Location of Incident Colonic Neoplasia According to Patient Age: Implications for Screening Colonoscopy Behavior (original) (raw)
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Gastrointestinal Endoscopy, 2004
Background: For colorectal cancer screening, the predictive value of distal findings in the ascertainment of proximal lesions is not fully established. The aims of this study were to assess distal findings as predictors of advanced proximal neoplasia and to compare the predictive value of endoscopy alone vs. combined endoscopic and histopathologic data. Methods: Primary colonoscopy screening was performed in 2210 consecutive, average-risk adults. Age, gender, endoscopic (size, number of polyps), and histopathologic distal findings were used as potential predictors of advanced proximal neoplasms (i.e., any adenoma $1 cm in size, and/or with villous histology, and/or with severe dysplasia or invasive cancer). Polyps were defined as distal if located in the descending colon, the sigmoid colon, or the rectum. Those in other locations were designated proximal. Results: Neoplastic lesions, including 11 invasive cancers, were found in 617 (27.9%) patients. Advanced proximal neoplasms without any distal adenoma were present in 1.3% of patients. Of the advanced proximal lesions, 39% were not associated with any distal polyp. Older age, male gender, and distal adenoma were independent predictors of advanced proximal neoplasms. The predictive ability of a model with endoscopic data alone did not improve after inclusion of histopathologic data. In multivariate logistic regression analysis, the predictive ability of models that use age, gender, and any combination of distal findings was relatively low. The proportion of advanced proximal neoplasms identified if any distal polyp was an indication for colonoscopy was only 62%. Conclusions: A strategy in which colonoscopy is performed solely in patients with distal colonic findings is not effective screening for the detection of advanced proximal neoplasms in an averagerisk population. Screening colonoscopy: distal colonic polyps and advanced proximal neoplasia M Bet e es Ib a añ nez, M Muñ noz-Navas, J Duque, et al. PPV, Positive predictive value; CI, confidence interval. VOLUME 59, NO. 6, 2004 GASTROINTESTINAL ENDOSCOPY 637 Screening colonoscopy: distal colonic polyps and advanced proximal neoplasia M Bet e es Ib a añ nez, M Muñ noz-Navas, J Duque, et al. VOLUME 59, NO. 6, 2004 GASTROINTESTINAL ENDOSCOPY 639 Screening colonoscopy: distal colonic polyps and advanced proximal neoplasia M Bet e es Ib a añ nez, M Muñ noz-Navas, J Duque, et al. VOLUME 59, NO. 6, 2004 GASTROINTESTINAL ENDOSCOPY 641
JNCI Journal of the National Cancer Institute, 2013
Background Screening for colorectal cancer with sigmoidoscopy benefits from the fact that distal findings predict the risk of advanced proximal neoplasms (APNs). This study was aimed at comparing the existing strategies of postsigmoidoscopy referral to colonoscopy in terms of accuracy and resources needed. Methods Asymptomatic individuals aged 50-69 years were eligible for a randomized controlled trial designed to compare colonoscopy and fecal immunochemical test. Sigmoidoscopy yield was estimated from results obtained in the colonoscopy arm according to three sets of criteria of colonoscopy referral (from those proposed in the UK Flexible Sigmoidoscopy, Screening for COlon REctum [SCORE], and Norwegian Colorectal Cancer Prevention [NORCCAP] trials). Advanced neoplasm detection rate, sensitivity, specificity, and number of individuals needed to refer for colonoscopy to detect one APN were calculated. Logistic regression analysis was performed to identify distal findings associated with APN. All statistical tests were two-sided. Results APN was found in 255 of 5059 (5.0%) individuals. Fulfillment of UK (6.2%), SCORE (12.0%), and NORCCAP (17.9%) criteria varied statistically significantly (P < .001). The NORCCAP strategy obtained the highest sensitivity for APN detection (36.9%), and the UK approach reached the highest specificity (94.6%). The number of individuals needed to refer for colonoscopy to detect one APN was 6 (95% confidence interval [CI] = 4 to 7), 8 (95% CI = 6 to 9), and 10 (95% CI = 8 to 12) when the UK, SCORE, and NORCCAP criteria were used, respectively. The logistic regression analysis identified distal adenoma ≥10 mm (odds ratio = 3.77; 95% CI = 2.52 to 5.65) as the strongest independent predictor of APN. Conclusions Whereas the NORCCAP criteria achieved the highest sensitivity for APN detection, the UK recommendations benefited from the lowest number of individuals needed to refer for colonoscopy.
Gastroenterology, 2003
Background and aims: The purpose of this study was to evaluate the utility of easily measured clinical variables at flexible sigmoidoscopy (FS) screening that might predict a proximal advanced neoplasm (PAN). Methods: We studied 1833 subjects with biopsy verified adenomas at FS who subsequently underwent full colonoscopy. Results: A total of 387 (21%) subjects had proximal colonic neoplasms (PCN) and 85 (5%) had PAN. In univariate comparison, the risk of PAN increased more than threefold in the presence of a distal adenoma measuring either >10 mm in diameter or containing villous components. Multiplicity of distal adenomas, severe dysplasia, or age >60 years increased the risk of PAN more than twofold. In the multivariate model, the presence of a distal adenoma >10 mm, villousness, and multiplicity maintained their significance as predictive variables for increased risk of proximal neoplasms, whereas sex and severe dysplasia lost their significance. By recommending colonoscopy only to individuals with multiple (>1) adenomas or any high risk adenoma at FS, we would have reduced the number of colonoscopies by 1209 (66%) but would have missed 32 (38%) participants with PAN and 217 (56%) with PCN. By using a 60 cm endoscope instead of an ordinary colonoscope at FS, nine (2%) participants with advanced neoplasms, including three patients with cancer, would have been missed. Conclusion: The present study supports the concept of defining "any adenoma" as a positive FS, qualifying for colonoscopy. We recommend the use of an ordinary colonoscope instead of a 60 cm sigmoidoscope for FS screening examinations.
Distal colonic neoplasms predict proximal neoplasia in average-risk, asymptomatic subjects
Journal of Gastroenterology and Hepatology, 1999
polyps up to 9 mm in size unresected. 4 However, the controversy surrounding this issue continued with the finding by Read et al. that in asymptomatic, average-risk subjects with rectosigmoid adenomas up to 1 cm in size there was a 30% prevalence of proximal neoplasms at colonoscopy and up to 10% prevalence of advanced proximal neoplasms, including early stage carcinoma. 5 This issue has important implications for FS-based colorectal cancer screening programmes. Increasing the number of colonoscopies which result from screening FS increases the cost of screening. The aims of this study were to evaluate, in asymptomatic, average-risk subjects: (i) the risk of having proximal neoplasms in those with distal colonic lesions; and (ii) whether the
Background & Aims Few studies have evaluated long-term outcomes of ongoing colonoscopic screening and surveillance in a screening population. We aimed to determine the 10-year risk for advanced neoplasia (defined as adenomas ≥10mm, adenomas with villous histology or high-grade dysplasia, or colorectal cancer [CRC]) and assessed whether baseline colonoscopy findings were associated with long-term outcomes. Methods We collected data from the Department of Veterans Affairs Cooperative Studies Program Study on 3121 veterans asymptomatic veterans (50-75 years old) who underwent a screening colonoscopy from 1994 through 1997 at 13 medical centers and were then followed for 10 years or until death. We included 1915 subjects with at least 1 surveillance colonoscopy and estimated cumulative incidence of advanced neoplasia Kaplan-Meier curves. We then fit a longitudinal joint model to estimate risk of advanced neoplasia at each subsequent examination, adjusting for multiple colonoscopies within individuals. Results Through 10 years of follow up, there were 146 individuals among all baseline colonoscopy groups found to have at least 1 incident advanced neoplasia. The cumulative 10-year incidence of advanced neoplasia was highest among those with baseline CRC (43.7%; 95% CI, 13.0%-74.4%), followed by those with baseline AA (21.9%; 95% CI, 15.7, 28.1). The cumulative 10-year incidence of advanced neoplasia was 6.3% (95% CI, 4.1%-8.5%) and 4.1% (95% CI, 2.7%-5.4%) for baseline 1-2 adenomas and no neoplasia, respectively (log-rank P=.10). After adjusting for prior surveillance, the risk of advanced neoplasia at each surveillance examination was not significantly increased in veterans with 1 or 2 small adenomas at baseline (odds ratio, 0.96; 95% CI, 0.67-1.41) compared to veterans with no baseline neoplasia. Conclusions Baseline screening colonoscopy findings associate with advanced neoplasia within 10 years. Individuals with only 1 or 2 small adenomas at baseline have a low risk of advanced neoplasia over 10 years. Alternative surveillance strategies, such as the use of non-invasive CRC screening modalities, could be considered for these individuals.
Gut, 1999
Background-Most cases of colorectal cancer originate from adenomas. Removing adenomas has been shown to reduce the incidence of colorectal cancer. The design of cost eVective endoscopic screening programmes requires a knowledge of the distribution of adenomas in diVerent age groups. Aim-To investigate the distribution of colorectal adenomas in older age groups in the normal population. Method-A total of 356 men and women selected randomly from the population register were oVered a colonoscopic screening examination to detect and remove polyps. Results-In all, 241(68%) subjects, mean age 67.4 years (range 62-73), attended. The caecum was intubated in 193 (80%), and in this group 32 (38%) women and 51 (47%) men had adenomas. One hundred and ten (54%) of the adenomas and 11 (39%) of the "high risk adenomas" (adenomas larger than 10 mm in diameter, adenomas containing villous components, and adenomas with severe dysplasia) were found proximal to the sigmoid colon. In 36 (43%) of the subjects with adenomas, the adenomas were only found proximal to the sigmoid colon. Twenty two (11%) subjects had more than two adenomas. Of 203 adenomas discovered, 189 (93%) were less than 10 mm in diameter. Conclusion-More than half of the adenomas were localised proximal to the sigmoid colon, and, in nearly half of the adenoma bearing subjects examined, the adenoma was proximal to the descending colon. This indicates that a sigmoidoscopic screening examination in this age group would miss a substantial number of adenomas, but this may be acceptable as the vast majority of proximal adenomas do not progress to clinical cancer within the life expectancy of this age group.
Age and site of Colonic Neoplastic Lesions: Implications of screening in South Asia
Pakistan Journal of Medical Sciences, 1969
Objective: To evaluate the Age of patients and the site of Colonic Neoplastic Lesions (CNL) and to determine the appropriate screening strategy for Colorectal Carcinoma (CRC) (sigmoidoscopy versus colonoscopy) in our population. Methods: This is a cross sectional study. Data of all patients more than 16 years of age who underwent full colonoscopic examination at the Aga Khan University hospital between January 2011 till December 2013 and were diagnosed to have CRC or advanced adenomas (defined as polyp more than 1 cm and/or having villous morphology on histology) was recorded. Lesions found distal to the splenic flexure were characterized as distal lesions and while lesions found between the splenic flexure and the cecum were characterized as proximal lesions. Results: During the study period colonic neoplastic lesions were found in 217 patients; 186 (85.7%) patients had CRC and 31(14.3%) patients had advanced adenomatous polyps. Mean age was 55.8±14 years and amongst them 72 (33.2%) patients were less than 50 years of age while 145 (66.8%) were more than 50 years. In 144 (66.4%) patients lesions were located in the distal colon, 65 (30%) had lesions in the proximal colon while in 8 (3.7%) patients the neoplastic lesions were found both in the proximal and distal colon. The predominant symptoms were bleeding per rectum in 39.6% of patients followed by weight loss in 31.8% of patients. Only 3 patients had familial syndromes with multiple polyps. When patients younger than 50 years of age were compared with patients more than 50 years there was no statistically significant difference between the site of neoplastic lesion as well as the presenting symptoms. (p value 0.85). Conclusion: Colonic Neoplastic Lesions presented at younger age in our study population and one third of the lesions were found in the right sided colon. Hence screening for CNLs should be implied at an earlier age preferably with colonoscopy. More population based data is required to further validate our results.