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Related Experiment Videos

Poor correlation between clinical impression, the small colonic polyp and their neoplastic risk.

Ian Craig Lawrance1, Colin Sherrington, Kevin Murray

  • 1School of Medicine and Pharmacology, University of Western Australia, Western Australia, Australia. ilawrance@cyllene.uwa.edu.au

Journal of Gastroenterology and Hepatology
|April 28, 2006
PubMed
Summary

Small colonic polyps often harbor advanced histology, regardless of clinical impression. Endoscopists should consider removing all polyps proximal to the rectum, irrespective of size, to improve patient outcomes.

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Area of Science:

  • Gastroenterology
  • Endoscopy
  • Oncology

Background:

  • The clinical significance of small colonic polyps remains uncertain.
  • Polyp removal decisions are often based on the proceduralist's subjective clinical impression.
  • Accurate assessment of small polyp histology is crucial for appropriate management.

Purpose of the Study:

  • To evaluate the accuracy of clinical discernment in assessing colonic polyp neoplasia.
  • To determine the likelihood of advanced histological findings in polyps smaller than 10 mm.
  • To inform guidelines for the management of small colonic polyps.

Main Methods:

  • Prospective collection of 1988 colonic lesions from 854 subjects undergoing 2215 colonoscopies.
  • Recording of lesion size, location, patient demographics, and colonoscopist's clinical impression.

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  • Analysis of histological outcomes and correlation with clinical assessment.

    • Main Results:

    • Clinical assessment accuracy for neoplasia was 73.4%, with a sensitivity of 87.4% and specificity of 65.0%.
    • Polyps < 5 mm showed 44.5% neoplasia and 3.5% advanced histology; 6-9 mm polyps had 79.3% neoplasia and 19.9% advanced histology.
    • Factors predicting correct impression included polyp size, rectal location, and pedunculated morphology; neoplasia was predicted by age, size, and sessile nature.

    Conclusions:

    • Colonic polyps < 10 mm present a significant risk of neoplasia and advanced histology.
    • Clinical impression poorly correlates with the presence of neoplasia in small polyps.
    • Consideration should be given to removing all lesions proximal to the rectum, regardless of size.