Histological assessment of colorectal adenomas by size. Are polyps less than 10 mm in size clinically important?

• Published in: The European journal of surgery Vol. 167; no. 10; pp. 777 - 781
• Main Authors: Aldridge, Andrew J., Simson, Jay N. L.
• Format: Journal Article
• Language: English
• Published: UK Taylor & Francis, Ltd 01.10.2001; Taylor & Francis
• Subjects: adenoma; Adenoma - pathology; Adult; Age Distribution; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy, Needle; colonic polyp; Colonic Polyps - epidemiology; Colonic Polyps - pathology; Colonic Polyps - surgery; Colonoscopy; colorectal cancer; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Confidence Intervals; dysplasia; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Immunohistochemistry; Incidence; Male; Medical sciences; Middle Aged; polypectomy; Precancerous Conditions - pathology; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Factors; Severity of Illness Index; Sex Distribution; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors; Human; Dysplasia; Rectal disease; Size; Surgical resection; Adenoma; Colonic disease; Treatment; Surgery; Malignant transformation; Risk factor; Rectum; Digestive diseases; Intestinal disease; Benign neoplasm; Colon; Polyp
• ISSN: 1102-4151; 1741-9271
• DOI: 10.1080/11024150152707770

Objective: To define the relative risk of malignant transformation in colorectal adenomas less than 10 mm in diameter. Design: Prospective study. Setting: District general hospital, UK. Subjects and materials: 1228 polyps detected endoscopically in 445 patients over the 10‐year period 1989–1999. Main outcome measures: Site, size, histological type and dysplastic grade of polyp. Results: 657 of the 1228 polyps were adenomas: 281 (43%) tubular, 339 (51%) tubulovillous and 37 (6%) villous. In the 357 adenomas less than 10 mm in diameter, 11 (3%) were severely dysplastic and 2 carcinomas were detected, though neither was less than 5 mm in size. The relative risk of malignancy or severe dysplasia in adenomas of 10 mm or more compared with those of less than 10 mm was 3.8 (p < 0.0001). Conclusions: Although severe dysplasia and malignancy do occur in adenomas less than 10 mm in size, they are rare in lesions of less than 5 mm. We recommend routine destruction of all polyps 5 mm or more in size, though it is not essential to remove those of less than 5 mm if they are kept under surveillance. Copyright © 2001 Taylor and Francis Ltd.