Abstract
Significance of the small colonic polyp is unclear and its removal is frequently determined by the proceduralist's clinical impression. Our aims were to determine if clinical discernment is accurate, and the likelihood that lesions < 10 mm are histologically advanced. We prospectively collected 1988 lesions from 854 subjects (2215 consecutive colonoscopies). Lesion size, location, patient age, sex and the colonoscopist's clinical impression was recorded. Clinical assessment for neoplasia had a sensitivity of 87.4%, specificity of 65.0%, positive predictive value of 76.0% and negative predictive value of 80.2%, resulting in an accuracy of 73.4%. Factors predictive of correct clinical impression were polyp size, location in the rectum and being pedunculated, but not the patient's age, sex or the endoscopist's experience. Of the 1434 lesions < or = 5 mm in size, 44.5% were neoplastic and 3.5% were histologically advanced. Of the 266 lesions 6-9 mm, 79.3% were neoplastic, 19.9% were histologically advanced, five demonstrated high-grade dysplasia and three were malignant. Only two patients with an adenocarcinoma or high-grade dysplasia in a polyp <10 mm had a lesion > or =10 mm elsewhere in the colon. Of the 288 lesions > or =10 mm ...Continue Reading
References
Mar 15, 1992·The New England Journal of Medicine·J V SelbyN S Weiss
Jan 1, 1991·Surgical Endoscopy·J M CosgroveI B Margolis
Mar 1, 1991·Gastrointestinal Endoscopy·L J HixsonH S Garewal
Nov 21, 1990·Journal of the National Cancer Institute·L J HixsonH Garewal
Nov 1, 1995·Seminars in Surgical Oncology·J I Allen
Sep 1, 1996·Gut·B HofstadM Osnes
Apr 1, 2000·Gastrointestinal Endoscopy·K C NoshirwaniG J Beck
May 29, 2001·Radiology·J YeeK R McQuaid
Oct 10, 2001·Surgical Endoscopy·G A Smith, P J O'Dwyer
Jan 5, 2002·The European Journal of Surgery = Acta Chirurgica·A J Aldridge, J N Simson
Jun 4, 2002·The Medical Journal of Australia·Cameron F E PlatellJohn K Olynyk
Jun 12, 2003·British Journal of Cancer·C-D ChenT H-H Chen
Sep 2, 2003·Gastroenterology·C Daniel JohnsonUNKNOWN American College of Radiology Imaging Network A6656
Dec 6, 2003·The New England Journal of Medicine·Perry J PickhardtWilliam R Schindler
Mar 3, 2004·Diseases of the Colon and Rectum·James M Church
Apr 15, 2004·JAMA : the Journal of the American Medical Association·Peter B CottonHarold Butler
Citations
Oct 26, 2007·Pharmaceutical Research·Abdel Kareem AzabAbraham Rubinstein
Nov 10, 2012·World Journal of Gastroenterology : WJG·Johanna L ChanZiad F Gellad
Dec 25, 2012·Gastrointestinal Endoscopy·Hank S WangBrennan M R Spiegel
Jun 14, 2015·Gastrointestinal Endoscopy·Douglas K RexKrishna C Vemulapalli