Columbia University Medical Center, United States of America.
Columbia University Medical Center, United States of America.
Ann Diagn Pathol. 2024 Oct;72:152323. doi: 10.1016/j.anndiagpath.2024.152323. Epub 2024 May 8.
High risk features in colorectal adenomatous polyps include size >1 cm and advanced histology: high-grade dysplasia and villous architecture. We investigated whether the diagnostic rates of advanced histology in colorectal adenomatous polyps were similar among institutions across the United States, and if not, could differences be explained by patient age, polyp size, and/or CRC rate. Nine academic institutions contributed data from three pathologists who had signed out at least 100 colorectal adenomatous polyps each from 2018 to 2019 taken from patients undergoing screening colonoscopy. For each case, we recorded patient age and sex, polyp size and location, concurrent CRC, and presence or absence of HGD and villous features. A total of 2700 polyps from 1886 patients (mean age: 61 years) were collected. One hundred twenty-four (5 %) of the 2700 polyps had advanced histology, including 35 (1 %) with HGD and 101 (4 %) with villous features. The diagnostic rate of advanced histology varied by institution from 1.7 % to 9.3 % (median: 4.3 %, standard deviation [SD]: 2.5 %). The rate of HGD ranged from 0 % to 3.3 % (median: 1 %, SD: 1.2 %), while the rate of villous architecture varied from 1 % to 8 % (median: 3.7 %, SD: 2.5 %). In a multivariate analysis, the factor most strongly associated with advanced histology was polyp size >1 cm with an odds ratio (OR) of 31.82 (95 % confidence interval [CI]: 20.52-50.25, p < 0.05). Inter-institutional differences in the rate of polyps >1 cm likely explain some of the diagnostic variance, but pathologic subjectivity may be another contributing factor.
结直肠腺瘤性息肉的高危特征包括大小>1cm 和高级别组织学：高级别异型增生和绒毛状结构。我们研究了美国各机构诊断结直肠腺瘤性息肉中高级别组织学的诊断率是否相似，如果不相似，患者年龄、息肉大小和/或 CRC 率是否可以解释差异。9 家学术机构提供了至少 3 名病理学家的数据，这些病理学家在 2018 年至 2019 年期间从接受筛查性结肠镜检查的患者中签署了至少 100 份结直肠腺瘤性息肉的诊断报告。对于每个病例，我们记录了患者的年龄和性别、息肉的大小和位置、同时存在的 CRC 以及高级别异型增生和绒毛状特征的存在与否。共收集了来自 1886 名患者的 2700 个息肉（平均年龄：61 岁）。2700 个息肉中有 124 个（5%）有高级别组织学，其中 35 个（1%）有高级别异型增生，101 个（4%）有绒毛状特征。高级别组织学的诊断率因机构而异，范围为 1.7%至 9.3%（中位数：4.3%，标准差[SD]：2.5%）。高级别异型增生的发生率为 0%至 3.3%（中位数：1%，SD：1.2%），而绒毛状结构的发生率为 1%至 8%（中位数：3.7%，SD：2.5%）。在多变量分析中，与高级别组织学最密切相关的因素是息肉大小>1cm，优势比（OR）为 31.82（95%置信区间[CI]：20.52-50.25，p<0.05）。机构间息肉大小>1cm 的比率差异可能解释了部分诊断差异，但病理主观性可能是另一个促成因素。
