Clinical significance of distal colon polyps for the prediction of an advanced proximal neoplasm: the KASID prospective multicenter study.
OBJECTIVE
The possibility of proximal lesion without distal polyps is a weak point of sigmoidoscopic colon cancer screening, but the clinical significance of distal findings for advanced proximal neoplasm (APN) is uncertain. The aim of this study was to assess the significance of a distal finding as a predictor of APN.


METHODS
Asymptomatic patients > or =50 years old were enrolled from among patients who underwent polypectomy at 11 tertiary medical centers during the Korean Association for the Study of Intestinal Disease prospective study conducted between July 2003 and March 2004. Polyps located distal to the splenic flexure were defined as distal polyps. An advanced neoplasm was defined as a polyp of > or =10 mm in size, and/or with villous features, and/or with high-grade dysplasia, or invasive cancer. Age, gender, and distal polyp size, appearance, and histology were analyzed as risk factors of APN. The sensitivity and positive predictive value of distal polyps for APN were calculated.


RESULTS
Data from 826 patients were analyzed. Mean patient age was 60.1 years (range 50-86), and 71.3% were men. APN was found in 98 patients, and 45 (45.9%) patients had no distal polyps. Risk factors of APN were a male gender, distal polyp size, and an advanced distal neoplasm. Sensitivities of a distal polyp of > or =10 mm and of an advanced distal neoplasm for APN were both 38.8% with positive predictive values of 13.3 and 14.4%, respectively.


CONCLUSIONS
Although distal colon findings were found to be helpful for predicting APN in asymptomatic patients aged > or =50 years, APN without distal polyps requires careful consideration.
Kang
Mun Su
MS
Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyeong-dong, Jongno-gu, Seoul 110-746, South Korea.
Park
Dong Il
DI
Jeen
Yoon Tae
YT
Keum
Bora
B
Choi
Jai Hyun
JH
Jung
Sung-Ae
SA
Kim
Hyun Soo
HS
Kim
Young-Ho
YH
Kim
Won Ho
WH
Kim
Tae Il
TI
Kim
Hyo Jung
HJ
Yang
Suk Kyun
SK
Myung
Seung Jae
SJ
Byeon
Jeong Sik
JS
Lee
Moon Sung
MS
Jung
Il Kwon
IK
Chung
Moon Kwan
MK
Choi
Hwang
H
Han
Dong Soo
DS
Song
Jae Suk
JS
D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000473:pathology*; D003111:Colonic Polyps / Q000473:pathology*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007723:Korea; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011230:Precancerous Conditions / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors