Characteristics of advanced adenomas detected at CT colonographic screening: implications for appropriate polyp size thresholds for polypectomy versus surveillance.

OBJECTIVE Advanced adenomas are the primary target in colorectal screening. The purpose of this study was to delineate the prevalence and imaging characteristics of advanced adenomas detected at screening CT colonography (CTC) and the rates of invasive carcinoma and high-grade dysplasia for various polyp size categories. These observations may be a basis for formulation of polypectomy thresholds and CTC surveillance strategies. MATERIALS AND METHODS The imaging and pathologic findings for polyps measuring 6 mm or more obtained from a CTC screening population of 3,536 persons during a 32-month period were retrospectively reviewed. From this group, prevalence, size, histologic features, morphologic features, and location of advanced adenomas were tabulated. Advanced adenomas were defined by size (> or = 10 mm) and/or histologic findings (prominent villous component or high-grade dysplasia). RESULTS A total of 123 (38.3%) of 321 adenomas measuring 6 mm or more were classified as advanced, the overall prevalence being 3.1% (111 of 3,536 patients). The mean size of advanced adenomas was 16.6 +/- 11.6 mm; most of the lesions (116/123, 94.3%) qualified as advanced on the basis of the size criterion alone. The seven lesions measuring 6-9 mm constituted 3.4% (7/205) of all medium-sized adenomas. The largest percentage (65/123, 52.8%) of the advanced adenomas had tubular histologic features, followed by tubulovillous (50/123, 40.6%), villous (5/123, 4.1%), and serrated (3/123, 2.4%) histologic features. High-grade dysplasia was uncommon (6/123, 4.9%), typically occurring in large lesions. Seven cases of cancer were detected, all lesions measuring 10 mm or more in size. The majority of advanced adenomas were classified as sessile (57/123, 46.3%) or pedunculated (57/123, 46.3%); a small percentage were flat (9/123, 7.3%). Advanced adenomas were located in the proximal colon in 43.9% (54/123) and distal colon in 56.1% (69/123) of the cases. CONCLUSION Advanced adenomas were generally large (> or = 10 mm in size); only a small percentage were medium sized (6-9 mm). There was a very low prevalence of high-grade dysplasia and invasive carcinoma in this series, particularly in the medium-sized group of lesions. These findings lend support to the practice of CTC screening in which large polyp size is used as a surrogate measure for the possible presence of advanced histologic features and medium-sized lesions are followed with noninvasive surveillance protocols.