Yield of advanced adenoma and cancer based on polyp size detected at screening flexible sigmoidoscopy

Gastroenterology. 2006 Dec;131(6):1683-9. doi: 10.1053/j.gastro.2006.08.025. Epub 2006 Aug 14.

Abstract

Background & aims: Observational screening of the colon with subsequent referral for colonoscopy raises questions about the threshold of polyp size that necessitates referral. To examine the yield at colonoscopy when a given size lesion is observed, we assessed the yield of advanced adenoma and cancer at colonoscopy based on the size of the abnormality detected at flexible sigmoidoscopy (FSG).

Methods: We used data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, a randomized, controlled, community-based study of FSG.

Results: Subsequent colonoscopy was performed on 10,850 subjects (60.4% male; mean age, 62.9 years) with a polyp visualized on screening FSG. For women with a polyp 0.5-0.9 cm on FSG (n = 1426), the yield in the distal colon on colonoscopy was 0.6% for cancer (number needed to screen [NNS] = 166) and 14.5% for advanced adenoma (NNS = 7). In men (n = 2183), the yield was 0.7% (NNS = 142) for cancer and 15.9% (NNS = 6) for advanced adenoma. Among persons with polyps 0.5-0.9 cm identified on FSG, 5.5% (198/3609) had distal advanced adenomas that measured <1.0 cm but had villous histology or high-grade dysplasia, and 9.9% (357/3609) had adenomas > or =1 cm.

Conclusions: The yield for a distal advanced adenomatous lesion when a polyp 0.5-0.9 cm is observed at FSG is substantial and is due to the presence of advanced histology in polyps <1 cm and to detection of polyps that measure > or =1.0 cm on colonoscopy. Establishing thresholds for observation versus evaluation will require careful assessment of the overall yield.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenoma / diagnosis*
  • Adenoma / pathology*
  • Aged
  • Colonic Neoplasms / diagnosis*
  • Colonic Neoplasms / pathology*
  • Colonic Polyps / pathology*
  • Disease Progression
  • Female
  • Humans
  • Male
  • Mass Screening / methods
  • Middle Aged
  • Randomized Controlled Trials as Topic
  • Sigmoidoscopy / methods*