Predicting Advanced Proximal Colonic Neoplasia With Screening Sigmoidoscopy
CONTEXT Indications are not well defined for follow-up colonoscopy for all patients with distal colonic tubular adenomas (TAs) found at screening sigmoidoscopy. OBJECTIVE To determine whether distal adenoma size, number, and villous histology, along with family history and age, are predictors of adv...
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Published in | JAMA : the journal of the American Medical Association Vol. 281; no. 17; pp. 1611 - 1617 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Chicago, IL
American Medical Association
05.05.1999
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Subjects | |
Online Access | Get full text |
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Summary: | CONTEXT Indications are not well defined for follow-up
colonoscopy for all patients with distal colonic tubular adenomas (TAs)
found at screening sigmoidoscopy. OBJECTIVE To determine whether distal adenoma size, number, and
villous histology, along with family history and age, are predictors of
advanced proximal colonic neoplasia. DESIGN Cross-sectional analysis conducted between January 1, 1994,
and December 31, 1995. SETTING Large group-model health maintenance organization in
northern California. PATIENTS A total of 2972 asymptomatic subjects aged 50 years or
older undergoing colonoscopy as follow-up to a screening sigmoidoscopy. MAIN OUTCOME MEASURE Based on sigmoidoscopy, colonoscopy, and
pathology reports, occurrence of advanced proximal neoplasia, defined
as adenocarcinoma or TAs 1 cm or larger or with villous features or
severe dysplasia located beyond sigmoidoscopic view. RESULTS The prevalence of advanced proximal neoplasia was
similar among patients with no TAs at sigmoidoscopy, those with TAs
less than 1 cm in diameter, and those with TAs 1 cm in diameter or
larger (prevalence, 5.3%, 5.5%, and 5.6%, respectively). Of patients
with a distal tubulovillous or villous adenoma, 12.1% had advanced
proximal neoplasia. In multivariate analyses, having a distal
tubulovillous adenoma or villous adenoma was the strongest predictor of
advanced proximal neoplasia (odds ratio, 2.30; 95% confidence
interval, 1.69-3.14). Age of 65 years or older, having more than 1
adenoma, and a positive family history of colorectal cancer were also
significant predictors. Distal adenoma size was not a significant
predictor in any multivariate analyses. CONCLUSIONS Advanced proximal neoplasia is not uncommon in
subjects with or without distal TAs, but subjects with advanced distal
histology and those older than 65 years are at increased risk.
Age-specific screening using sigmoidoscopy starting at ages 50 to 55
years and colonoscopy after age 65 years may be justified. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0098-7484 1538-3598 |
DOI: | 10.1001/jama.281.17.1611 |