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.
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.
Authors: Sascha C van Doorn; Y Hazewinkel; James E East; Monique E van Leerdam; Amit Rastogi; Maria Pellisé; Silvia Sanduleanu-Dascalescu; Barbara A J Bastiaansen; Paul Fockens; Evelien Dekker Journal: Am J Gastroenterol Date: 2014-10-21 Impact factor: 10.864
Authors: Pushpak Taunk; Christopher D Atkinson; David Lichtenstein; Eladio Rodriguez-Diaz; Satish K Singh Journal: Int J Colorectal Dis Date: 2019-11-06 Impact factor: 2.571
Authors: Perry J Pickhardt; David H Kim; B Dustin Pooler; J Louis Hinshaw; Duncan Barlow; Don Jensen; Mark Reichelderfer; Brooks D Cash Journal: Lancet Oncol Date: 2013-06-07 Impact factor: 41.316