Prognostic significance of high‐grade dysplasia in colorectal adenomas

Abstract

Aim Colonoscopy to detect and remove polyps has contributed to a reduction in colorectal carcinoma. Three‐year follow up is recommended for patients considered to be at high risk (at least three adenomas, adenoma ≥ 1 cm, villous or high‐grade features). Our study focused on patients diagnosed with high‐grade dysplasia with regard to initial management and follow up. Method A search of patients who had had endoscopic removal of a high‐grade adenoma was carried out. Patients with the following were excluded: follow up of < 1 year, polyposis syndromes, prior colon cancer and a diagnosis of adenocarcinoma within 6 months following initial diagnosis. Results Eighty‐three patients treated between 1999 and 2007 for high‐grade dysplasia (HGD) in a colorectal adenoma were identified. Over a median follow‐up period of 4 years, 53 (64%) developed further adenomatous polyps. Among these, 7% had an adenoma with HGD or an adenocarcinoma. In all these patients, the initial high‐grade adenoma was > 1 cm in diameter. Initial follow‐up colonoscopy was performed on average 7 months following the initial diagnosis. Ten per cent of patients underwent prophylactic segmental resection, and 6% received argon laser therapy. Conclusion The study demonstrates that patients who have a colorectal adenoma > 1 cm with HGD may be at high risk of developing further adenomas with HGD or carcinoma. Close follow up is warranted.

Altered plasma levels of decanoic acid in colorectal cancer as a new diagnostic biomarker

“…The HGDA patients, who were at very high risk of colorectal cancer, presented comparable levels of decanoic acid to the CRC patients. Moreover, even though such patients usually undergo endoscopic removal of the adenoma in order to reduce tumor progression, they remain at high risk of developing further high-grade dysplasia adenoma or carcinoma [28].…”

Right-Sided Adenomas of the Colon: A Risk Factor For High-Grade Dysplasia or Invasive Cancer

“…Just over 1% of adenomatous polyps <1 cm are malignant, whereas up to 40% of adenomas >2 cm are malignant 9 . Also in one study demonstrated that patients who have a colorectal adenoma > 1 cm with HGD may be at high risk of developing further adenomas with HGD or carcinoma 10 . In a recent study the authors showed that the factors that are associated most strongly with risk of advanced neoplasia are patient age and the number and size of prior adenomas 11 .…”

A novel method for screening colorectal cancer by infrared spectroscopy of peripheral blood mononuclear cells and plasma

“…Median size of the lowgrade adenomatous polyps (benign group) was 3.5 mm (SD 17.6, range 2-50 mm). Although it is common to define polyps greater than 10 mm as advanced adenoma together with high-grade dysplasia (HGD) polyps, only patients with HGD (n = 7) were included in the CRC group because these polyps have the biological characteristics of premalignant rather than benign tumors [17]. Median size of the high-grade adenomatous polyps was 22.5 mm (SD 5.3, range 18-30 mm).…”