Abstract:The prevalence of cancer in small and diminutive polyps is relevant to "resect and discard" and CT colonography reporting recommendations.We evaluated a prospectively collected colonoscopy polyp database to identify polyps < 10 mm and those with cancer or advanced histology (high-grade dysplasia or villous elements)Of 32,790 colonoscopies, 15,558 colonoscopies detected 42,630 polyps < 10 mm in size. A total of 4,790 lesions were excluded as they were not conventional adenomas or serrated class lesions.There we… Show more
“…Villous elements and invasive cancer are associated with increasing size of adenomas. Invasive cancer in adenomas ≤5 mm in size is extremely rare, and the prevalence remains well below 1% in adenomas 6 to 9 mm in size ( 36 ). Recent colonoscopic studies have identifi ed lower prevalence rates of cancer in polyps <1 cm in size compared with early studies, probably because improvements in colonoscope technology and performance have led to routine detection of an array of small, fl at, low-volume adenomas ( 36 ).…”
Section: Screening Targetsmentioning
confidence: 99%
“…Invasive cancer in adenomas ≤5 mm in size is extremely rare, and the prevalence remains well below 1% in adenomas 6 to 9 mm in size ( 36 ). Recent colonoscopic studies have identifi ed lower prevalence rates of cancer in polyps <1 cm in size compared with early studies, probably because improvements in colonoscope technology and performance have led to routine detection of an array of small, fl at, low-volume adenomas ( 36 ). Interobserver agreement in diff erentiation of high-vs. low-grade dysplasia by pathologists and tubular vs. tubulovillous histology is poor to moderate, particularly in adenomas <1 cm in size ( 37 ).…”
“…Villous elements and invasive cancer are associated with increasing size of adenomas. Invasive cancer in adenomas ≤5 mm in size is extremely rare, and the prevalence remains well below 1% in adenomas 6 to 9 mm in size ( 36 ). Recent colonoscopic studies have identifi ed lower prevalence rates of cancer in polyps <1 cm in size compared with early studies, probably because improvements in colonoscope technology and performance have led to routine detection of an array of small, fl at, low-volume adenomas ( 36 ).…”
Section: Screening Targetsmentioning
confidence: 99%
“…Invasive cancer in adenomas ≤5 mm in size is extremely rare, and the prevalence remains well below 1% in adenomas 6 to 9 mm in size ( 36 ). Recent colonoscopic studies have identifi ed lower prevalence rates of cancer in polyps <1 cm in size compared with early studies, probably because improvements in colonoscope technology and performance have led to routine detection of an array of small, fl at, low-volume adenomas ( 36 ). Interobserver agreement in diff erentiation of high-vs. low-grade dysplasia by pathologists and tubular vs. tubulovillous histology is poor to moderate, particularly in adenomas <1 cm in size ( 37 ).…”
“…Diminutive colorectal polyps are the most commonly found polyps during colonoscopy 6 and rarely harbor advanced histology or malignancy. 7 If diminutive polyp histology can be determined in real time, polyps confidently diagnosed as adenomas can be resected and discarded, and non-neoplastic polyps in the rectosigmoid colon can be left in place, leading to enormous cost savings. 8,9 Endoscopists can always send polyps for pathology if the optical diagnosis is not clear.…”
“…10, 11, 12, 13, 14, 15, 16, 17 A recent and largest cross-sectional study to date included >42,000 polypectomies of up to 9 mm polyps did not find any cancer in any of these diminutive or small polyps. 18 Resection of diminutive polyps increases patient risk and cost, yet the benefit on cancer prevention by removing diminutive polyps is questionable. 15, 19, 20 However, histopathology evaluation of diminutive polyps remains important because presence of adenoma may determine low- or high-risk status of the patient and affect the colonoscopy surveillance interval.…”
Detection and complete removal of precancerous neoplastic polyps are central to effective colorectal cancer screening. The prevalence of neoplastic polyps in the screening population in the United States is likely >50%. However, most persons with neoplastic polyps are never destined to develop cancer, and do not benefit for finding and removing polyps, and may only be harmed by the procedure. Further 70–80% of polyps are diminutive (≤5 mm) and such polyps almost never contain cancer. Given the questionable benefit, the high-cost and the potential risk changing our approach to the management of diminutive polyps is currently debated. Deemphasizing diminutive polyps and shifting our efforts to detection and complete removal of larger and higher-risk polyps deserves discussion and study. This article explores three controversies, and emerging concepts related to endoscopic polyp resection. First, we discuss challenges of optical resect-and-discard strategy and possible alternatives. Second, we review recent studies that support the use of cold snare resection for ≥5 mm polyps. Thirdly, we examine current evidence for prophylactic clipping after resection of large polyps.
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