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Predicting proximal advanced neoplasms at screening sigmoidoscopy.

Carlo Senore·Nereo Segnan·Luigina Bonelli·Stefania Sciallero·Marco Pennazio·Donato Angioli·Cristiano Crosta·Stefano Gasperoni·Giuseppe Malfitana·SCORE Working Group
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Abstract

PURPOSE: This study was designed to assess the predictive value for advanced proximal neoplasms (cancer, adenoma > or = 10 mm, or villous component > 20 percent, or severe dysplasia) of the characteristics of distal polyps. METHODS: The study was conducted among patients, aged 55 to 64 years, referred for colonoscopy in the Italian trial of sigmoidoscopy screening for colorectal cancer. Patients reporting a history of colorectal cancer, adenomas, inflammatory bowel disease, recent colorectal endoscopy, or two first-degree relatives with colorectal cancer were excluded. We compared the prevalence of advanced proximal neoplasia in patients with "low-risk" (1-2 tubular adenomas, < 10 mm, with low-grade dysplasia, or hyperplastic polyp) and in those with "high-risk" (size, > or = 10 mm, or > or = 3 adenomas, or villous component > 20 percent, or severe dysplasia) polyps in the distal colon. RESULTS: Of 426 patients with polyps > 5 mm, 29 (6.9 percent) were detected with an advanced proximal neoplasm (including 4 colorectal cancers). The prevalence of proximal advanced neoplasia was 9.4 percent among patients with high-risk distal polyps and 2.5 percent among those with low-risk lesions (adjusted odds ratio, 3.19; 95 percent confidence interval, 1.06-9.59). Approximately 40 people with low-risk distal polyps 6 to 9 mm should undergo colonoscopy to detect one proximal advanced neoplasm; the corresponding number for patients with high-risk distal polyps is 10. CONCLUSIONS: The 2.5 percent prevalence of proximal advanced neoplasms among people with low-risk 6-mm to 9-mm distal polyps is similar to the prevalence observed among people without distal polyps. Restricting colonoscopy referral to patients with high-risk distal polyps might represent a cost-effective strategy in a screening context.

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AdenomaColonic PolypsColorectal NeoplasmsCost-Benefit AnalysisFemaleGenetic Predisposition to DiseaseHumansInflammatory Bowel DiseasesMaleMass ScreeningMiddle AgedOdds RatioPatient SelectionPredictive Value of TestsPrevalenceRisk FactorsSigmoidoscopyClinical TrialJournal ArticleMulticenter StudyRandomized Controlled TrialResearch Support, Non-U.S. Gov't

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Carlo Senore, Nereo Segnan, Luigina Bonelli, Stefania Sciallero, Marco Pennazio, Donato Angioli, Cristiano Crosta, Stefano Gasperoni, Giuseppe Malfitana, SCORE Working Group. 2004. Predicting proximal advanced neoplasms at screening sigmoidoscopy.. https://doi.org/10.1007/s10350-004-0595-y

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