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Intermediate-risk patients with three to four small adenomas should be considered low risk for colorectal cancer screening.
Dig Endosc. 2016 May; 28(4):450-455.DE

Abstract

BACKGROUND AND AIM

Intermediate-risk patients following a colorectal cancer screening program may have differential risk of advanced lesions depending on the findings of an index colonoscopy. The aim of the present study was to comparatively assess advanced colorectal neoplasia risk at the first follow-up colonoscopy among the different intermediate-risk subgroups with a focus on patients with three to four adenomas.

METHODS

All patients recruited for a baseline screening colonoscopy between 2006 and 2011 were included. Number, size and histopathological characteristics of adenomas were collected. Main outcome was an advanced colorectal neoplasia detection rate (invasive carcinoma or advanced adenoma) at the first follow-up colonoscopy. Low- and high-risk patients were excluded.

RESULTS

Five hundred and sixty-one intermediate-risk patients (63.3% men, mean age: 59.01 ± 6.16 years) underwent indexing and follow-up colonoscopy. By multivariate analysis, three to four adenomas (OR: 3.613 [95% CI: 1.661-7.859], P = 0.001) and adenoma size ≥10 <20 mm (OR: 3.374 [95% CI: 1.618-7.034], P = 0.001) were independent factors associated with advanced colorectal neoplasia. Advanced lesions were detected in 7.66% of cases. Of patients with advanced colorectal neoplasia, 51.16% belonged to the three-to-four-adenoma group and ≥1 of ≥10 <20-mm subgroups (n = 132, 23.53%). These patients demonstrated a higher rate of advanced lesions [OR: 3.886 (95% CI: 2.061-7.325), P < 0.001] than patients with three to four small adenomas of <10 mm (16.67% vs 5.07%, P < 0.001). The association between patients with small adenomas (n = 217, 38.68%) and advanced lesions was not significant (OR: 0.521 [95% CI: 0257-1.056], P = 0.066).

CONCLUSION

Intermediate-risk patients with three to four small adenomas achieved a very low advanced lesion rate at follow up. Surveillance interval should be lengthened because these patients should be considered low risk.

Authors+Show Affiliations

Department of Gastroenterology, Morales Meseguer Hospital, Alicante, Spain.Department of Gastroenterology, Morales Meseguer Hospital, Alicante, Spain.Department of Gastroenterology, Morales Meseguer Hospital, Alicante, Spain.Department of Gastroenterology, Alicante University Hospital, Alicante, Spain.Department of Gastroenterology, Morales Meseguer Hospital, Alicante, Spain.Department of Gastroenterology, Morales Meseguer Hospital, Alicante, Spain.Department of Gastroenterology, Morales Meseguer Hospital, Alicante, Spain.Department of Gastroenterology, Morales Meseguer Hospital, Alicante, Spain.Department of Gastroenterology, Morales Meseguer Hospital, Alicante, Spain.Colorectal Cancer Prevention Program for Región de Murcia, Servicio Murciano de Salud, Murcia, Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26538148

Citation

Pérez-Cuadrado-Robles, Enrique, et al. "Intermediate-risk Patients With Three to Four Small Adenomas Should Be Considered Low Risk for Colorectal Cancer Screening." Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society, vol. 28, no. 4, 2016, pp. 450-455.
Pérez-Cuadrado-Robles E, Torrella-Cortés E, Bebia-Conesa P, et al. Intermediate-risk patients with three to four small adenomas should be considered low risk for colorectal cancer screening. Dig Endosc. 2016;28(4):450-455.
Pérez-Cuadrado-Robles, E., Torrella-Cortés, E., Bebia-Conesa, P., Quesada-Vázquez, N., Rodrigo-Agudo, J. L., Chacón-Martínez, S., López-Martín, A., Esteban-Delgado, P., Pérez-Cuadrado-Martínez, E., & Pérez-Riquelme, F. (2016). Intermediate-risk patients with three to four small adenomas should be considered low risk for colorectal cancer screening. Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society, 28(4), 450-455. https://doi.org/10.1111/den.12570
Pérez-Cuadrado-Robles E, et al. Intermediate-risk Patients With Three to Four Small Adenomas Should Be Considered Low Risk for Colorectal Cancer Screening. Dig Endosc. 2016;28(4):450-455. PubMed PMID: 26538148.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intermediate-risk patients with three to four small adenomas should be considered low risk for colorectal cancer screening. AU - Pérez-Cuadrado-Robles,Enrique, AU - Torrella-Cortés,Emilio, AU - Bebia-Conesa,Paloma, AU - Quesada-Vázquez,Noé, AU - Rodrigo-Agudo,José Luis, AU - Chacón-Martínez,Silvia, AU - López-Martín,Aurelio, AU - Esteban-Delgado,Pilar, AU - Pérez-Cuadrado-Martínez,Enrique, AU - Pérez-Riquelme,Francisco, Y1 - 2015/12/09/ PY - 2015/07/27/received PY - 2015/10/15/revised PY - 2015/11/04/accepted PY - 2015/11/6/entrez PY - 2015/11/6/pubmed PY - 2018/3/17/medline KW - adenoma KW - advanced adenoma (AA) KW - colorectal cancer screening KW - colorectal neoplasm KW - risk SP - 450 EP - 455 JF - Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society JO - Dig Endosc VL - 28 IS - 4 N2 - BACKGROUND AND AIM: Intermediate-risk patients following a colorectal cancer screening program may have differential risk of advanced lesions depending on the findings of an index colonoscopy. The aim of the present study was to comparatively assess advanced colorectal neoplasia risk at the first follow-up colonoscopy among the different intermediate-risk subgroups with a focus on patients with three to four adenomas. METHODS: All patients recruited for a baseline screening colonoscopy between 2006 and 2011 were included. Number, size and histopathological characteristics of adenomas were collected. Main outcome was an advanced colorectal neoplasia detection rate (invasive carcinoma or advanced adenoma) at the first follow-up colonoscopy. Low- and high-risk patients were excluded. RESULTS: Five hundred and sixty-one intermediate-risk patients (63.3% men, mean age: 59.01 ± 6.16 years) underwent indexing and follow-up colonoscopy. By multivariate analysis, three to four adenomas (OR: 3.613 [95% CI: 1.661-7.859], P = 0.001) and adenoma size ≥10 <20 mm (OR: 3.374 [95% CI: 1.618-7.034], P = 0.001) were independent factors associated with advanced colorectal neoplasia. Advanced lesions were detected in 7.66% of cases. Of patients with advanced colorectal neoplasia, 51.16% belonged to the three-to-four-adenoma group and ≥1 of ≥10 <20-mm subgroups (n = 132, 23.53%). These patients demonstrated a higher rate of advanced lesions [OR: 3.886 (95% CI: 2.061-7.325), P < 0.001] than patients with three to four small adenomas of <10 mm (16.67% vs 5.07%, P < 0.001). The association between patients with small adenomas (n = 217, 38.68%) and advanced lesions was not significant (OR: 0.521 [95% CI: 0257-1.056], P = 0.066). CONCLUSION: Intermediate-risk patients with three to four small adenomas achieved a very low advanced lesion rate at follow up. Surveillance interval should be lengthened because these patients should be considered low risk. SN - 1443-1661 UR - https://www.unboundmedicine.com/medline/citation/26538148/Intermediate_risk_patients_with_three_to_four_small_adenomas_should_be_considered_low_risk_for_colorectal_cancer_screening_ L2 - https://doi.org/10.1111/den.12570 DB - PRIME DP - Unbound Medicine ER -