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Endoscopic prediction of advanced histology in diminutive and small colorectal polyps.
J Gastroenterol Hepatol 2019; 34(2):397-403JG

Abstract

BACKGROUND AND AIM

Most polyps detected during colonoscopies are diminutive or small, and they rarely have advanced histology. Real-time prediction of advanced histology would help clinicians to assess the need for pathological evaluation. Here, we investigated endoscopic predictors of advanced histology in diminutive and small polyps.

METHODS

Consecutive patients with adenomatous polyps (<10 mm) removed endoscopically from January 2013 to December 2014 at a single tertiary cancer center were eligible for inclusion. Two endoscopists reviewed all endoscopic images to identify significant findings associated with advanced histology using multivariate models. The sensitivity, specificity, and negative predictive value of the identified endoscopic predictors for advanced histology were calculated.

RESULTS

Of 6170 polyps (4746 diminutive) removed from 2611 patients, 320 (5.2%) showed advanced histology, including five submucosal invasive cancers. In multivariate analysis, advanced histology was significantly associated with the following: loss of lobulation (odds ratio [OR] 61.7; 95% confidence interval [95% CI]: 19.1-199.0); heterogeneity in mucosal patterns (OR 29.0; 95% CI: 14.6-57.3); non-polypoid growth (OR 15.7; 95% CI: 4.4-55.5); white spots (OR 13.5; 95% CI: 7.8-23.5); and surface redness (OR 6.6; 95% CI: 3.0-14.5); and irregular capillary pattern (OR 4.8; 95% CI: 2.5-9.1). These significant predictors successfully predicted all submucosal invasive cancers as advanced histology. The sensitivity, specificity, and negative predictive values were 37.2%, 97.8%, and 96.6%.

CONCLUSIONS

We identified six endoscopic predictors for advanced histology in diminutive or small colon polyps. Diminutive and small polyps lacking these predictors would not be considered to have advanced histology.

Authors+Show Affiliations

Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, Japan.Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, Japan.Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, Japan.Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, Japan.Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, Japan.Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, Japan.Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, Japan.Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, Japan.Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, Japan.Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, Japan.Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, Japan.Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30070395

Citation

Iwai, Tomohiro, et al. "Endoscopic Prediction of Advanced Histology in Diminutive and Small Colorectal Polyps." Journal of Gastroenterology and Hepatology, vol. 34, no. 2, 2019, pp. 397-403.
Iwai T, Imai K, Hotta K, et al. Endoscopic prediction of advanced histology in diminutive and small colorectal polyps. J Gastroenterol Hepatol. 2019;34(2):397-403.
Iwai, T., Imai, K., Hotta, K., Ito, S., Yamaguchi, Y., Kawata, N., ... Ono, H. (2019). Endoscopic prediction of advanced histology in diminutive and small colorectal polyps. Journal of Gastroenterology and Hepatology, 34(2), pp. 397-403. doi:10.1111/jgh.14409.
Iwai T, et al. Endoscopic Prediction of Advanced Histology in Diminutive and Small Colorectal Polyps. J Gastroenterol Hepatol. 2019;34(2):397-403. PubMed PMID: 30070395.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic prediction of advanced histology in diminutive and small colorectal polyps. AU - Iwai,Tomohiro, AU - Imai,Kenichiro, AU - Hotta,Kinichi, AU - Ito,Sayo, AU - Yamaguchi,Yuichiro, AU - Kawata,Noboru, AU - Tanaka,Masaki, AU - Kakushima,Naomi, AU - Takizawa,Kohei, AU - Ishiwatari,Hirotoshi, AU - Matsubayashi,Hiroyuki, AU - Ono,Hiroyuki, Y1 - 2018/08/16/ PY - 2018/01/10/received PY - 2018/07/15/revised PY - 2018/07/20/accepted PY - 2018/8/3/pubmed PY - 2019/7/31/medline PY - 2018/8/3/entrez KW - advanced histology KW - colonic polyps KW - colonoscopy KW - narrow-band imaging KW - optical diagnosis SP - 397 EP - 403 JF - Journal of gastroenterology and hepatology JO - J. Gastroenterol. Hepatol. VL - 34 IS - 2 N2 - BACKGROUND AND AIM: Most polyps detected during colonoscopies are diminutive or small, and they rarely have advanced histology. Real-time prediction of advanced histology would help clinicians to assess the need for pathological evaluation. Here, we investigated endoscopic predictors of advanced histology in diminutive and small polyps. METHODS: Consecutive patients with adenomatous polyps (<10 mm) removed endoscopically from January 2013 to December 2014 at a single tertiary cancer center were eligible for inclusion. Two endoscopists reviewed all endoscopic images to identify significant findings associated with advanced histology using multivariate models. The sensitivity, specificity, and negative predictive value of the identified endoscopic predictors for advanced histology were calculated. RESULTS: Of 6170 polyps (4746 diminutive) removed from 2611 patients, 320 (5.2%) showed advanced histology, including five submucosal invasive cancers. In multivariate analysis, advanced histology was significantly associated with the following: loss of lobulation (odds ratio [OR] 61.7; 95% confidence interval [95% CI]: 19.1-199.0); heterogeneity in mucosal patterns (OR 29.0; 95% CI: 14.6-57.3); non-polypoid growth (OR 15.7; 95% CI: 4.4-55.5); white spots (OR 13.5; 95% CI: 7.8-23.5); and surface redness (OR 6.6; 95% CI: 3.0-14.5); and irregular capillary pattern (OR 4.8; 95% CI: 2.5-9.1). These significant predictors successfully predicted all submucosal invasive cancers as advanced histology. The sensitivity, specificity, and negative predictive values were 37.2%, 97.8%, and 96.6%. CONCLUSIONS: We identified six endoscopic predictors for advanced histology in diminutive or small colon polyps. Diminutive and small polyps lacking these predictors would not be considered to have advanced histology. SN - 1440-1746 UR - https://www.unboundmedicine.com/medline/citation/30070395/Endoscopic_prediction_of_advanced_histology_in_diminutive_and_small_colorectal_polyps_ L2 - https://doi.org/10.1111/jgh.14409 DB - PRIME DP - Unbound Medicine ER -