From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.).
Radiology. 2024 Jan;310(1):e232078. doi: 10.1148/radiol.232078.
Background The natural history of colorectal polyps is not well characterized due to clinical standards of care and other practical constraints limiting in vivo longitudinal surveillance. Established CT colonography (CTC) clinical screening protocols allow surveillance of small (6-9 mm) polyps. Purpose To assess the natural history of colorectal polyps followed with CTC in a clinical screening program, with histopathologic correlation for resected polyps. Materials and Methods In this retrospective study, CTC was used to longitudinally monitor small colorectal polyps in asymptomatic adult patients from April 1, 2004, to August 31, 2020. All patients underwent at least two CTC examinations. Polyp growth patterns across multiple time points were analyzed, with histopathologic context for resected polyps. Regression analysis was performed to evaluate predictors of advanced histopathology. Results In this study of 475 asymptomatic adult patients (mean age, 56.9 years ± 6.7 [SD]; 263 men), 639 unique polyps (mean initial diameter, 6.3 mm; volume, 50.2 mm) were followed for a mean of 5.1 years ± 2.9. Of these 639 polyps, 398 (62.3%) underwent resection and histopathologic evaluation, and 41 (6.4%) proved to be histopathologically advanced (adenocarcinoma, high-grade dysplasia, or villous content), including two cancers and 38 tubulovillous adenomas. Advanced polyps showed mean volume growth of +178% per year (752% per year for adenocarcinomas) compared with +33% per year for nonadvanced polyps and -3% per year for unresected, unretrieved, or resolved polyps ( < .001). In addition, 90% of histologically advanced polyps achieved a volume of 100 mm and/or volume growth rate of 100% per year, compared with 29% of nonadvanced and 16% of unresected or resolved polyps ( < .001). Polyp volume-to-diameter ratio was also significantly greater for advanced polyps. For polyps observed at three or more time points, most advanced polyps demonstrated an initial slower growth interval, followed by a period of more rapid growth. Conclusion Small colorectal polyps ultimately proving to be histopathologically advanced neoplasms demonstrated substantially faster growth and attained greater overall size compared with nonadvanced polyps. Clinical trial registration no. NCT00204867 © RSNA, 2024 See also the editorial by Dachman in this issue.
背景 由于临床护理标准和其他限制体内纵向监测的实际限制，结直肠息肉的自然史尚不清楚。已建立的 CT 结肠成像（CTC）临床筛查方案允许监测小（6-9mm）息肉。目的 在临床筛查计划中使用 CTC 评估结直肠息肉的自然史，并对切除的息肉进行组织病理学相关性分析。材料与方法 本回顾性研究于 2004 年 4 月 1 日至 2020 年 8 月 31 日对无症状成年患者进行 CTC 纵向监测小的结直肠息肉。所有患者均至少接受两次 CTC 检查。分析了多个时间点的息肉生长模式，并对切除的息肉进行了组织病理学分析。对预测高级组织病理学的因素进行了回归分析。结果 在这项针对 475 名无症状成年患者（平均年龄 56.9 岁±6.7[标准差]；263 名男性）的研究中，对 639 个独特的息肉（平均初始直径 6.3mm；体积 50.2mm）进行了平均 5.1 年±2.9 的随访。在这 639 个息肉中，398 个（62.3%）进行了切除和组织病理学评估，41 个（6.4%）被证实为组织病理学上的高级病变（腺癌、高级别异型增生或绒毛内容物），包括 2 例癌症和 38 例管状绒毛状腺瘤。高级息肉的平均体积增长率为每年+178%（腺癌为每年+752%），而非高级息肉的平均体积增长率为每年+33%，未切除、未检索或已解决的息肉的平均体积增长率为每年-3%（ <.001）。此外，90%的组织学上的高级息肉的体积达到 100mm，体积增长率达到每年 100%，而非高级息肉和未切除或已解决的息肉分别为 29%和 16%（ <.001）。高级息肉的息肉体积与直径比也明显更大。对于观察到 3 个或更多时间点的息肉，大多数高级息肉显示出初始较慢的生长间隔，随后是更快的生长阶段。结论 最终被证实为组织学上的高级肿瘤的小结直肠息肉的生长速度明显更快，并且总体尺寸更大。临床试验注册号 NCT00204867 © RSNA，2024 也可参见本期 Dachman 的社论。
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