Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography.
Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography.
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DOI：
10.1053/j.gastro.2008.06.083
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发表时间：
2008-10
期刊：
影响因子：
29.4
通讯作者：
Eisen G
中科院分区：
文献类型：
--
作者：
Lieberman D;Moravec M;Holub J;Michaels L;Eisen G
结直肠癌(CRC)筛查与诊断成像可以发现息肉。对最大息肉小于10 mm的患者的处理是不确定的。这项研究的主要目的是确定接受结直肠癌筛查的最大息肉小于或等于9 mm的患者的晚期组织学比率。研究对象包括2005年期间在17个实习地点接受结肠镜检查筛查的所有无症状成年人，这些实习地点向临床结果研究计划储存库提供结肠镜检查和病理报告。根据最大息肉的大小对患者进行分类。高级组织学定义为具有绒毛或锯齿状组织学特征的腺瘤、高度不典型增生或浸润性癌。采用皮尔逊卡方检验和费舍尔精确检验确定晚期组织学的危险因素。13,992名无症状的患者接受了结肠镜检查；6360名患者(45%)有息肉，5977名(94%)有完整的组织学检查。1~5 mm组为1.7%，6~9 mm组为6.6%，>10 mm组为30.6%，肿瘤组为72.1%。在6-9 mm组(p=0.04)和大于10 mm组(p=0.002)中，远端位置与组织学进展有关。根据目前的指导方针，每15名最大息肉为6至9毫米的无症状患者中就有一人具有晚期组织学，并将在3年内接受监测。由于组织学对这一决定是必要的，这些患者中的大多数都应该接受结肠镜检查。进一步的研究应该确定最大息肉为1-5 mm的患者是否可以安全地随访，而不需要切除息肉。
Colorectal cancer (CRC) screening with diagnostic imaging can detect polyps. The management of patients whose largest polyp is less than 10mm is uncertain. The primary aim of this study was to determine rates of advanced histology in patients undergoing CRC screening whose largest polyp is 9mm or less. Subjects include all asymptomatic adults receiving colonoscopy for screening during 2005 from 17 practice sites, which provide both colonoscopy and pathology reports to the Clinical Outcomes Research Initiative repository. Patients were classified by size of largest polyp. Advanced histology was defined as an adenoma with villous or serrated histology, high-grade dysplasia or an invasive cancer. Risk factors for advanced histology were determined using Pearson chi-square and Fisher’s Exact tests. 13,992 asymptomatic patients had screening with colonoscopy; 6360 patients (45%) had polyps, with complete histology available in 5977 (94%). The proportion with advanced histology was 1.7% in the 1–5mm group; 6.6% in the 6–9mm group; 30.6% in the greater than 10mm group; 72.1% in the tumor group. Distal location was associated with advanced histology in the 6–9mm group (p =0.04) and the greater than 10mm group (p = 0.002). One in 15 asymptomatic patients whose largest polyp is 6 to 9mm will have advanced histology and would undergo surveillance at 3 years based on current guidelines. Since histology is necessary for this decision, most of these patients should be offered colonoscopy. Further study should determine if patients whose largest polyp is 1–5mm, can be safely followed without polypectomy.
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