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DOI: 10.1055/s-0029-1244020
© Georg Thieme Verlag KG Stuttgart · New York
Prevalence of nonpolypoid colorectal neoplasia: An Italian multicenter observational study
Publikationsverlauf
submitted 28 October 2009
accepted after revision 4 February 2010
Publikationsdatum:
16. März 2010 (online)
![](https://www.thieme-connect.de/media/endoscopy/201004/lookinside/thumbnails/10.1055-s-0029-1244020-1.jpg)
Background and study aim: The aim of this study was to assess the prevalence of nonpolypoid lesions (NPLs) in Italy and their risk of containing neoplasia or advanced histology.
Patients and methods: This was a multicenter cross-sectional observational study on consecutive patients undergoing total colonoscopy over a 3-month period in 80 Italian centers.
Results: In all, 27 400 total colonoscopies were analyzed. Cancer was diagnosed in 801 patients (2.9 %). A total of 6553 precancerous lesions were detected in 5609 patients. Of these, 4154 patients (74.1 %) had polypoid lesions and 1455 patients (25.9 %) had NPLs. Therefore, the prevalence of NPLs was 5.3 % (95 %CI 5.0 – 5.6). NPLs larger than 10 mm were detected in 254 patients (17.5 %). NPLs were more predominant in the proximal colon (OR 2.92, 95 %CI 2.56 – 3.43; P < 0.0001 vs. polypoid lesions). Neoplastic tissue was diagnosed in 79.0 % and advanced histology (high-grade intraepithelial neoplasia or more) in 20.9 % of resected lesions. The risk of advanced histology was similar for polypoid and nonpolypoid lesions when adjusted for size. Depressed lesions had the highest risk of advanced histology (OR 10.56, 95 %CI 6.02 – 18.55; P < 0.0000 vs. flat-elevated). Age was an independent predictor of both neoplasia and advanced histology (P = 0.0001).
Conclusions: NPLs are relatively common in the Italian population, with a prevalence similar to that in other Western series. NPLs are not more aggressive than polypoid lesions, except for those with depressed morphology.
References
- 1 Jemal A, Siegel R, Ward E. et al . Cancer statistics, 2008. CA Cancer J Clin. 2008; 58 71-96
- 2 Levin B, Lieberman D A, McFarland B. et al . Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008; 134 1570-1595
- 3 Singh H, Turner D, Xue L. et al . Risk of developing colorectal cancer following a negative colonoscopy examination: evidence for a 10-year interval between colonoscopies. JAMA. 2006; 295 2366-2373
- 4 Muto T, Kamiya J, Sawada T. et al . Small “flat adenoma” of the large bowel with special reference to its clinicopathologic features. Dis Colon Rectum. 1985; 28 847-851
- 5 Ross A S, Waxman I. Flat and depressed neoplasms of the colon in Western populations. Am J Gastroenterol. 2006; 101 172-180
- 6 Soetikno R, Friedland S, Kaltenbach T. et al . Nonpolypoid (flat and depressed) colorectal neoplasms. Gastroenterology. 2006; 130 566-576
- 7 Kudo S, Lambert R, Allen J I. et al . Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc. 2008; 68(4 Suppl) S3-S47
- 8 Soetikno R M, Kaltenbach T, Rouse R V. et al . Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA. 2008; 299 1027-1035
- 9 Jaramillo E, Watanabe M, Slezak P. et al . Flat neoplastic lesions of the colon and rectum detected by high-resolution video endoscopy and chromoscopy. Gastrointest Endosc. 1995; 42 114-122
- 10 Rembacken B, Fujii T, Cairns A. et al . Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK. Lancet. 2000; 355 1211-1214
- 11 Saitoh Y, Waxman I, West A B. et al . Prevalence and distinctive biologic features of flat colorectal adenomas in a North American population. Gastroenterology. 2001; 120 1657-1665
- 12 Tsuda S, Veress B, Toth E. et al . Flat and depressed colorectal tumors in a southern Swedish population: a prospective chromoendoscopic and histopathological study. Gut. 2002; 51 550-555
- 13 Fujii T, Rembacken B J, Dixon M F. et al . Flat adenomas in the United Kingdom: are treatable cancers being missed?. Endoscopy. 1998; 30 437-443
- 14 Hurlstone D P, Cross S S, Adam I. et al . A prospective clinicopathological and endoscopic evaluation of flat and depressed colorectal lesions in the United Kingdom. Am J Gastroenterol. 2003; 98 2543-2549
- 15 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. Gastrointest Endosc. 2003; 58(6 Suppl) S3-S43
- 16 Tamura S, Nakajo K, Yokoyama Y. et al . Evaluation of endoscopic mucosal resection for laterally spreading rectal tumors. Endoscopy. 2004; 36 306-312
- 17 Uraoka T, Saito Y, Matsuda T. et al . Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut. 2006; 55 1592-1597
- 18 Rex D K, Petrini J L, Baron T H. et al . Quality indicators for colonoscopy. Am J Gastroenterol. 2006; 101 873-885
- 19 Dixon M F. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut. 2002; 51 130-131
- 20 Kuramoto S, Oohara T. Flat early cancers of the large intestine. Cancer. 1989; 64 950-955
- 21 Chiu H M, Lin J T, Chen C C. et al . Prevalence and characteristics of nonpolypoid colorectal neoplasm in an asymptomatic and average-risk Chinese population. Clin Gastroenterol Hepatol. 2009; 7 463-470
- 22 Park D H, Kim H S, Kim W H. et al . Clinicopathologic characteristics and malignant potential of colorectal flat neoplasia compared with that of polypoid neoplasia. Dis Colon Rectum. 2008; 51 43-49
- 23 Okamoto M, Kawabe T, Yamaji Y. et al . Flat-type early colorectal cancer preferentially develops in right-sided colon in older patients. Dis Colon Rectum. 2005; 48 101-107
- 24 Rex D K. Maximizing detection of adenomas and cancers during colonoscopy. Am J Gastroenterol. 2006; 101 2866-2877
- 25 Sung J J, Lau J Y, Young G P. et al . Asia Pacific Working Group on Colorectal Cancer. Asia Pacific consensus recommendations for colorectal cancer screening. Gut. 2008; 57 1166-1176
- 26 Lieberman D. A call to action – measuring the quality of colonoscopy. N Engl J Med. 2006; 355 2588-2589
- 27 Winawer S J, Zauber A G, Fletcher R H. et al . Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006; 130 1872-1885
- 28 Kiesslich R, von Bergh M, Hahn M. et al . Chromoendoscopy with indigocarmine improves the detection of adenomatous and non adenomatous lesions in the colon. Endoscopy. 2001; 33 1001-1006
- 29 Fu K I, Sano Y, Kato S. et al . Chromoendoscopy using indigo carmine dye spraying with magnifying observation is the most reliable method for differential diagnosis between non-neoplastic and neoplastic colorectal lesions: a prospective study. Endoscopy. 2004; 36 1089-1093
- 30 Bianco M A, Rotondano G, Marmo R. et al . Predictive value of magnification chromoendoscopy for diagnosing invasive neoplasia in nonpolypoid colorectal lesions and stratifying patients for endoscopic resection or surgery. Endoscopy. 2006; 38 470-476
- 31 Chiu H M, Chang C Y, Chen C C. et al . A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia. Gut. 2007; 56 373-379
- 32 Matsuda T, Fujii T, Saito Y. et al . Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol. 2008; 103 2700-2706
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