PHILADELPHIA — A finding of three or more adenomas on colonoscopy was the strongest predictor of identifying high-risk individuals on follow-up colonoscopy in a review of 800 patients with colonic adenomas identified during their baseline examination. Those are individuals that harbor more than two large or histologically advanced neoplasms.
“When doing colonoscopy, we must be diligent about identifying synchronous neoplasia, regardless of size, in order to identify high-risk people” who need more frequent colonoscopy exams, Dr. Carol A. Burke said at the annual meeting of the American College of Gastroenterology.
An adenoma count of three or more was a stronger predictor of having numerous or advanced adenomas on the next colonoscopy, which was more important than adenomas 1 cm or greater in size of advanced pathology, said Dr. Burke, director of the Center for Colon Polyps and Cancer Prevention at the Cleveland Clinic.
For colonic adenomas, “what's important is number, number, number,” she said in an interview.
Her study compiled data from the placebo groups of three postpolypectomy chemoprevention trials that were conducted during the mid-1980s to late 1990s. For inclusion in the new analysis, patients could not have colorectal cancer at baseline, and they had to have a follow-up colonoscopy about 3 years after they entered one of the included trials.
A total of 800 patients met these criteria, and their average age was 60 years. Follow-up colonoscopy was done an average of 37 months after the baseline examination.
Demographic and clinical findings during the baseline colonoscopy were assessed as predictors of identifying a high-risk individual on follow-up colonoscopy after 3 years. Those individuals have either advanced adenomas or more than two adenomas on the second colonoscopy. In both the univariate and multivariate analyses, more than two adenomas was the only predictor of both advanced neoplasms (defined as those that were 1 cm or greater in size and had significant villous pathology) or more than two adenomas on follow-up.
The take-home message from these findings is that physicians should not discount the importance of detecting numerous adenomas, regardless of size on colonoscopy, Dr. Burke said.
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