A detailed study of colon polyps

Česká verzia

Authors: J. Špičák ¹; M. Beneš ¹; T. Hucl ¹; P. Štirand ¹; P. Drastich ¹ ; P. Wohl ¹; D. Kamenář ¹; M. Kliment ³; E. Kundratová ³; O. Urban ³; J. Pintová ⁴ ; J. Pícha ⁴; Š. Suchánek ²; V. Želízko ²; M. Štefanová ²; M. Řehoř ⁴; V. Nosek ⁴ ; M. Zavoral ²
Authors place of work: Klinika hepatogastroenterologie IKEM Praha, přednosta prof. MUDr. Julius Špičák, DrSc. ¹; Interní klinika 1. lékařské fakulty UK a ÚVN Praha, přednosta prof. MUDr. Miroslav Zavoral, Ph. D. ²; Centrum péče o zažívací trakt Vítkovické nemocnice, a. s., Ostrava-Vítkovice, přednosta prim. MUDr. Ondřej Urban, Ph. D. ³; Oddělení gastroenterologie Nemocnice Jablonec nad Nisou, přednosta prim. MUDr. Vladimír Nosek ⁴
Published in the journal: Vnitř Lék 2012; 58(1): 18-23
Category: Original Contributions

Summary

Introduction, study aim:
Colorectal carcinoma is one of the most frequent malignancies. Most frequently, neoplasms, including malignant precursors, are in the form of polyps, although these might be of a non-tumour origin. The aim of this prospective multicentre study was to provide an overview of coloscopic identification and biological nature of polyps.

Results:
3,400 consecutive coloscopies performed between 2009 and 2010 were analyzed. At different centres, the top of the cecum was reached in 89% to 93% and terminal ileum in 73% to 87% of cases. In the above 40 age group, 26.6% were screening coloscopies. The mean age of the above 40 patients was 56 years. The incidence of potential neoplastic lesions (polyps, carcinomas), advanced adenomas and carcinomas were: 7.8 %, 0.8 % and 0.16 %, respectively, in the above 40 age group, 41.5 %, 9.8 % and 1.6 %, respectively, in the 40–50 years age group and 70.5 %, 31.3 % and 6.8 %, respectively, in the above 50 age group. The incidence of tubular adenoma and hyperplastic polyps was 23.9% and 66.2%, respectively, in the below 40 age group and 53.1% and 26.1% in the above 50 age group. 57.8% of advances neoplasms were located in the rectosigmoid a descendent colon. The incidence ratio for adenomas and hyperplastic polyps was 76.6% and 14%, respectively, for rectosigmoid colon, 63.6 and 17.4 %, respectively, for descendent colon, 63.6 and 11.4 % for traverse colon and 63,4 a 17,9 %, respectively, for cecum and ascendant colon. The incidence of tubulovillous adenomas and hyperplastic polyps in pedunculated polyps larger than 1 cm was 19.4 % and 20.4 %, respectively, and 34.2 % and 13.1 %, respectively, in other polyps. The incidence of potential lesions (polyps and carcinomas), advanced adenomas, carcinomas and advanced neoplasms was 66.7 %, 23.1 %, 5.8 % and 28.9 %, respectively, in women and 63.1 %, 30.0 %, 5.7 % and 34.7 %, respectively, in men.

Conclusion:
The top of the cecum was reached in a higher proportion of cases than required, although this was lower than in the majority of other recent studies. Terminal ileum was reached in high number of cases. The incidence of polyps and neoplasms rose sharply from 40 years of age. Therefore, the screening threshold should be extended to the below 50 age group. Hyperplastic polyps predominated in younger age and adenomas in the above 40 age group. Histological profile was similar and did not suggest importantly different pathogenesis with respect to localization. There were relatively fewer adenomas and more hyperplastic polyps in pedunculated polyps and vice verse in other types of polyps, suggesting a higher risk associated with non-pedunculated lesions. Both sexes differed less than suggested based on epidemiological statistics.

Key words:
carcinoma – advanced adenoma – polyp – screening colposcopy

Zdroje

1. Špičák J, Štirand P, Drastich P et al. Postavení a výtěžnost koloskopie v rámci screeningového programu založeného na testu na okultní krvácení (TOK) ve stolici. Čes a Slov Gastroent a Hepatol 2010; 64: 4–9.

2. Regula J, Rupinski M, Kraszewska E et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med 2006; 355: 1863–1872.

3. Kaminski MF, Kraszewska E, Polkowski M et al. Continuous quality improvement of screening colonoscopy: data from a large colorectal cancer screening program. Gut 2009; 58 (Suppl 8): A369.

4. Maar C. Increasing public acceptance for CRC screening through public relation campaigns and networking. Z Gastroenterol 2008; 46 (Suppl 1): S35–S37.

5. Adler A, Roll S, Marowski B et al. Appropriateness of colonoscopy in the era of colorectal cancer screening: a prospective, multicenter study in a private-practice setting (Berlin Colonoscopy Project 1, BECOP 1). Dis Colon Rectum 2007; 50: 1628–1638.

6. Johnson DA, Gurney MS, Volpe RJ et al. A prospective study of the prevalence of colonic neoplasms in asymptomatic patients with an age-related risk. Am J Gastroenterol 1990; 85: 969–974.

7. Rex DK, Khan AM, Shah P et al. Screening colonoscopy in asymptomatic average-risk African Americans. Gastrointest Endosc 2000; 51: 524–527.

8. Prajapati DN, Saeian K, Binion DG et al. Volume and yield of screening colonoscopy at a tertiary medical center after change in medicare reimbursement. Am J Gastroenterol 2003; 98: 194–199.

9. Imperiale TF, Ransohoff DF, Itzkowitz SH et al. Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population. N Engl J Med 2004; 351: 2704–2714.

10. Pickhardt PJ, Choi JR, Hwang I et al. Nonadenomatous polyps at CT colonography: prevalence, size distribution, and detection rates. Radiology 2004; 232: 784–790.

11. Kim DH, Pickhardt PJ, Taylor AJ et al. CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 2007; 357: 1403–1412.

12. Johnson CD, Chen MH, Toledano AY et al. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 2008; 359: 1207–1217.

13. Regge D, Laudi C, Galatola G et al. Diagnostic accuracy of computed tomographic colonography for the detection of advanced neoplasia in individuals at increased risk of colorectal cancer. JAMA 2009; 301: 2453–2461.

14. Lewis JD, Ng K, Hung KE et al. Detection of proximal adenomatous polyps with screening sigmoidoscopy: a systematic review and meta-analysis of screening colonoscopy. Arch Intern Med 2003; 163: 413–420.

15. Dušek L, Mužík J, Kubásková M et al. Epidemiologie zhoubných nádorů v České republice (online). Brno: Masarykova universita. Dostuné na: http//www.svod.cz.

16. Hofstad B. Colon polyps: prevalence rates, incidence rates, and growth rates. In: Waye JD, Rex DK, Williams CB (eds). Colonoscopy: Principles and Practice. 2nd ed. New York: Willey-Blackwell 2009: 358–378.

17. Brenner H, Hoffmeister M, Arndt V et al. Gender differences in colorectal cancer: implications for age at initiation of screening. Br J Cancer 2007; 96: 828–831.

18. Schreiner MA, Weiss DG, Lieberman DA. Proximal and large hyperplastic and nondysplastic serrated polyps detected by colonoscopy are associated with neoplasia. Gastroenterology 2010; 139: 1497–1502.

19. Frič P, Zavoral M, Dvořáková H et al. An adapted program of colorectal cancer screening – 7 years experience and cost-benefit analysis. Hepatogastroenterology 1994; 41: 413–416.

20. Suchánek S, Zavoral M, Majek O et al. National colorectal cancer screening programe in the Czech republic. Gut 2010; 59 (Suppl 3): A84.