title: Prevalence of advanced histological features in diminutive and small colon polyps.
abstract: BACKGROUND
  Investigators have proposed "predict, resect, and discard" strategies for diminutive (≤ 5 mm) or small (6-9 mm) polyps to reduce screening colonoscopy costs. Advanced histological features such as villous histology, high-grade dysplasia, and/or cancer in these polyps could deter adoption of these strategies.
  
  
  OBJECTIVE
  Determine the prevalence of advanced histological features in diminutive and small colon polyps.
  
  
  METHODS
  Retrospective analysis of data from 3 prospective clinical trials.
  
  
  METHODS
  Two tertiary-care referral centers.
  
  
  METHODS
  This study involved patients undergoing screening or surveillance colonoscopy.
  
  
  METHODS
  The location, size, and morphology of each polyp detected was documented. Each polyp was then resected, placed in a unique specimen jar, and sent for histopathological evaluation.
  
  
  METHODS
  Rates of advanced histological features (villous histology, high-grade dysplasia, and cancer).
  
  
  RESULTS
  A total of 2361 polyps were detected, removed, and retrieved. Both diminutive and small polyps had a lower frequency of any advanced histological features compared with large polyps (0.5% and 1.5%, respectively vs 15.0%; P < .001 for both comparisons). Polyps <10 mm in size had a lower frequency of advanced histology compared with polyps ≥ 10 mm (0.8% vs 15.0%; P < .001). During sensitivity analysis, the frequency of advanced histological features varied from 0.2% to 0.7% within diminutive polyps, 1.5% to 3.6% within small polyps, and 0.8% to 1.2% within polyps <10 mm.
  
  
  CONCLUSIONS
  Retrospective analysis from tertiary-care referral centers; predominantly white, male, veteran patient population resulting in limited generalizability of results.
  
  
  CONCLUSIONS
  The prevalence of advanced histological features in colon polyps ≤ 5 mm is very low (0.5%). This has important implications for the potential practice of "predicting, resecting, and discarding" diminutive colon polyps.
authors.affiliation: Division of Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Gupta
authors.forename: Ajay
authors.initials: A
authors.lastname: Bansal
authors.forename: Deepthi
authors.initials: D
authors.lastname: Rao
authors.forename: Dayna S
authors.initials: DS
authors.lastname: Early
authors.forename: Sreenivasa
authors.initials: S
authors.lastname: Jonnalagadda
authors.forename: Sachin B
authors.initials: SB
authors.lastname: Wani
authors.forename: Steven A
authors.initials: SA
authors.lastname: Edmundowicz
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
mesh_terms: D000236:Adenoma / Q000473:pathology*; D018253:Adenoma, Villous / Q000473:pathology; D003110:Colonic Neoplasms / Q000473:pathology*; D003111:Colonic Polyps / Q000473:pathology* / Q000601:surgery; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D047368:Tumor Burden