High risk features in colorectal adenomatous polyps: A multi-institutional study

Area of Science:

• Gastroenterology
• Pathology
• Oncology

Background:

• High-risk features in colorectal adenomatous polyps include size >1 cm, high-grade dysplasia (HGD), and villous architecture.
• Variability in diagnosing these features can impact patient management and risk stratification.

Purpose of the Study:

• To assess inter-institutional diagnostic rates of advanced histology in colorectal adenomatous polyps.
• To determine if patient age, polyp size, or colorectal cancer (CRC) rates explain observed diagnostic variations.

Main Methods:

• Data from 2700 colorectal adenomatous polyps across nine academic institutions (2018-2019) were analyzed.
• Pathologists reviewed polyp size, location, concurrent CRC, HGD, and villous features.
• Multivariate analysis identified factors associated with advanced histology.

Main Results:

• Advanced histology was diagnosed in 5% of polyps (HGD: 1%, villous features: 4%).
• Diagnostic rates for advanced histology varied from 1.7% to 9.3% across institutions.
• Polyp size >1 cm was the strongest predictor of advanced histology (OR: 31.82).

Conclusions:

• Significant inter-institutional variability exists in diagnosing advanced histology in colorectal polyps.
• Polyp size >1 cm is a key factor influencing advanced histology diagnosis.
• Differences in polyp size detection and potential pathologic subjectivity contribute to diagnostic variance.