A comparison of endoscopy versus pathology sizing of colorectal adenomas and potential implications for surveillance colonoscopy.
OBJECTIVE
The aim of this study was to compare endoscopy and pathology sizing in a large population-based series of colorectal adenomas and to evaluate the implications for patient stratification into surveillance colonoscopy.


METHODS
Endoscopy and pathology sizes available from intact adenomas removed at colonoscopies performed as part of the Northern Ireland Bowel Cancer Screening Programme, from 2010 to 2015, were included in this study. Chi-squared tests were applied to compare size categories in relation to clinicopathologic parameters and colonoscopy surveillance strata according to current American Gastroenterology Association and British Society of Gastroenterology guidelines.


RESULTS
A total of 2521 adenomas from 1467 individuals were included. There was a trend toward larger endoscopy than pathology sizing in 4 of the 5 study centers, but overall sizing concordance was good. Significantly greater clustering with sizing to the nearest 5 mm was evident in endoscopy versus pathology sizing (30% vs 19%, P < .001), which may result in lower accuracy. Applying a 10-mm cut-off relevant to guidelines on risk stratification, 7.3% of all adenomas and 28.3% of those 8 to 12 mm in size had discordant endoscopy and pathology size categorization. Depending on which guidelines are applied, 4.8% to 9.1% of individuals had differing risk stratification for surveillance recommendations, with the use of pathology sizing resulting in marginally fewer recommended surveillance colonoscopies.


CONCLUSIONS
Choice of pathology or endoscopy approaches to determine adenoma size will potentially influence surveillance colonoscopy follow-up in 4.8% to 9.1% of individuals. Pathology sizing appears more accurate than endoscopy sizing, and preferential use of pathology size would result in a small, but clinically important, decreased burden on surveillance colonoscopy demand. Careful endoscopy sizing is required for adenomas removed piecemeal.
Department of Histopathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland.
Jennifer L
JL
Taylor
Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
Helen G
HG
Coleman
Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
Ronan T
RT
Gray
Department of Histopathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland; Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland.
Paul J
PJ
Kelly
Department of Pathology, Western Health and Social Care Trust, Altnagelvin Area Hospital, Londonderry, Northern Ireland.
R Iain
RI
Cameron
Department of Cellular and Molecular Pathology, Northern Health and Social Care Trust, Antrim Area Hospital, Antrim, Northern Ireland.
Ciaran J
CJ
O'Neill
Department of Pathology, Southern Health and Social Care Trust, Craigavon Area Hospital, Portadown, Northern Ireland.
Rajeev M
RM
Shah
Public Health Agency, Quality Assurance Reference Centre, Northern Ireland Cancer Screening Programmes, Belfast, Northern Ireland.
Tracy A
TA
Owen
Department of Gastroenterology, Western Health and Social Care Trust, Altnagelvin Area Hospital, Londonderry, Northern Ireland.
William
W
Dickey
Department of Histopathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland; Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland.
Maurice B
MB
Loughrey
D000236:Adenoma / Q000473:pathology*; D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D047368:Tumor Burden