The predictive value of small versus diminutive adenomas for subsequent advanced neoplasia
The predictive value of small versus diminutive adenomas for subsequent advanced neoplasia
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DOI：
10.1016/j.gie.2019.08.047
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发表时间：
2020-03-01
影响因子：
7.7
通讯作者：
Rex, Douglas K.
中科院分区：
文献类型：
--
作者：
Hartstein, Joseph D.;Vemulapalli, Krishna C.;Rex, Douglas K.
背景和目的：既往有结直肠腺瘤的患者患结直肠癌的风险增加。目前的息肉切除术后监测间隔指南将所有1-9 mm大小的管状腺瘤合并低度异型增生的患者视为具有相同风险水平。我们评估了在结肠镜检查中发现的6到9 mm的腺瘤与基线的1到5 mm的腺瘤相比，在随访中是否与晚期肿瘤的风险更高有关。方法：我们回顾了美国一个学术中心的结肠镜检查数据库。基线检查显示管状腺瘤大小为1-9 mm的患者包括低度不典型增生和无晚期腺瘤。至少200天后进行随诊结肠镜检查，并评估是否发生晚期肿瘤(癌、高度不典型增生、腺瘤或10 mm大小的腺瘤或绒毛成分)。结果：共有2477例合格的基线结肠镜检查。发生异时性晚期肿瘤的绝对风险从1-5 mm腺瘤患者的3.6%增加到至少1-9 mm腺瘤患者的6.9%(P=.001)。有5个或更多腺瘤的患者，其中1个至少6-9 mm的患者在随访时发生晚期肿瘤的风险最高(10.4%，P=0.006)。当只考虑筛查结肠镜检查时，腺瘤大小为6-9 mm的所有基线组(1-2个腺瘤，3-4个腺瘤，5个腺瘤)发生异时性晚期肿瘤的风险增加(优势比[OR]，4.07；95%可信区间[CI]，1.50-11.04；OR，4.91；95%CI，1.44-16.75；OR，4.71；95%可信区间分别为1.30-17.05。结论：与仅有微小腺瘤(1-5 mm)的患者相比，基线小腺瘤(6-9 mm)患者发生晚期病变的风险更高。息肉切除术后指南应考虑基于小腺瘤和小腺瘤的风险分层。
Background and Aims: Patients with previous colorectal adenomas are at increased risk of colorectal cancer. Current guidelines for postpolypectomy surveillance intervals treat all tubular adenomas 1 to 9 mm in size with low-grade dysplasia as carrying the same level of risk. We evaluated whether 6 to 9 mm adenomas detected at colonoscopy are associated with greater risk of advanced neoplasia at follow-up compared with baseline 1 to 5 mm adenomas.Methods: We retrospectively evaluated a colonoscopy database at a single U.S. academic center. Patients with baseline examinations demonstrating tubular adenomas 1 to 9 mm in size with low-grade dysplasia and no advanced adenomas were included. Follow-up colonoscopies were performed at least 200 days later and were assessed for incident advanced neoplasia (cancer, high-grade dysplasia, adenoma >= 10 mm in size, or villous elements).Results: There were 2477 qualifying baseline colonoscopies. The absolute risk of metachronous advanced neoplasia increased from 3.6% in patients with 1 to 5 mm adenomas to 6.9% in patients with at least 1 adenoma of 6 to 9 mm (P = .001). Patients with 5 or more adenomas 1 of which was at least 6 to 9 mm had the highest risk of advanced neoplasia at follow-up (10.4%, P = .006). When only screening colonoscopies were considered, all baseline groups (1-2 adenomas, 3-4 adenomas, >= 5 adenomas) with adenomas 6 to 9 mm in size had an increased risk for metachronous advanced neoplasia (odds ratio [OR], 4.07; 95% confidence interval [CI], 1.50-11.04; OR, 4.91; 95% CI, 1.44-16.75; OR, 4.71; 95% CI, 1.30-17.05, respectively).Conclusions: Patients with baseline small (6-9 mm) adenomas have an increased risk of advanced lesions on follow-up compared with patients with only diminutive (1-5 mm) adenomas. Postpolypectomy guidelines should consider risk stratification based on small versus diminutive adenomas.