title: Risk factors for advanced neoplasia within subcentimetric polyps: implications for diagnostic imaging.
abstract: OBJECTIVE
  Diagnostic imaging by CT colonography and capsule endoscopy is used to detect colonic lesions. Controversy exists regarding the work-up of subcentimetric lesions. The aim of this study was to identify risk indicators for advanced neoplasia (AN) in subcentimetric polyps.
  
  
  METHODS
  Colonoscopies were classified on the basis of the largest lesion found. AN was defined as high-grade dysplasia, villous histology, or cancer. Logistic regression models were developed to identify risk factors for AN, and validated on separate datasets. A risk index based on the logistic regression was generated, and the number needed to screen (NNS) to detect AN was determined.
  
  
  RESULTS
  1,077,956 colonoscopies identified 106,270 intermediate (5-9 mm) and 198,954 diminutive (≤ 4 mm) lesions; 13% of intermediate and 3.7% of diminutive lesions contained AN. The risk of AN was higher in intermediate than in diminutive lesions (OR 3.1; 95% CI 3.0 to 3.3). Age ≥ 85 versus <45 years was associated with ORs of 2.4 (95% CI 1.8 to 3.1) for intermediate polyps and 3.2 (95% CI 2.3 to 4.5) for diminutive polyps. Pedunculated versus sessile morphology was associated with a higher risk of AN in intermediate (OR 2.0; 95% CI 1.9 to 2.2) and diminutive (OR 3.5; 95% CI 2.9 to 4.1) lesions. In the combined analysis for subcentimetric lesions, ORs were 2.7 (95% CI 2.2 to 3.3) for age ≥ 85 versus <45 years, 1.1 (95% CI 1.1 to 1.2) for male sex, 1.6 (95% CI 1.4 to 1.7) for occult blood, 1.3 (95% CI 1.2 to 1.5) for overt blood in stool, 1.3 (95% CI 1.2 to 1.4) for more than four lesions, and 2.2 (95% CI 2.1 to 2.3) for pedunculated versus sessile lesions. At median risk index values, the NNS was 9.3 (95% CI 9.1 to 9.5) in individuals with intermediate lesions and 29.4 (95% CI 28.5 to 30.2) in those with diminutive lesions. Compared with the NNS of 15 of the whole cohort, the majority of intermediate, but a minority of diminutive, lesions were deemed at high risk of AN.
  
  
  CONCLUSIONS
  This study successfully identified risk factors and established a risk index for subcentimetric lesions. This has implications for the work-up of patients with subcentimetric lesions identified on diagnostic imaging.
authors.affiliation: Department of Medicine II, University of Munich, Marchioninistr 15, 81377 Munich, Germany. fkolligs@med.uni-muenchen.de
authors.forename: Frank Thomas
authors.initials: FT
authors.lastname: Kolligs
authors.forename: Alexander
authors.initials: A
authors.lastname: Crispin
authors.forename: Anno
authors.initials: A
authors.lastname: Graser
authors.forename: Axel
authors.initials: A
authors.lastname: Munte
authors.forename: Ulrich
authors.initials: U
authors.lastname: Mansmann
authors.forename: Burkhard
authors.initials: B
authors.lastname: Göke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging*; D003111:Colonic Polyps / Q000473:pathology*; D023881:Colonography, Computed Tomographic; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000000981:diagnostic imaging*; D012307:Risk Factors