Abstract
Purpose: Since the concept of “advanced” or “dangerous” adenomas was introduced in 1992, less concern has been directed to diminutive colorectal adenomas. They apparently confer no increased risk of metachronous colorectal cancer and some investigators have suggested that they need neither follow-up nor treatment. This study is intended to discover how often small colorectal adenomas have unfavorable histologic features. Methods: Since 1995 the details of all colorectal polyps have been entered into a database, along with data concerning patients, symptoms, treatment, and outcome. Using this database all adenomas were categorized into three groups: Group I, < 6 mm diameter, Group II, 6 to 10 mm diameter, and Group III, < 10 mm diameter. “High risk” adenomas were defined as those containing < 25 percent villous architecture, those with severe dysplasia, and those over 10 mm in size. Thus all Group III adenomas are high-risk by definition. The effects of family history, patient age, and polyp location on the proportions of Group I and Group II adenomas that were histologically high risk were examined. Results: There were 5, 722 polyps of which 4, 381 (76.6 percent) were Group I, 666 (11.6 percent) were Group II, and 675 (11.8 percent) were Group III. These included 24 invasive cancers (2 in Group I, 1 in Group II, and 21 in Group III. Of the Group I adenomas, 91/2, 064 (4.4 percent) were high risk compared to 65/417 (15.6 percent) in Group II. Of the 564 Group III adenomas, 326 (57.8 percent) had unfavorable histology. There was no effect of age, family history, or site of the polyp on the proportion of polyps that were high risk. Conclusions: Four percent of adenomas less than 6 mm diameter and 16 percent of those between 6 and 10 mm have unfavorable histology. Small adenomas can still be clinically significant and should not be ignored.
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References
Atkin WS, Morson BC, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Eng J Med 1992; 326: 658–62
Nusko G, Mansmann U, Altendorf-Hofmann A, Groitl H, Wittekind C, Haln EG. Risk of invasive canrcinoma in colorectal adenomas assessed by size and site. Int J Colored Dis 1997; 12: 267–71
Chantereau MJ, Faivre J, Boutron MC, et al. Epidemiology, management and prognosis of malignant large bowel polyps within a defined population. Gut 1992; 33: 259–63
Fletcher JG. Future directions in CT colonography. Abdom Imaging 2002, 27: 301–8
Dachman AH. Diagnostic performance of virtual colonoscopy. Abdom Imaging 2002; 27: 260–7
Rex DK, Cutler CS, Lemmel GT, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology 1978; 112: 24–8
Fennerty MB, Davidson J, Emerson SS, et al. Are endoscopic measurements of colonic polyps reliable? Am J Gastroenterol 1993, 88: 496–500
Margulies C, Krevsky B, Catalano MF. How accurate are endoscopic estimates of size? Gastrointest Endosc 1994; 40: 174–7
Tedesco FJ, Hendrix JC, Pickens CA, Brady PG, Mills LR. Diminutive polyps: histopathology, spatial distribution and clinical significance. Gastointest Endosc 1982; 28: 1–5
Granquist S, Gabrielsson N, Sundelin P. Diminutive coIonic polyps: clinical significance and management. Endoscopy 1979; 11: 36–42
Waye JD, Frankel A, Braunfield SF. The histo-pathology of small colon polyps. Gastrointest Endosc 1980; 26: 80
Gottlieb LS, Winawer SJ, Sternberg S, et al. National polyp study: the diminutive colonic polyp. Gastrointest Endosc 1984; 30: 143
Church JM, Fazio VW, Jones IT. Small colorectal polyps: are they worth treating? Dis Colon Rectum 1988; 31; 50–3
Bersentes K, Fennerty MB, Sampliner RE, Garewal HS. Lack of spontaneous regression of tubular adenomas in two years of follow-up. Am J Gastroenterol 1997; 92: 1117–20
Hofstad B, Vatn MH, Andersen SN, et al. Growth of colorectal polyps: redetection and evaluation of unresected polyps for a period of three years. Gut 1996; 39: 449–56
Brooker JC, Saunders BP, Shah SG, et al. Total colonic dye-spray increases the detection of diminutive adenomas during routine colonoscopy: a randomized controlled trial. Gastrointest Endosc 2002; 55: 695–700
Neale AV, Demers RY, Budev H, Scott RO. Physician accuracy in diagnosing colorectal polyps. Dis Colon Rectum 1987; 30: 247–50
Jass JR, Whitehall VL, Young J, Leggett BA. Emerging concepts in colorectal neoplasia. Gastroenterology 2002; 123: 862–76
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Church, J.M. Clinical significance of small colorectal polyps. Dis Colon Rectum 47, 481–485 (2004). https://doi.org/10.1007/s10350-003-0078-6
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DOI: https://doi.org/10.1007/s10350-003-0078-6