Clin Endosc.  2018 Sep;51(5):485-490. 10.5946/ce.2017.183.

Mis-sizing of Adenomatous Polyps is Common among Endoscopists and Impacts Colorectal Cancer Screening Recommendations

• Pham T
• Bajaj A
• Berberi L
• Hu C
• Taleban S

• KMID: 2427722
• DOI: http://doi.org/10.5946/ce.2017.183

Abstract

BACKGROUND/AIMS
To determine the accuracy of identifying ≥6-mm adenomatous polyps during colonoscopy and define its impact on subsequent interval screening.
METHODS
We conducted a retrospective study of patients who underwent colonoscopies at Banner University Medical Center, Tucson from 2011 to 2015. All patients with ≥6-mm adenomatous polyps based on their colonoscopy report were included. Adenomatous polyps were excluded if they did not meet the criteria. Discrepancies in the polyp size were determined by calculating the percentage of size variation (SV). Clinical mis-sizing was defined as SV >33%.
RESULTS
The polyps analyzed were predominantly <10 mm in size. Approximately 13% of the examined polyps met the inclusion criteria, and 40.7% of the adenomas were ≥10 mm. A total of 189 ≥6-mm adenomatous polyps were collected from 10 different gastroenterologists and a colorectal surgeon. Adenomatous polyps were clinically mis-sized in 56.6% of cases and overestimated in 71.4%. Among the adenomas reviewed, 22% of mis-sized polyps and 11% of non-mis-sized polyps resulted in an inappropriate surveillance interval.
CONCLUSIONS
We found that more than half of ≥6-mm adenomatous polyps are mis-sized and that there is a tendency to overestimate adenoma size among endoscopists. This frequently leads to inappropriate intervals of surveillance colonoscopy.

Keyword

Polyp size; Endoscopist estimate; Adenomatous polyps

MeSH Terms

Academic Medical Centers
Adenoma
Adenomatous Polyps*
Colonoscopy
Colorectal Neoplasms*
Humans
Mass Screening*
Polyps
Retrospective Studies

Figure

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  Fig. 1. Schematic of polyps that met the study criteria. All polyps included in this study were collected at Banner University Medical Center in Tucson, AZ, USA. Of the reviewed polyps, 12.9% had a reported size and 5% met the criteria for statistical analysis.

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  Fig. 2. Endoscopic evaluation of polyp size. Consistency of polyp size estimate per year. The mean mis-sizing rate per year is 41%.

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  Fig. 3. Percentage of included polyps with clinical mis-sizing (size variation [SV] >33%) per endoscopist. Six of eleven endoscopists had polyps that were clinically mis-sized. SV is defined as follows: (Endoscopic estimate – Pathology measurement) / (Pathology measurement).

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  Fig. 4. Clinical mis-sizing of adenomatous polyps ≥6 mm among different endoscopists. Size variation (SV) is defined as follows: (Endoscopic estimate –Pathology measurement) / (Pathology measurement).

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