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Among patients with diminutive (1-5 mm) colonic polyps, multiplicity was a significant risk factor for advanced metachronous colonic neoplasia, while advanced histologic features alone were not, according to the results of a pooled analysis of data from 64,344 patients.
Metachronous advanced neoplasia affected similar proportions of patients with and without high-risk diminutive polyps (17.6% vs. 14.6%, respectively; relative risk, 1.13; 95% confidence interval, 0.79-1.61), reported Jasper L.A. Vleugels, MD, of the University of Amsterdam, together with his associates. However, patients with at least three nonadvanced (diminutive or small) adenomas were at significantly increased risk of metachronous advanced neoplasia, compared with low-risk patients (overall risk ratio, 2.12; 95% CI, 1.89-2.38), the investigators wrote in the February issue of Gastroenterology.
This multicenter study spanned 12 prospectively evaluated cohorts of patients in the United States and Europe. All patients underwent colonoscopy because of a positive fecal immunochemical test result or for the purpose of screening, surveillance, or evaluation of symptoms. The researchers defined low-risk patients as individuals with one or two diminutive or small nonadvanced adenomas. In contrast, “high-risk” patients had a polyp with advanced histology (at least a 25% villous component, high-grade dysplasia, or colonic rectal carcinoma), at least three diminutive (1-5 mm) or small (6-9 mm) nonadvanced adenomas, or an adenomatous or sessile serrated lesion measuring at least 10 mm.
Among more than 50,000 diminutive polyps in the dataset, the prevalence of advanced histologic features was 7.1% among patients who underwent colonoscopy because of a positive fecal immunochemical test and 1.5% among those who had a colonoscopy for other reasons (P = .04). However, statistically similar proportions of patients in each of these subgroups were classified as “high risk” because of advanced histology (0.8% and 0.4%, respectively) or multiplicity (3.8% and 3.0%, respectively). Because metachronous advanced neoplasia was detected in similar proportions of patients with and without diminutive polyps with advanced histologic features (17.6% vs. 14.6%, respectively), the presence of such features did not independently predict metachronous advanced neoplasia, either overall (relative risk, 1.13; 95% CI, 0.79-1.61), or in either subgroup.
“On the other hand, multiplicity of diminutive adenomas was associated with increased risk of metachronous advanced neoplasia,” the researchers wrote. Among these patients, nearly 24% of those in the fecal immunochemical subgroup developed metachronous advanced neoplasia, as did nearly 30% of those who had a colonoscopy for other reasons, yielding risk ratios of 2.45 (95% CI, 1.67-3.58) and 1.92 (95% CI, 1.68-2.20), respectively.
“While multiplicity has been described as a risk factor of metachronous advanced adenomas, we were surprised to find that even if all adenomas are diminutive, the risk was increased,” the investigators commented. Taken together, the findings “underline the importance of correctly classifying diminutive adenomatous lesions, preventing misclassification of patients with at least three adenomas to a low-risk status.”
Partial funding for this study came from PERIS and Fundción Científica de la Asociación Española contra el Cáncer. Dr. Vleugels reported having no conflicts of interest. Three coinvestigators disclosed ties to Fujifilm, Olympus, Norgine, Clinical Genomics, and Boston Scientific.
SOURCE: Vleugels J et al. Gastroenterology. 2018 Nov 2. doi: 10.1053/j.gastro.2018.10.050.
When to perform surveillance colonoscopy in patients previously diagnosed with colorectal neoplasms is one of the most significant questions facing experts creating guidelines for colorectal cancer (CRC) screening. This study by Vleugels et al. provides important information that should better inform this issue.
The authors pooled data from 12 different study cohorts of patients undergoing colonoscopy in either the United States or Europe. The cohorts included patients who underwent colonoscopy to follow up a positive fecal immunochemical test (FIT) or as a primary test for screening, surveillance, or symptom management. The authors found that diminutive adenomas (1-5 mm) rarely contained advanced histology (CRC, high-grade dysplasia, or more than 25% villous features) and that these lesions seldom defined patients regarding risk for metachronous neoplasms. They also found that high-risk patients defined by 1-2 diminutive adenomas with advanced histology were no more likely to develop metachronous advanced neoplasia (adenoma containing advanced histology, at least three diminutive or small nonadvanced adenomas, or an adenoma or sessile serrated lesion at least 10 mm) than were patients defined as low risk by their initial adenoma histology. Interestingly, multiplicity (more than three) of diminutive or small adenomas regardless of histology did predict a significantly increased risk of metachronous advanced neoplasia. These data support a resect-and-discard strategy (not sending the resected polyp to pathology) for diminutive polyps and polyp surveillance guidelines that employ less frequent colonoscopy to follow patients whose most significant finding at initial colonoscopy is a diminutive adenoma.
Future studies should examine the risk for metachronous neoplasms posed by diminutive adenoma within the milieu of other patient characteristics informing colorectal cancer risk.
Reid M. Ness, MD, MPH, AGAF, is an associate professor of medicine in the division compliance and a quality expert in the division of gastroenterology, hepatology, and nutrition in the department of medicine at Vanderbilt University Medical Center, Nashville, Tenn. He has no financial conflicts to disclose.
When to perform surveillance colonoscopy in patients previously diagnosed with colorectal neoplasms is one of the most significant questions facing experts creating guidelines for colorectal cancer (CRC) screening. This study by Vleugels et al. provides important information that should better inform this issue.
The authors pooled data from 12 different study cohorts of patients undergoing colonoscopy in either the United States or Europe. The cohorts included patients who underwent colonoscopy to follow up a positive fecal immunochemical test (FIT) or as a primary test for screening, surveillance, or symptom management. The authors found that diminutive adenomas (1-5 mm) rarely contained advanced histology (CRC, high-grade dysplasia, or more than 25% villous features) and that these lesions seldom defined patients regarding risk for metachronous neoplasms. They also found that high-risk patients defined by 1-2 diminutive adenomas with advanced histology were no more likely to develop metachronous advanced neoplasia (adenoma containing advanced histology, at least three diminutive or small nonadvanced adenomas, or an adenoma or sessile serrated lesion at least 10 mm) than were patients defined as low risk by their initial adenoma histology. Interestingly, multiplicity (more than three) of diminutive or small adenomas regardless of histology did predict a significantly increased risk of metachronous advanced neoplasia. These data support a resect-and-discard strategy (not sending the resected polyp to pathology) for diminutive polyps and polyp surveillance guidelines that employ less frequent colonoscopy to follow patients whose most significant finding at initial colonoscopy is a diminutive adenoma.
Future studies should examine the risk for metachronous neoplasms posed by diminutive adenoma within the milieu of other patient characteristics informing colorectal cancer risk.
Reid M. Ness, MD, MPH, AGAF, is an associate professor of medicine in the division compliance and a quality expert in the division of gastroenterology, hepatology, and nutrition in the department of medicine at Vanderbilt University Medical Center, Nashville, Tenn. He has no financial conflicts to disclose.
When to perform surveillance colonoscopy in patients previously diagnosed with colorectal neoplasms is one of the most significant questions facing experts creating guidelines for colorectal cancer (CRC) screening. This study by Vleugels et al. provides important information that should better inform this issue.
The authors pooled data from 12 different study cohorts of patients undergoing colonoscopy in either the United States or Europe. The cohorts included patients who underwent colonoscopy to follow up a positive fecal immunochemical test (FIT) or as a primary test for screening, surveillance, or symptom management. The authors found that diminutive adenomas (1-5 mm) rarely contained advanced histology (CRC, high-grade dysplasia, or more than 25% villous features) and that these lesions seldom defined patients regarding risk for metachronous neoplasms. They also found that high-risk patients defined by 1-2 diminutive adenomas with advanced histology were no more likely to develop metachronous advanced neoplasia (adenoma containing advanced histology, at least three diminutive or small nonadvanced adenomas, or an adenoma or sessile serrated lesion at least 10 mm) than were patients defined as low risk by their initial adenoma histology. Interestingly, multiplicity (more than three) of diminutive or small adenomas regardless of histology did predict a significantly increased risk of metachronous advanced neoplasia. These data support a resect-and-discard strategy (not sending the resected polyp to pathology) for diminutive polyps and polyp surveillance guidelines that employ less frequent colonoscopy to follow patients whose most significant finding at initial colonoscopy is a diminutive adenoma.
Future studies should examine the risk for metachronous neoplasms posed by diminutive adenoma within the milieu of other patient characteristics informing colorectal cancer risk.
Reid M. Ness, MD, MPH, AGAF, is an associate professor of medicine in the division compliance and a quality expert in the division of gastroenterology, hepatology, and nutrition in the department of medicine at Vanderbilt University Medical Center, Nashville, Tenn. He has no financial conflicts to disclose.
Among patients with diminutive (1-5 mm) colonic polyps, multiplicity was a significant risk factor for advanced metachronous colonic neoplasia, while advanced histologic features alone were not, according to the results of a pooled analysis of data from 64,344 patients.
Metachronous advanced neoplasia affected similar proportions of patients with and without high-risk diminutive polyps (17.6% vs. 14.6%, respectively; relative risk, 1.13; 95% confidence interval, 0.79-1.61), reported Jasper L.A. Vleugels, MD, of the University of Amsterdam, together with his associates. However, patients with at least three nonadvanced (diminutive or small) adenomas were at significantly increased risk of metachronous advanced neoplasia, compared with low-risk patients (overall risk ratio, 2.12; 95% CI, 1.89-2.38), the investigators wrote in the February issue of Gastroenterology.
This multicenter study spanned 12 prospectively evaluated cohorts of patients in the United States and Europe. All patients underwent colonoscopy because of a positive fecal immunochemical test result or for the purpose of screening, surveillance, or evaluation of symptoms. The researchers defined low-risk patients as individuals with one or two diminutive or small nonadvanced adenomas. In contrast, “high-risk” patients had a polyp with advanced histology (at least a 25% villous component, high-grade dysplasia, or colonic rectal carcinoma), at least three diminutive (1-5 mm) or small (6-9 mm) nonadvanced adenomas, or an adenomatous or sessile serrated lesion measuring at least 10 mm.
Among more than 50,000 diminutive polyps in the dataset, the prevalence of advanced histologic features was 7.1% among patients who underwent colonoscopy because of a positive fecal immunochemical test and 1.5% among those who had a colonoscopy for other reasons (P = .04). However, statistically similar proportions of patients in each of these subgroups were classified as “high risk” because of advanced histology (0.8% and 0.4%, respectively) or multiplicity (3.8% and 3.0%, respectively). Because metachronous advanced neoplasia was detected in similar proportions of patients with and without diminutive polyps with advanced histologic features (17.6% vs. 14.6%, respectively), the presence of such features did not independently predict metachronous advanced neoplasia, either overall (relative risk, 1.13; 95% CI, 0.79-1.61), or in either subgroup.
“On the other hand, multiplicity of diminutive adenomas was associated with increased risk of metachronous advanced neoplasia,” the researchers wrote. Among these patients, nearly 24% of those in the fecal immunochemical subgroup developed metachronous advanced neoplasia, as did nearly 30% of those who had a colonoscopy for other reasons, yielding risk ratios of 2.45 (95% CI, 1.67-3.58) and 1.92 (95% CI, 1.68-2.20), respectively.
“While multiplicity has been described as a risk factor of metachronous advanced adenomas, we were surprised to find that even if all adenomas are diminutive, the risk was increased,” the investigators commented. Taken together, the findings “underline the importance of correctly classifying diminutive adenomatous lesions, preventing misclassification of patients with at least three adenomas to a low-risk status.”
Partial funding for this study came from PERIS and Fundción Científica de la Asociación Española contra el Cáncer. Dr. Vleugels reported having no conflicts of interest. Three coinvestigators disclosed ties to Fujifilm, Olympus, Norgine, Clinical Genomics, and Boston Scientific.
SOURCE: Vleugels J et al. Gastroenterology. 2018 Nov 2. doi: 10.1053/j.gastro.2018.10.050.
Among patients with diminutive (1-5 mm) colonic polyps, multiplicity was a significant risk factor for advanced metachronous colonic neoplasia, while advanced histologic features alone were not, according to the results of a pooled analysis of data from 64,344 patients.
Metachronous advanced neoplasia affected similar proportions of patients with and without high-risk diminutive polyps (17.6% vs. 14.6%, respectively; relative risk, 1.13; 95% confidence interval, 0.79-1.61), reported Jasper L.A. Vleugels, MD, of the University of Amsterdam, together with his associates. However, patients with at least three nonadvanced (diminutive or small) adenomas were at significantly increased risk of metachronous advanced neoplasia, compared with low-risk patients (overall risk ratio, 2.12; 95% CI, 1.89-2.38), the investigators wrote in the February issue of Gastroenterology.
This multicenter study spanned 12 prospectively evaluated cohorts of patients in the United States and Europe. All patients underwent colonoscopy because of a positive fecal immunochemical test result or for the purpose of screening, surveillance, or evaluation of symptoms. The researchers defined low-risk patients as individuals with one or two diminutive or small nonadvanced adenomas. In contrast, “high-risk” patients had a polyp with advanced histology (at least a 25% villous component, high-grade dysplasia, or colonic rectal carcinoma), at least three diminutive (1-5 mm) or small (6-9 mm) nonadvanced adenomas, or an adenomatous or sessile serrated lesion measuring at least 10 mm.
Among more than 50,000 diminutive polyps in the dataset, the prevalence of advanced histologic features was 7.1% among patients who underwent colonoscopy because of a positive fecal immunochemical test and 1.5% among those who had a colonoscopy for other reasons (P = .04). However, statistically similar proportions of patients in each of these subgroups were classified as “high risk” because of advanced histology (0.8% and 0.4%, respectively) or multiplicity (3.8% and 3.0%, respectively). Because metachronous advanced neoplasia was detected in similar proportions of patients with and without diminutive polyps with advanced histologic features (17.6% vs. 14.6%, respectively), the presence of such features did not independently predict metachronous advanced neoplasia, either overall (relative risk, 1.13; 95% CI, 0.79-1.61), or in either subgroup.
“On the other hand, multiplicity of diminutive adenomas was associated with increased risk of metachronous advanced neoplasia,” the researchers wrote. Among these patients, nearly 24% of those in the fecal immunochemical subgroup developed metachronous advanced neoplasia, as did nearly 30% of those who had a colonoscopy for other reasons, yielding risk ratios of 2.45 (95% CI, 1.67-3.58) and 1.92 (95% CI, 1.68-2.20), respectively.
“While multiplicity has been described as a risk factor of metachronous advanced adenomas, we were surprised to find that even if all adenomas are diminutive, the risk was increased,” the investigators commented. Taken together, the findings “underline the importance of correctly classifying diminutive adenomatous lesions, preventing misclassification of patients with at least three adenomas to a low-risk status.”
Partial funding for this study came from PERIS and Fundción Científica de la Asociación Española contra el Cáncer. Dr. Vleugels reported having no conflicts of interest. Three coinvestigators disclosed ties to Fujifilm, Olympus, Norgine, Clinical Genomics, and Boston Scientific.
SOURCE: Vleugels J et al. Gastroenterology. 2018 Nov 2. doi: 10.1053/j.gastro.2018.10.050.
FROM GASTROENTEROLOGY
Key clinical point: Among patients with diminutive polyps, multiplicity was a significant risk factor for advanced metachronous colonic neoplasia, while high-risk histologic features alone were not.
Major finding: Metachronous advanced neoplasia was found in similar proportions of patients with and without high-risk diminutive polyps (17.6% vs. 14.6%, respectively; relative risk, 1.13; 95% confidence interval, 0.79-1.61). Having at least three nonadvanced adenomas was, however, a significant correlate of metachronous advanced neoplasia (risk ratio, 2.12; 95% CI, 1.89-2.38).
Study details: Pooled analysis of data from 12 international cohorts (64,344 patients).
Disclosures: Partial funding came from PERIS and Fundación Científica de la Asociación Española contra el Cáncer. Dr. Vleugels reported having no conflicts of interest. Three coinvestigators disclosed ties to Fujifilm, Olympus, Norgine, Clinical Genomics, and Boston Scientific.
Source: Vleugels J et al. Gastroenterology. 2018 Nov 2. doi: 10.1053/j.gastro.2018.10.050.