Characteristics of Advanced Adenomas Detected at CT Colonographic Screening: Implications for Appropriate Polyp Size Thresholds for Polypectomy Versus Surveillance

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Abstract
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 (≥ 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 ...