Browsing by Subject "adenomas"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    The predictive value of small versus diminutive adenomas for subsequent advanced neoplasia
    (Elsevier, 2019) Hartstein, Joseph D.; Vemulapalli, Krishna C.; Rex, Douglas K.; Medicine, School of Medicine
    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.
  • Thumbnail Image
    Item
    Risk of cancer in small and diminutive colorectal polyps
    (Elsevier, 2017-01) Ponugoti, Prasanna L.; Cummings, Oscar W.; Rex, Douglas K.; Department of Medicine, School of Medicine
    The prevalence of cancer in small and diminutive polyps is relevant to “resect and discard” and CT colonography reporting recommendations. We evaluated a prospectively collected colonoscopy polyp database to identify polyps <10 mm and those with cancer or advanced histology (high-grade dysplasia or villous elements). Of 32,790 colonoscopies, 15,558 colonoscopies detected 42,630 polyps <10 mm in size. A total of 4790 lesions were excluded as they were not conventional adenomas or serrated class lesions. There were 23,524 conventional adenomas <10 mm of which 22,952 were tubular adenomas. There were 14,316 serrated class lesions of which 13,589 were hyperplastic polyps and the remainder were sessile serrated polyps. Of all conventional adenomas, 96 had high-grade dysplasia including 0.3% of adenomas ≤5 mm in size and 0.8% of adenomas 6–9 mm in size. Of all conventional adenomas, 2.1% of those ≤5 mm in size and 5.6% of those 6–9 mm in size were advanced. Among 36,107 polyps ≤5 mm in size and 6523 polyps 6–9 mm in size, there were no cancers. These results support the safety of resect and discard as well as current CT colonography reporting recommendations for small and diminutive polyps.
  • Thumbnail Image
    Item
    The “valley sign” in small and diminutive adenomas: prevalence, interobserver agreement, and validation as an adenoma marker
    (Elsevier, 2016) Rex, Douglas K.; Ponugoti, Prasanna; Kahi, Charles; Department of Medicine, IU School of Medicine
    Background Classification schemes for differentiation of conventional colorectal adenomas from serrated lesions rely on patterns of blood vessels and pits. Morphologic features have not been validated as predictors of histology. Aim Describe the prevalence of the “valley sign” and validate it as a marker of conventional adenomas Methods Three experts judged the prevalence of the valley sign in 301 consecutive small adenomas. Medical students were taught to recognize the valley and tested on their recognition of the valley sign. Consecutive diminutive polyps were video-recorded and used to validate the association of the valley sign with conventional adenomas. Results The prevalence of the valley sign in 301 consecutive adenomas <10 mm in size, determined by 3 experts, ranged from 35% to 50%. Kappa values for agreement among the 3 experts were 0.557, 0.679, and 0.642. Ten medical students were taught to interpret the valley sign and recognized it with accuracy of 96% or higher in 50 selected photographs of diminutive polyps. Four medical students evaluated video-recordings of 170 consecutive diminutive polyps for the presence of the valley sign. Kappa values for the interpretation of the valley sign ranged from 0.52 to 0.68 among the students. The sensitivity of the valley sign for adenoma ranged from 40.2% to 54.9%, and specificity ranged from 90.2% to 91.7%. The valley sign was strongly associated with adenomas (p<0.0001). Conclusions The valley sign is insensitive but highly specific for conventional adenoma in diminutive polyps. It may enhance classification schemes for differentiation of adenomas from serrated lesions based on vessels and pits.