Endoscopic prediction of advanced histology in diminutive and small colorectal polyps.
Adenomatous Polyps
/ pathology
Adolescent
Adult
Aged
Aged, 80 and over
Colectomy
Colonic Polyps
/ pathology
Colonoscopy
Colorectal Neoplasms
/ pathology
Female
Humans
Japan
Male
Middle Aged
Narrow Band Imaging
Predictive Value of Tests
Reproducibility of Results
Retrospective Studies
Tertiary Care Centers
Tumor Burden
Young Adult
advanced histology
colonic polyps
colonoscopy
narrow-band imaging
optical diagnosis
Journal
Journal of gastroenterology and hepatology
ISSN: 1440-1746
Titre abrégé: J Gastroenterol Hepatol
Pays: Australia
ID NLM: 8607909
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
10
01
2018
revised:
15
07
2018
accepted:
20
07
2018
pubmed:
3
8
2018
medline:
31
7
2019
entrez:
3
8
2018
Statut:
ppublish
Résumé
Most polyps detected during colonoscopies are diminutive or small, and they rarely have advanced histology. Real-time prediction of advanced histology would help clinicians to assess the need for pathological evaluation. Here, we investigated endoscopic predictors of advanced histology in diminutive and small polyps. Consecutive patients with adenomatous polyps (<10 mm) removed endoscopically from January 2013 to December 2014 at a single tertiary cancer center were eligible for inclusion. Two endoscopists reviewed all endoscopic images to identify significant findings associated with advanced histology using multivariate models. The sensitivity, specificity, and negative predictive value of the identified endoscopic predictors for advanced histology were calculated. Of 6170 polyps (4746 diminutive) removed from 2611 patients, 320 (5.2%) showed advanced histology, including five submucosal invasive cancers. In multivariate analysis, advanced histology was significantly associated with the following: loss of lobulation (odds ratio [OR] 61.7; 95% confidence interval [95% CI]: 19.1-199.0); heterogeneity in mucosal patterns (OR 29.0; 95% CI: 14.6-57.3); non-polypoid growth (OR 15.7; 95% CI: 4.4-55.5); white spots (OR 13.5; 95% CI: 7.8-23.5); and surface redness (OR 6.6; 95% CI: 3.0-14.5); and irregular capillary pattern (OR 4.8; 95% CI: 2.5-9.1). These significant predictors successfully predicted all submucosal invasive cancers as advanced histology. The sensitivity, specificity, and negative predictive values were 37.2%, 97.8%, and 96.6%. We identified six endoscopic predictors for advanced histology in diminutive or small colon polyps. Diminutive and small polyps lacking these predictors would not be considered to have advanced histology.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
Most polyps detected during colonoscopies are diminutive or small, and they rarely have advanced histology. Real-time prediction of advanced histology would help clinicians to assess the need for pathological evaluation. Here, we investigated endoscopic predictors of advanced histology in diminutive and small polyps.
METHODS
METHODS
Consecutive patients with adenomatous polyps (<10 mm) removed endoscopically from January 2013 to December 2014 at a single tertiary cancer center were eligible for inclusion. Two endoscopists reviewed all endoscopic images to identify significant findings associated with advanced histology using multivariate models. The sensitivity, specificity, and negative predictive value of the identified endoscopic predictors for advanced histology were calculated.
RESULTS
RESULTS
Of 6170 polyps (4746 diminutive) removed from 2611 patients, 320 (5.2%) showed advanced histology, including five submucosal invasive cancers. In multivariate analysis, advanced histology was significantly associated with the following: loss of lobulation (odds ratio [OR] 61.7; 95% confidence interval [95% CI]: 19.1-199.0); heterogeneity in mucosal patterns (OR 29.0; 95% CI: 14.6-57.3); non-polypoid growth (OR 15.7; 95% CI: 4.4-55.5); white spots (OR 13.5; 95% CI: 7.8-23.5); and surface redness (OR 6.6; 95% CI: 3.0-14.5); and irregular capillary pattern (OR 4.8; 95% CI: 2.5-9.1). These significant predictors successfully predicted all submucosal invasive cancers as advanced histology. The sensitivity, specificity, and negative predictive values were 37.2%, 97.8%, and 96.6%.
CONCLUSIONS
CONCLUSIONS
We identified six endoscopic predictors for advanced histology in diminutive or small colon polyps. Diminutive and small polyps lacking these predictors would not be considered to have advanced histology.
Types de publication
Journal Article
Langues
eng
Pagination
397-403Informations de copyright
© 2018 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.