Cindy M Chang; Victoria M Chia; Marc J Gunter; Krista A Zanetti; Bríd M Ryan; Julie E Goodman; Curtis C Harris; Joel Weissfeld; Wen-Yi Huang; Stephen Chanock; Meredith Yeager; Richard B Hayes; Sonja I Berndt Journal: Carcinogenesis Date: 2013-06-26 Impact factor: 4.944
Authors: Wen-Yi Huang; L Joseph Su; Richard B Hayes; Lee E Moore; Hormuzd A Katki; Sonja I Berndt; Joel L Weissfeld; Srinivasan Yegnasubramanian; Mark P Purdue Journal: Cancer Epidemiol Biomarkers Prev Date: 2012-09-20 Impact factor: 4.254
Authors: Sonja I Berndt; John D Potter; Aditi Hazra; Meredith Yeager; Gilles Thomas; Karen W Makar; Robert Welch; Amanda J Cross; Wen-Yi Huang; Robert E Schoen; Edward Giovannucci; Andrew T Chan; Stephen J Chanock; Ulrike Peters; David J Hunter; Richard B Hayes Journal: Hum Mol Genet Date: 2008-06-04 Impact factor: 6.150
Authors: Sonja I Berndt; Wen-Yi Huang; Meredith Yeager; Joel L Weissfeld; Stephen J Chanock; Richard B Hayes Journal: Cancer Causes Control Date: 2008-12-09 Impact factor: 2.506