4.8 Article

A Comparison of Risk Classification Systems of Colorectal Adenomas: A Case-Cohort Study

Journal

GASTROENTEROLOGY
Volume 165, Issue 2, Pages 483-+

Publisher

W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.gastro.2023.04.028

Keywords

Colorectal Cancer; Screening; Surveillance; Adenoma; Case-Cohort

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By comparing three different adenoma classification systems, we found that using the ESGE 2020 and novel risk classifications can substantially reduce resources needed for colonoscopy surveillance after adenoma removal.
BACKGROUND & AIMS: Because post-polypectomy surveil-lance uses a growing proportion of colonoscopy capacity, more targeted surveillance is warranted. We therefore compared surveillance burden and cancer detection using 3 different adenoma classification systems. METHODS: In a case-cohort study among individuals who had adenomas removed between 1993 and 2007, we included 675 in-dividuals with colorectal cancer (cases) diagnosed a median of 5.6 years after adenoma removal and 906 randomly selected individuals (subcohort). We compared colorectal cancer inci-dence among high-and low-risk individuals defined according to the traditional (high-risk: diameter >10 mm, high-grade dysplasia, villous growth pattern, or 3 or more adenomas), European Society of Gastrointestinal Endoscopy (ESGE) 2020 (high-risk: diameter >10 mm, high-grade dysplasia, or 5 or more adenomas), and novel (high-risk: diameter >20 mm or high-grade dysplasia) classification systems. For the different classification systems, we calculated the number of in-dividuals recommended frequent surveillance colonoscopy and estimated number of delayed cancer diagnoses. RESULTS: Four hundred and thirty individuals with adenomas (52.7%) were high risk based on the traditional classification, 369 (45.2%) were high risk based on the ESGE 2020 classification, and 220 (27.0%) were high risk based on the novel classifica-tion. Using the traditional, ESGE 2020, and novel classifications, the colorectal cancer incidences per 100,000 person-years were 479, 552, and 690 among high-risk individuals, and 123, 124, and 179 among low-risk individuals, respectively. Compared with the traditional classification, the number of individuals who needed frequent surveillance was reduced by 13.9% and 44.2%, respectively, and 1 (3.4%) and 7 (24.1%) cancer diagnoses were delayed using the ESGE 2020 and novel classifications. CONCLUSIONS: Using the ESGE 2020 and novel risk classifica-tions will substantially reduce resources needed for colonoscopy surveillance after adenoma removal.

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