Prevalence of Clinically Important Histology in Small Adenomas

doi:10.1016/j.cgh.2005.12.021

Clinical Gastroenterology and Hepatology

Volume 4, Issue 3, March 2006, Pages 343-348

https://doi.org/10.1016/j.cgh.2005.12.021 Get rights and content

Background & Aims: The prevalence of advanced histology in small polyps has become a crucial issue in optimizing colorectal cancer screening strategies, especially in view of the advent of computed tomography colonography. We evaluated the prevalence of advanced histology in small and diminutive adenomas to clarify their clinical importance in terms of malignant potential. Methods: Data were reviewed retrospectively from 3291 colonoscopies performed on asymptomatic patients found to have an adenoma on screening with flexible sigmoidoscopy a few weeks before the colonoscopy or who had a family history of colorectal cancer. All polyps were excised endoscopically and sent for pathology testing. Specimens with advanced histology were confirmed by a second reading. Results: Of the 3291 colonoscopies performed, 1235 colonoscopies yielded a total of 1933 small or diminutive adenomatous polyps. Advanced histology including carcinoma was found in 10.1% of small (5–10 mm) adenomas and in 1.7% of diminutive adenomas (≤4 mm). Carcinoma was found in .9% of small adenomas, and 0% of diminutive adenomas. Of the 107 patients found to have polyps 2–10 mm with advanced histology, 100 (93%) were referred for colonoscopy because of an adenoma found on a recent screening with flexible sigmoidoscopy. Seven patients underwent colonoscopy for a positive family history of colon cancer; all 7 had a single affected first-degree relative older than age 50. Conclusions: Adenomas 5–10 mm in size harbor pathologically significant histology, and the need for removal of these lesions must be addressed to optimize colorectal cancer prevention.

Section snippets

Methods

Data were reviewed retrospectively from 3291 consecutive colonoscopies performed on asymptomatic patients by a single endoscopist (L.B.) at a multispecialty clinic from May 1989 through May 1998. Patients initially were referred by their primary care providers for screening with flexible sigmoidoscopy; individuals found to have 1 or more adenomatous polyps detected on the sigmoidoscopy, or a family history of colon cancer in 1 or more first-degree relatives, were referred for colonoscopy within

Results

Of 3291 colonoscopies performed between May 1989 and May 1998, 1235 colonoscopies revealed 1933 adenomas 10 mm or less in size. In this entire group, a total of 110 adenomatous polyps were noted to contain advanced histology (Table 1). Eight of these advanced adenomas contained invasive carcinoma and 57 contained high-grade dysplasia. Forty-five polyps contained at least 25% villous architecture and were classified as villous histology.

As shown in Table 1, carcinoma was found in adenomas

Discussion

In asymptomatic patients referred for colonoscopy for an adenoma found on flexible sigmoidoscopy or a family history of colorectal cancer, advanced histology (defined as high-grade dysplasia, carcinoma, or at least 25% villous architecture) was present in 10.1% of small adenomas measuring 5–10 mm in diameter. Carcinoma was not detected in diminutive polyps (size, ≤4 mm) but was present in .9% of small (size, 5–10 mm) adenomatous polyps.

The potential for malignant transformation of an

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Original articlePrevalence of Clinically Important Histology in Small Adenomas

Section snippets

Methods

Results

Discussion

Gastroenterology

Am J Gastroenterol

Gastroenterology

Gastroenterology

Gastroenterol Clin North Am

Gastrointest Endosc

Gastroenterology

Gastroenterology

Clin Gastroenterol Hepatol

Gastroenterology

Cancer statistics, 2005

CA Cancer J Clin

Prevention of colorectal cancer by colonoscopic polypectomy

N Engl J Med

Screening for colorectal cancer in adults at average riska summary of the evidence for the U.S. Preventive Services Task Force

Ann Intern Med

American Cancer Society guidelines for the early detection of cancer, 2004

CA Cancer J Clin

Incidence and distribution of adenomatous polyps of the colon and rectum based on 1,000 autopsy examinations

Dis Colon Rectum

The evolution of cancer of the colon and rectum

Cancer

Carcinomatous mucosal excrescence of the rectum

JAMA

Original article
Prevalence of Clinically Important Histology in Small Adenomas