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DOI: 10.1055/s-0040-1704131
COVERT CANCER IN COLORECTAL POLYPS - SIZE MATTERS!
Publication History
Publication Date:
23 April 2020 (online)
Aims To demonstrate the risk of covert cancer in colorectal polyps based on their size in one of the largest series of polyps to date
Methods Outcomes of patients who had polyps on screening colonoscopy were analysed. Data was prospectively collected on an online endoscopy and pathology reporting system. A chart review was then carried out using multinomial logistic regression.
Results A total of 15906 polyps were removed at colonoscopy. Mean size was 7.3 mm.
Histopathological diagnosis of cancer was made in 104 polyps (0.65%). 94 polyp cancers (90.25%) were associated with non pedunculated morphology [OR 1.45 p=0.005].
No cancer was found in polyps < 5mm in size. Risk of cancer increased with polyp size as depicted in [Table 1]. Risk of developing cancer in polyps >20mm was significantly higher than in smaller polyps [OR 6.57 p< 0.001].
89 cancers were found in the left colon and rectum compared with 15 cancers in the right colon. [OR 1.98 p=0.007].
Conclusions The prevalence of covert cancer in colorectal lesions < 5mm is negligible and that of polyps 6-10 mm is very low (0.17%). All these cancers were in non-pedunculated polyps in left colon.This means that the ‘resect and discard’ strategy could be extended to 6-10 mm polyps in right colon and potentially to pedunculated polyps in left colon.
Cancer risk, however, increased almost 7 fold in polyps ≥2cm. This calls for careful resection (preferably en-bloc) and retrieval of these polyps to obtain all prognostic information.
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