Debate: Diminutive Polyps Noted at CT Colonography Need Not Be Reported

Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA.
Gastrointestinal endoscopy clinics of North America 04/2010; 20(2):227-37. DOI: 10.1016/j.giec.2010.02.002
Source: PubMed


Colorectal polyps less than 6 mm in size pose a negligible risk to the development of colorectal carcinoma. The sensitivity and specificity for detection of diminutive lesions on all available examinations including CT colonography (CTC) and optical colonoscopy (OC) is relatively low. In the context of regular screening, the low clinical significance and slow to negligible growth of diminutive polyps, as well as the low detection performance of CTC and OC for these lesions, would contribute to wasted health care resource and excess morbidity if each diminutive polyp were referred for potential resection. Respect for patient safety, attention to proper use of resources, and appropriate focus on larger, clinically significant polyps lead the authors to the conclusion that colonic polyps of less than 6 mm should not be separately reported.

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    • "While the clinical implications and optimal management of small polyps are controversial [23,24], several lines of evidence indicate that detection of small polyps may result in long-term benefits for patients [12,25]. In a close follow-up of 30 polyps during 2 years, the mean tubular adenoma growth rate was 0.58 mm/year and 3 tubular adenomas had growth rates >2 mm/year [26]. "
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    ABSTRACT: The majority of recent cost-effectiveness reviews concluded that computerised tomographic colonography (CTC) is not a cost-effective colorectal cancer (CRC) screening strategy yet. The objective of this review is to examine cost-effectiveness of CTC versus optical colonoscopy (COL) for CRC screening and identify the main drivers influencing cost-effectiveness due to the emergence of new research. A systematic review was conducted for cost-effectiveness studies comparing CTC and COL as a screening tool and providing outcomes in life-years saved, published between January 2006 and November 2012. Nine studies were included in the review. There was considerable heterogeneity in modelling complexity and methodology. Different model assumptions and inputs had large effects on resulting cost-effectiveness of CTC and COL. CTC was found to be dominant or cost-effective in three studies, assuming the most favourable scenario. COL was found to be not cost effective in one study. CTC has the potential to be a cost-effective CRC screening strategy when compared to COL. The most important assumptions that influenced the cost-effectiveness of CTC and COL were related to CTC threshold-based reporting of polyps, CTC cost, CTC sensitivity for large polyps, natural history of adenoma transition to cancer, AAA parameters and importantly, adherence. There is a strong need for a differential consideration of patient adherence and compliance to CTC and COL. Recent research shows that laxative-free CTC screening has the potential to become a good alternative screening method for CRC as it can improve patient uptake of screening.
    European journal of radiology 08/2013; 82(11). DOI:10.1016/j.ejrad.2013.07.019 · 2.37 Impact Factor
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