Endoscopic overestimation of colorectal polyp size

Area of Science:

• Gastroenterology
• Endoscopic procedures
• Pathology

Background:

• Colonoscopic surveillance guidelines often rely on polyp size estimates.
• Endoscopic size assessment is subjective and may lead to inaccuracies.
• Accurate polyp size measurement is crucial for determining appropriate patient follow-up.

Purpose of the Study:

• To compare polyp size assessments made during endoscopy with precise pathology measurements.
• To identify factors contributing to discrepancies between endoscopic and pathological polyp sizing.

Main Methods:

• Retrospective review of colonoscopy and pathology reports from 2012.
• Inclusion of polyps with both endoscopic estimates and pathology measurements.
• Multivariate analysis to assess factors influencing endoscopic miscall rates.

Main Results:

• Significant discordance was observed between endoscopic and pathology polyp size measurements.
• Endoscopic estimates showed modal clustering around 1 cm, with many polyps measuring smaller pathologically.
• Almost half of polyps estimated at ≥ 1 cm by endoscopy were <1 cm on pathology.
• Overestimation varied by polyp histology and configuration, and was more common in women and proximal lesions.

Conclusions:

• Substantial discrepancies exist between endoscopic estimations and pathological measurements of polyp size.
• Endoscopic size assessment can lead to misclassification of polyp advancement, potentially affecting surveillance strategies.
• Pathology measurements are the gold standard for accurate polyp size determination.