BACKGROUND & AIMS: Colorectal cancer screening with diagnostic imaging can detect polyps. The management of patients whose largest polyp is less than 10 mm is uncertain. The primary aim of this study was to determine rates of advanced histology in patients undergoing colorectal cancer screening whose largest polyp is 9 mm or less. METHODS: Subjects include all asymptomatic adults receiving colonoscopy for screening during 2005 from 17 practice sites, which provide both colonoscopy and pathology reports to the Clinical Outcomes Research Initiative repository. Patients were classified by size of largest polyp. Advanced histology was defined as an adenoma with villous or serrated histology, high-grade dysplasia, or an invasive cancer. Risk factors for advanced histology were determined using Pearson chi(2) and Fisher exact tests. RESULTS: Among 13,992 asymptomatic patients who had screening colonoscopy, 6360 patients (45%) had polyps, with complete histology available in 5977 (94%) patients. The proportion with advanced histology was 1.7% in the 1- to 5-mm group, 6.6% in the 6- to 9-mm group, 30.6% in the greater than 10-mm group, and 72.1% in the tumor group. Distal location was associated with advanced histology in the 6- to 9-mm group (P = .04) and in the greater than 10-mm group (P = .002). CONCLUSIONS: One in 15 asymptomatic patients whose largest polyp is 6 to 9 mm will have advanced histology and would undergo surveillance at 3 years based on current guidelines. Because histology is necessary for this decision, most of these patients should be offered colonoscopy. Further study should determine whether patients whose largest polyp is 1-5 mm can be safely followed without polypectomy.
BACKGROUND & AIMS:Colorectal cancer screening with diagnostic imaging can detect polyps. The management of patients whose largest polyp is less than 10 mm is uncertain. The primary aim of this study was to determine rates of advanced histology in patients undergoing colorectal cancer screening whose largest polyp is 9 mm or less. METHODS: Subjects include all asymptomatic adults receiving colonoscopy for screening during 2005 from 17 practice sites, which provide both colonoscopy and pathology reports to the Clinical Outcomes Research Initiative repository. Patients were classified by size of largest polyp. Advanced histology was defined as an adenoma with villous or serrated histology, high-grade dysplasia, or an invasive cancer. Risk factors for advanced histology were determined using Pearson chi(2) and Fisher exact tests. RESULTS: Among 13,992 asymptomatic patients who had screening colonoscopy, 6360 patients (45%) had polyps, with complete histology available in 5977 (94%) patients. The proportion with advanced histology was 1.7% in the 1- to 5-mm group, 6.6% in the 6- to 9-mm group, 30.6% in the greater than 10-mm group, and 72.1% in the tumor group. Distal location was associated with advanced histology in the 6- to 9-mm group (P = .04) and in the greater than 10-mm group (P = .002). CONCLUSIONS: One in 15 asymptomatic patients whose largest polyp is 6 to 9 mm will have advanced histology and would undergo surveillance at 3 years based on current guidelines. Because histology is necessary for this decision, most of these patients should be offered colonoscopy. Further study should determine whether patients whose largest polyp is 1-5 mm can be safely followed without polypectomy.
Authors: Perry J Pickhardt; J Richard Choi; Inku Hwang; James A Butler; Michael L Puckett; Hans A Hildebrandt; Roy K Wong; Pamela A Nugent; Pauline A Mysliwiec; William R Schindler Journal: N Engl J Med Date: 2003-12-01 Impact factor: 91.245
Authors: M J O'Brien; S J Winawer; A G Zauber; L S Gottlieb; S S Sternberg; B Diaz; G R Dickersin; S Ewing; S Geller; D Kasimian Journal: Gastroenterology Date: 1990-02 Impact factor: 22.682
Authors: Sidney Winawer; Robert Fletcher; Douglas Rex; John Bond; Randall Burt; Joseph Ferrucci; Theodore Ganiats; Theodore Levin; Steven Woolf; David Johnson; Lynne Kirk; Scott Litin; Clifford Simmang Journal: Gastroenterology Date: 2003-02 Impact factor: 22.682
Authors: David H Kim; Perry J Pickhardt; Andrew J Taylor; Winifred K Leung; Thomas C Winter; J Louis Hinshaw; Deepak V Gopal; Mark Reichelderfer; Richard H Hsu; Patrick R Pfau Journal: N Engl J Med Date: 2007-10-04 Impact factor: 91.245
Authors: David A Lieberman; David G Weiss; William V Harford; Dennis J Ahnen; Dawn Provenzale; Stephen J Sontag; Thomas G Schnell; Gregorio Chejfec; Donald R Campbell; Jayashri Kidao; John H Bond; Douglas B Nelson; George Triadafilopoulos; Francisco C Ramirez; Judith F Collins; Tiina K Johnston; Kenneth R McQuaid; Harinder Garewal; Richard E Sampliner; Romeo Esquivel; Douglas Robertson Journal: Gastroenterology Date: 2007-10 Impact factor: 22.682
Authors: Bernard Levin; David A Lieberman; Beth McFarland; Robert A Smith; Durado Brooks; Kimberly S Andrews; Chiranjeev Dash; Francis M Giardiello; Seth Glick; Theodore R Levin; Perry Pickhardt; Douglas K Rex; Alan Thorson; Sidney J Winawer Journal: CA Cancer J Clin Date: 2008-03-05 Impact factor: 508.702
Authors: S J Winawer; A G Zauber; M N Ho; M J O'Brien; L S Gottlieb; S S Sternberg; J D Waye; M Schapiro; J H Bond; J F Panish Journal: N Engl J Med Date: 1993-12-30 Impact factor: 91.245
Authors: Ethna McFerran; James F O'Mahony; Richard Fallis; Duncan McVicar; Ann G Zauber; Frank Kee Journal: Epidemiol Rev Date: 2017-01-01 Impact factor: 6.222
Authors: Jennifer L Holub; Cynthia Morris; Lyle J Fagnan; Judith R Logan; LeAnn C Michaels; David A Lieberman Journal: J Rural Health Date: 2017-01-03 Impact factor: 4.333
Authors: Adeyinka O Laiyemo; Chyke Doubeni; Paul F Pinsky; V Paul Doria-Rose; Robert Bresalier; Lois E Lamerato; E David Crawford; Paul Kvale; Mona Fouad; Thomas Hickey; Thomas Riley; Joel Weissfeld; Robert E Schoen; Pamela M Marcus; Philip C Prorok; Christine D Berg Journal: J Natl Cancer Inst Date: 2010-03-31 Impact factor: 13.506