Department of Veterans Affairs Medical Center, White River Junction, VT.
The Geisel School of Medicine at Dartmouth College, Hanover, NH.
J Clin Gastroenterol. 2018 Aug;52(7):628-634. doi: 10.1097/MCG.0000000000000899.
Recent data suggest that adenoma size and number are more important predictors of metachronous colorectal neoplasia than advanced histology. Furthermore, there is poor reproducibility in diagnosing advanced histology; high-grade dysplasia and villous histology. Therefore we developed a new metric, adenoma bulk, the sum of diameters of all baseline adenomas, regardless of advanced features.
Compare the predictive value for metachronous advanced neoplasia of adenoma bulk to conventional paradigm.
Data were collected prospectively in a multicenter adenoma-chemoprevention trial (2004 to 2013). For the conventional paradigm, high-risk baseline findings were defined as ≥3 adenomas, large adenomas (≥1 cm) or adenomas with villous components or high-grade dysplasia. Adenoma bulk was examined across quartiles and as a continuous variable. Predictive characteristics (sensitivities, specificities, c-statistics) for metachronous advanced neoplasia using conventional criteria and adenoma bulk were calculated. receiver operator characteristic curves were computed using logistic regression.
In total, 1948 adults had index and follow-up colonoscopies (mean follow-up, 45.2 mo). Those with an adenoma bulk ≥10 mm (4th quartile) had a higher metachronous advanced neoplasia risk (14.4% vs. 6.9-8.2% in lower 3 quartiles; P=0.0002). The c-statistics and sensitivities (specificity fixed at 0.73) for the adenoma bulk and conventional models were 0.587 and 0.563 (P=0.17) and 0.396 and 0.390, respectively.
Categorizing sporadic adenoma patients as high versus low risk for metachronous advanced neoplasia by adenoma bulk of <versus ≥10 mm may be comparably predictive as conventional paradigm and simplifies risk stratification by obviating need for additional histology regarding extent of villous component or degree of dysplasia in resected polyps. The adenoma bulk metric and the 10 mm cutoff in particular would have to be validated in other populations before it can be used in clinical practice.
最近的数据表明，腺瘤的大小和数量比高级别组织学更能预测结直肠腺瘤的异时性新生物。此外，高级别组织学（高级别异型增生和绒毛状组织学）的诊断重复性较差。因此，我们提出了一种新的指标——腺瘤体积，即所有基线腺瘤直径的总和，无论是否具有高级别特征。
比较腺瘤体积与传统模式对异时性高级别新生物的预测价值。
数据是在一项多中心腺瘤化学预防试验（2004 年至 2013 年）中前瞻性收集的。对于传统模式，高危基线发现定义为≥3 个腺瘤、大腺瘤（≥1cm）或具有绒毛成分或高级别异型增生的腺瘤。腺瘤体积在四分位数和连续变量中进行了检查。使用传统标准和腺瘤体积计算异时性高级别新生物的预测特征（敏感性、特异性、c 统计量）。使用逻辑回归计算接收者操作特征曲线。
共有 1948 例成人接受了基线和随访结肠镜检查（平均随访时间 45.2 个月）。腺瘤体积≥10mm（第 4 四分位数）的患者异时性高级别新生物风险较高（14.4%比第 3 四分位数的 6.9%-8.2%；P=0.0002）。腺瘤体积和传统模型的 c 统计量和敏感性（特异性固定为 0.73）分别为 0.587 和 0.563（P=0.17）和 0.396 和 0.390。
通过腺瘤体积<10mm 与≥10mm 将散发性腺瘤患者分为异时性高级别新生物的高风险与低风险，与传统模式相比可能具有相似的预测价值，并通过避免对切除息肉的绒毛成分范围或异型增生程度进行额外的组织学检查来简化风险分层。在该指标在其他人群中得到验证之前，不能将其用于临床实践。
