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• W1990297712 abstract "BackgroundBased on the ability of advanced imaging techniques such as narrow band imaging to predict colon polyp histology in real time, it has been suggested that a “resect and discard” strategy can be employed for diminutive (≤ 5mm) polyps instead of submitting them for histopathological examination, resulting in significant cost savings. However, the absence of advanced histological features such as villous histology, high grade dysplasia (HGD), and/or cancer in small (6-9mm) polyps may allow for the ability to discard these polyps without histopathological examination as well.AimsTo determine the prevalence of advanced histological features in diminutive and small colon polyps.MethodsPatients undergoing either screening or surveillance colonoscopy at two tertiary referral centers were prospectively enrolled from November 2007 - October 2010 in one of three clinical trials investigating the impact of novel imaging techniques on polyp detection and/or polyp histology prediction. A centralized database was created to maintain all the data from these studies. The colonoscopies were performed by one of six experienced endoscopists. Following cecal intubation, the location, size, and morphology of each polyp detected during withdrawal was documented. Each polyp was then resected, placed in a unique specimen jar, and sent for histopathological evaluation. Patients in whom the cecum could not be intubated or bowel prep was inadequate were excluded. Polyps were classified as either neoplastic (adenomatous) or non-neoplastic (hyperplastic, no diagnostic abnormality, other benign histology). Polyps were also grouped by size: diminutive (0-5mm), small (6-9mm), and large (10mm or more). The rates of advanced histological features including villous histology, HGD, and cancer were calculated for each size category with 95% confidence intervals.ResultsA total of 1150 patients underwent colonoscopy and were included in the analysis. The mean age was 61.0 years (SD 8.3), 907 (78.9%) were male, and 843 (73.3%) were Caucasian. 756 (65.7%) patients were found to have colon polyps. A total of 2361 polyps were detected, removed, and retrieved: 1532 were adenomatous (52 villous, 9 HGD, 1 cancer) and 829 were non-adenomatous (575 hyperplastic, 156 no diagnostic abnormality, 98 others). The rates of advanced histological features in the different size categories are shown in the table. The overall rate of advanced histology was 0.5% in diminutive polyps, 1.5% in small polyps, and 0.8% in all polyps < 10mm.Tabled 10 - 5 mm (n = 1620)6 - 9 mm (n = 455)>= 1 cm (n = 286)TotalNon-neoplastic643 (39.7%) [37.3% −42.1%]134 (29.4%) [25.3% - 33.9%]52 (18.2%) [13.9% - 23.1%]829Neoplastic977 (60.3%) [57.9% - 62.7%]321 (70.5%) [66.1% - 74.7%]234 (81.8%) [76.8% - 86.1%]1532Tubular adenoma968 (59.7%) [57.3% - 62.1%]314 (69.0%) [64.5% - 73.2%]191 (66.8%) [61.0% - 72.2%]1473Adenoma with villous features8 (0.5%) [0.2% - 1.0%]7 (1.5%) [0.6% - 3.1%]37 (12.9%) [9.3% - 17.4%]52Adenoma with HGD1 (0.1%) [0% - 0.3%]08 (2.8%) [1.2% - 5.4%]9Cancer001 (0.3%) [0% - 1.9%]1Adenoma with any adv histology9 (0.5%) [0.2% - 1.0%]7 (1.5%) [0.6% - 3.1%]43 (15.0%) [11.1% - 19.7%]59 Open table in a new tab ConclusionThe prevalence of advanced histological features in colon polyps < 10mm is very low (<1%). Thus, accurate prediction of polyp histology real time during colonoscopy and then “resecting and discarding” polyps < 10mm can be a safe and viable strategy. BackgroundBased on the ability of advanced imaging techniques such as narrow band imaging to predict colon polyp histology in real time, it has been suggested that a “resect and discard” strategy can be employed for diminutive (≤ 5mm) polyps instead of submitting them for histopathological examination, resulting in significant cost savings. However, the absence of advanced histological features such as villous histology, high grade dysplasia (HGD), and/or cancer in small (6-9mm) polyps may allow for the ability to discard these polyps without histopathological examination as well. Based on the ability of advanced imaging techniques such as narrow band imaging to predict colon polyp histology in real time, it has been suggested that a “resect and discard” strategy can be employed for diminutive (≤ 5mm) polyps instead of submitting them for histopathological examination, resulting in significant cost savings. However, the absence of advanced histological features such as villous histology, high grade dysplasia (HGD), and/or cancer in small (6-9mm) polyps may allow for the ability to discard these polyps without histopathological examination as well. AimsTo determine the prevalence of advanced histological features in diminutive and small colon polyps. To determine the prevalence of advanced histological features in diminutive and small colon polyps. MethodsPatients undergoing either screening or surveillance colonoscopy at two tertiary referral centers were prospectively enrolled from November 2007 - October 2010 in one of three clinical trials investigating the impact of novel imaging techniques on polyp detection and/or polyp histology prediction. A centralized database was created to maintain all the data from these studies. The colonoscopies were performed by one of six experienced endoscopists. Following cecal intubation, the location, size, and morphology of each polyp detected during withdrawal was documented. Each polyp was then resected, placed in a unique specimen jar, and sent for histopathological evaluation. Patients in whom the cecum could not be intubated or bowel prep was inadequate were excluded. Polyps were classified as either neoplastic (adenomatous) or non-neoplastic (hyperplastic, no diagnostic abnormality, other benign histology). Polyps were also grouped by size: diminutive (0-5mm), small (6-9mm), and large (10mm or more). The rates of advanced histological features including villous histology, HGD, and cancer were calculated for each size category with 95% confidence intervals. Patients undergoing either screening or surveillance colonoscopy at two tertiary referral centers were prospectively enrolled from November 2007 - October 2010 in one of three clinical trials investigating the impact of novel imaging techniques on polyp detection and/or polyp histology prediction. A centralized database was created to maintain all the data from these studies. The colonoscopies were performed by one of six experienced endoscopists. Following cecal intubation, the location, size, and morphology of each polyp detected during withdrawal was documented. Each polyp was then resected, placed in a unique specimen jar, and sent for histopathological evaluation. Patients in whom the cecum could not be intubated or bowel prep was inadequate were excluded. Polyps were classified as either neoplastic (adenomatous) or non-neoplastic (hyperplastic, no diagnostic abnormality, other benign histology). Polyps were also grouped by size: diminutive (0-5mm), small (6-9mm), and large (10mm or more). The rates of advanced histological features including villous histology, HGD, and cancer were calculated for each size category with 95% confidence intervals. ResultsA total of 1150 patients underwent colonoscopy and were included in the analysis. The mean age was 61.0 years (SD 8.3), 907 (78.9%) were male, and 843 (73.3%) were Caucasian. 756 (65.7%) patients were found to have colon polyps. A total of 2361 polyps were detected, removed, and retrieved: 1532 were adenomatous (52 villous, 9 HGD, 1 cancer) and 829 were non-adenomatous (575 hyperplastic, 156 no diagnostic abnormality, 98 others). The rates of advanced histological features in the different size categories are shown in the table. The overall rate of advanced histology was 0.5% in diminutive polyps, 1.5% in small polyps, and 0.8% in all polyps < 10mm.Tabled 10 - 5 mm (n = 1620)6 - 9 mm (n = 455)>= 1 cm (n = 286)TotalNon-neoplastic643 (39.7%) [37.3% −42.1%]134 (29.4%) [25.3% - 33.9%]52 (18.2%) [13.9% - 23.1%]829Neoplastic977 (60.3%) [57.9% - 62.7%]321 (70.5%) [66.1% - 74.7%]234 (81.8%) [76.8% - 86.1%]1532Tubular adenoma968 (59.7%) [57.3% - 62.1%]314 (69.0%) [64.5% - 73.2%]191 (66.8%) [61.0% - 72.2%]1473Adenoma with villous features8 (0.5%) [0.2% - 1.0%]7 (1.5%) [0.6% - 3.1%]37 (12.9%) [9.3% - 17.4%]52Adenoma with HGD1 (0.1%) [0% - 0.3%]08 (2.8%) [1.2% - 5.4%]9Cancer001 (0.3%) [0% - 1.9%]1Adenoma with any adv histology9 (0.5%) [0.2% - 1.0%]7 (1.5%) [0.6% - 3.1%]43 (15.0%) [11.1% - 19.7%]59 Open table in a new tab A total of 1150 patients underwent colonoscopy and were included in the analysis. The mean age was 61.0 years (SD 8.3), 907 (78.9%) were male, and 843 (73.3%) were Caucasian. 756 (65.7%) patients were found to have colon polyps. A total of 2361 polyps were detected, removed, and retrieved: 1532 were adenomatous (52 villous, 9 HGD, 1 cancer) and 829 were non-adenomatous (575 hyperplastic, 156 no diagnostic abnormality, 98 others). The rates of advanced histological features in the different size categories are shown in the table. The overall rate of advanced histology was 0.5% in diminutive polyps, 1.5% in small polyps, and 0.8% in all polyps < 10mm. ConclusionThe prevalence of advanced histological features in colon polyps < 10mm is very low (<1%). Thus, accurate prediction of polyp histology real time during colonoscopy and then “resecting and discarding” polyps < 10mm can be a safe and viable strategy. The prevalence of advanced histological features in colon polyps < 10mm is very low (<1%). Thus, accurate prediction of polyp histology real time during colonoscopy and then “resecting and discarding” polyps < 10mm can be a safe and viable strategy." @default.
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• W1990297712 title "1099 Prevalence of Advanced Histological Features in Diminutive and Small Colon Polyps: Implications for the “Resect and Discard” Strategy During Colonoscopy" @default.
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