OBJECTIVES: The American College of Radiology (ACR) recommends that polyps 5mm in size not be reported on computed tomography (CT) colonography studies. Patients with 1 or 2 polyps 6-9mm in size can be offered CTC surveillance in 3 years in lieu of polypectomy. The aim of the study was to determine the impact of ACR recommendations on resection of high-risk adenoma findings using an endoscopic polyphistology database. METHODS: Excluding patients with inflammatory bowel disease (IBD) and polyposis, 10,034 patients underwent colonoscopy and 10,780 polyps were removed from 5,079 patients over a 5-year interval. High-risk adenoma findings were defined as an advanced adenoma (1cm in size, high-grade dysplasia (HGD), or villous elements) or 3 or more adenomas of any size, per postpolypectomy surveillance recommendations. RESULTS: A total of 5,079 patients (51) had at least 1 polyp, 2,907 (29) had at least 1 adenoma, and 1,001 (10) had high-risk adenoma findings, of these, 293 (29) had either 3 adenomas 5mm in size (n267) or an advanced adenoma 5mm in size (or both) and no polyp of any histology 6mm in size. There were 774 patients with 1 or 2 polyps 6-9mm in size and no polyps of any histology 10mm in size. Of these patients 184 (18 of the patients with high-risk adenomas) had either 3 or more adenomas 9mm in size (n149) or an advanced adenoma 9mm in size (or both findings). There were 2,174 patients age 50 years with the primary indication of screening of whom 326 (15) had high-risk adenoma findings. Of these, 108 (33) had either 3 adenomas 5mm in size or an advanced adenoma 5mm in size and no polyps 6mm in size. An additional 75 (23) had no polyp 10mm in size, 1 or 2 polyps 6-9mm in size and 3 adenomas 9mm in size or an advanced adenoma 9mm in size. CONCLUSIONS: If computed tomographic colonography (CTC) rather than colonoscopy were used in this population, assuming 100 sensitivity of CTC for polyps 6mm and ACR interpretation recommendations, then 29 of all patients and 33 of screening patients age 50 years with high-risk adenoma findings would be interpreted as normal, and an additional 18-23 of these groups with high-risk adenoma findings, respectively, could have polypectomy delayed at least 3 years.
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