Estimation of Impact of American College of Radiology Recommendations on CT Colonography Reporting for Resection of High-Risk Adenoma Findings

Rex, Douglas K.; Overhiser, Andrew J.; Chen, Shawn C.; Cummings, Oscar W.; Ulbright, Thomas M.
January 2009
American Journal of Gastroenterology;Jan2009, Vol. 104 Issue 1, p149
Academic Journal
OBJECTIVES: The American College of Radiology (ACR) recommends that polyps ≤5 mm in size not be reported on computed tomography (CT) colonography studies. Patients with 1 or 2 polyps 6-9 mm in size can be offered "CTC surveillance" in 3 years in lieu of polypectomy. The aim of the study was to determine the impact of ACR recommendations on resection of high-risk adenoma findings using an endoscopic polyp/histology database. METHODS: Excluding patients with inflammatory bowel disease (IBD) and polyposis, 10,034 patients underwent colonoscopy and 10,780 polyps were removed from 5,079 patients over a 5-year interval. High-risk adenoma findings were defined as an advanced adenoma (≥1 cm in size, high-grade dysplasia (HGD), or villous elements) or 3 or more adenomas of any size, per postpolypectomy surveillance recommendations. RESULTS: A total of 5,079 patients (51%) had at least 1 polyp, 2,907 (29%) had at least 1 adenoma, and 1,001 (10%) had high-risk adenoma findings, of these, 293 (29%) had either 3 adenomas ≤5 mm in size (n = 267) or an advanced adenoma ≤5 mm in size (or both) and no polyp of any histology ≥6 mm in size. There were 774 patients with 1 or 2 polyps 6-9 mm in size and no polyps of any histology ≥10 mm in size. Of these patients 184 (18% of the patients with high-risk adenomas) had either 3 or more adenomas ≤9 mm in size (n = 149) or an advanced adenoma ≤9 mm in size (or both findings). There were 2,174 patients age ≥50 years with the primary indication of screening of whom 326 (15%) had high-risk adenoma findings. Of these, 108 (33%) had either ≥3 adenomas ≤5 mm in size or an advanced adenoma ≤5 mm in size and no polyps ≥6 mm in size. An additional 75 (23%) had no polyp ≥10 mm in size, 1 or 2 polyps 6-9 mm in size and ≥3 adenomas ≤9 mm in size or an advanced adenoma ≤9 mm in size. CONCLUSIONS: If computed tomographic colonography (CTC) rather than colonoscopy were used in this population, assuming 100% sensitivity of CTC for polyps ≥6 mm and ACR interpretation recommendations, then 29% of all patients and 33% of screening patients age ≥50 years with high-risk adenoma findings would be interpreted as normal, and an additional 18-23% of these groups with high-risk adenoma findings, respectively, could have polypectomy delayed at least 3 years.


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