Diminutive Polyps With Advanced Histologic Features Do Not Increase Risk for Metachronous Advanced Colon Neoplasia

Vleugels, Jasper L A; Hassan, Cesare; Senore, Carlo; Cassoni, Paola; Baron, John A.; Rex, Douglas K.; Ponugoti, Prasanna L.; Pellisé, María; Parejo, Sofía; Bessa, Xavier; Arnau‐Collell, Coral; Bugajski, Marek; Wieszczy, Paulina; Kuipers, Ernst J.; Melson, Joshua; Karen, H. Lu; Holman, Rebecca; Dekker, Evelien; Pohl, Heiko

doi:10.1053/j.gastro.2018.10.050

Cited by 45 publications

(37 citation statements)

References 37 publications

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“…So far, data have been obtained predominantly in well controlled study settings, where endoscopists were additionally trained in recognition and characterization of lesions and had been instructed on the systematic use of image-enhancement. Baseline characteristics of the diminutive lesions in our study are within the range of variation reported in recent ▶ ▶ literature, and are therefore representative for national and global data [19,20]. When evaluating published data from additionally trained endoscopists, the NPV for optical diagnosis of adenomas in the rectosigmoid varies from 82.0 % to 94.7 % in studies where narrow-band imaging (NBI) was used [21].…”

Section: E260supporting

confidence: 63%

Optical diagnosis of diminutive polyps in the Dutch Bowel Cancer Screening Program: Are we ready to start?

et al. 2020

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w.vandewetering@maastrichtuniversity.nl ABSTR AC T Background and study aims Implementation of optical diagnosis of diminutive polyps may potentially increase the efficacy and cost-effectiveness of colonoscopies. To adopt such strategy in clinical practice, the Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) thresholds provide the basis to be met: ≥ 90 % negative predictive value (NPV) for diagnosis of adenomatous histology and ≥ 90 % agreement on surveillance intervals. We evaluated this within the Dutch Bowel Cancer Screening Program (BCSP). Patients and methods Endoscopic and histological datawere collected from participants of the national bowel cancer screening program with an unfavorable fecal immunochemical test referred for colonoscopy between February 2014 and August 2015 at four endoscopy centers. The "resect and discard" scenario was studied, resecting diminutive polyps without histological evaluation. Agreement between optical diagnosis and histological diagnosis was measured for surveillance intervals according to Dutch, European and American post-polypectomy surveillance guideline.Results Fifteen certified endoscopists participated in this study and included 3028 diminutive polyps. In 2,330 patients both optical and histological diagnosis were available. Optical diagnosis of diminutive polyps showed NPV of 84 % (95 % CI 80-87) for adenomatous histology in the rectosigmoid. Applying the 'resect and discard' strategy resulted in 90.6 %, 91.2 %, 90.9 % agreement on surveillance intervals for the Dutch, European and American guideline respectively.Conclusion Our data representing current clinical practice in the Dutch BCSP practice on optical diagnosis of diminutive polyps showed that accuracy of predicting histology remains challenging, and risk of incorrect optical diagnosis is still significant. Therefore, it is too early to safely implement these strategies.

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Section: E260supporting

confidence: 63%

Optical diagnosis of diminutive polyps in the Dutch Bowel Cancer Screening Program: Are we ready to start?

et al. 2020

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“…Potentially this obviates the need for pathological review of diminutive lesions, which could simply be counted to determine whether surveillance was required or not. Such lesions ≤5 mm have a low risk of containing advanced pathology, and an exceptionally low risk of containing cancer, 5.6% and 0.07%, respectively 158. Diminutive SSLs also have a very low risk of containing dysplasia (≤5 mm, 0%; 6–9 mm, 6.0%; ≥10 mm, 13.6%) 159.…”

Section: Implementation Of Guidelinesmentioning

confidence: 99%

British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines

Rutter

East

Rees

et al. 2019

Gut

262

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These consensus guidelines were jointly commissioned by the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE). They provide an evidence-based framework for the use of surveillance colonoscopy and non-colonoscopic colorectal imaging in people aged 18 years and over. They are the first guidelines that take into account the introduction of national bowel cancer screening. For the first time, they also incorporate surveillance of patients following resection of either adenomatous or serrated polyps and also post-colorectal cancer resection. They are primarily aimed at healthcare professionals, and aim to address:Which patients should commence surveillance post-polypectomy and post-cancer resection?What is the appropriate surveillance interval?When can surveillance be stopped?two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); orfive or more premalignant polypsThe Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument provided a methodological framework for the guidelines. The BSG’s guideline development process was used, which is National Institute for Health and Care Excellence (NICE) compliant.two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); orfive or more premalignant polypsThe key recommendations are that the high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise either:two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); orfive or more premalignant polypsThis cohort should undergo a one-off surveillance colonoscopy at 3 years. Post-CRC resection patients should undergo a 1 year clearance colonoscopy, then a surveillance colonoscopy after 3 more years.

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“…However, long-term studies may be limited by low numbers of CRC as well as the analytic challenge of accounting for the impact of surveillance examinations when comparing the risk for individuals with low-risk adenomas with those with no adenomas 6,7 . Although preventing CRC is the primary aim of CRC screening and surveillance through colonoscopy, evidence to inform guidelines is often based on the risk of metachronous advanced adenomas, which are more commonly detected and are often used as a surrogate outcome for CRC [9][10][11][12] . Thus, data examining metachronous risk for advanced adenomas are useful in investigating clinical management issues for individuals with index adenomas ≤1 cm.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Association of small versus diminutive adenomas and the risk for metachronous advanced adenomas: data from the New Hampshire Colonoscopy Registry

Anderson

Rex

Robinson³

et al. 2019

Gastrointestinal Endoscopy

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Background and Aims Limited data are available to investigate the impact of index adenoma size on the risk of metachronous advanced adenomas. Our goal was to examine the impact of having small (5-9 mm) versus diminutive (<5 mm) adenomas on the future risk of advanced adenomas within the categories for polyps <1cm currently used in the United States: 1 to 2 and 3 or more tubular adenomas. Methods We included data from individuals participating in the statewide, population-based New Hampshire Colonoscopy Registry (NHCR). Groups were based on index findings: (1) 1 to 2 adenomas <5 mm (both diminutive), (2) 1 to 2 adenomas <1 cm (one or both small), (3) 3 to 10 adenomas <5 mm (all diminutive), (4) 3 to 10 adenomas <1 cm (one or more small), and (5) advanced adenomas (AA). AAs were defined as adenomas >1cm or those with villous elements or high-grade dysplasia and colorectal cancer (CRC). Outcomes were the absolute and adjusted risk of metachronous advanced adenomas. Covariates included age, sex, body mass index, family history of CRC, lifestyle factors, presence of serrated polyps, and time since the index examination. Results After adjusting for the covariates, we observed that having 1 to 2 adenomas with at least one 5 to 9 mm adenoma (adjusted odds ratio [AOR], 1.54; 95% CI, 1.12-2.11), 3 to 10 diminutive adenomas (AOR, 1.75; 95% CI, 1.03-2.95), 3 to 10 adenomas <1 cm (1 or more small) (AOR, 2.14; 95% CI, 1.39-3.29) or advanced adenomas (AOR, 2.77; 95% CI, 2.05-3.74) were associated with an increased risk for metachronous AA as compared with having 1 to 2 diminutive adenomas. A further stratification of Group 2 observed that those with exactly 2 small adenomas had an absolute risk of future AA of 7.6% (11/144) (95% CI, 4.3%-13.2%), higher than the absolute risk in the 1 to 2 diminutive polyp group, and similar to the risk for 3 to 10 adenomas 8.2 (95% CI, 5.4-11.9). Conclusions For individuals with 1 to 2 adenomas <1 cm, having at least 1 small adenoma increased the metachronous risk of AA compared to having only diminutive adenomas. Furthermore, the subset with 2 small adenomas had a risk of future AA similar to the risk for 3 to 10 adenomas. These data suggest that individuals with at least 1 small adenoma may be at higher risk for future advanced adenomas and thus require closer follow-up than those with only diminutive adenomas. These data may be valuable to guideline committees for the creation of future surveillance recommendations. Background Colorectal cancer (CRC) is the second most common cause of death from cancer in the United States 1 , despite being a preventable disease. The key to prevention lies in delivery of appropriate and timely screening and surveillance colonoscopies, and development of appropriate guideline recommendations for prevention requires evidence to inform those guidelines. Colonoscopy is the most common form of CRC screening in the United States, and surveillance colonoscopies, which are follow-up colonoscopies in individuals found to have

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Diminutive Polyps With Advanced Histologic Features Do Not Increase Risk for Metachronous Advanced Colon Neoplasia

Cited by 45 publications

References 37 publications

Optical diagnosis of diminutive polyps in the Dutch Bowel Cancer Screening Program: Are we ready to start?

Optical diagnosis of diminutive polyps in the Dutch Bowel Cancer Screening Program: Are we ready to start?

British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines

Association of small versus diminutive adenomas and the risk for metachronous advanced adenomas: data from the New Hampshire Colonoscopy Registry

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