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. 2024 Feb 12:14:1294745.
doi: 10.3389/fonc.2024.1294745. eCollection 2024.

The absolute number of small and diminutive adenomas with high-grade dysplasia is substantially higher compared with large adenomas: a retrospective pooled study

Jiancheng Zhang #  1 , Huajun Sun #  2 , Fei Xiong #  1 , Shan Lei  1 , Guanyu Zhou  1 , Xun Xiao  1 , Lin Liu  3 , Pu Wang  1
Affiliations

The absolute number of small and diminutive adenomas with high-grade dysplasia is substantially higher compared with large adenomas: a retrospective pooled study

Jiancheng Zhang et al. Front Oncol. .

Abstract

Introduction: The risk that a large polyp (≥10 mm) evolves into high-grade dysplasia (HGD) is relatively high compared with that of a small/diminutive polyp (<10 mm). Recently, the detection of small and diminutive polyps has been substantially improved with the advancement of endoscopy. However, further research is needed on the role of the incidence of HGD caused by the co-occurrence of small and diminutive polyps in the progression of HGD. In this study, we aim to investigate whether and how the small and diminutive polyps correlate with the incidence of HGD in the population.

Methods: The pooled data were deeply analyzed from four published randomized controlled trials (RCTs) regarding colon polyp detection. All polyps detected were examined and confirmed by pathologists. The primary outcome was the composition ratio of the HGD polyps in each polyp size category.

Results: Among a total of 3,179 patients with 2,730 polyps identified, there were 83 HGD polyps confirmed, and 68 patients had at least one polyp with HGD. The risk of development of HGD was lower for a single small and diminutive polyp than for one large polyp (2.18% vs. 22.22%, P < 0.0001). On the contrary, the composition ratio for HGD from small and diminutive polyps was significantly higher than that from the large ones (68.67% vs. 31.33%, P < 0.0001). The combined number of HGD presented a trend negatively correlated to size.

Conclusions: Our data demonstrated that the absolute number of HGD significantly derives more from small and diminutive polyps than from the large ones, and the collective number of small and diminutive polyps per patient is indicative of his/her HGD exposure. These findings positively provide novel perspectives on the management of polyps and may further optimize the prevention of colorectal cancer.

Systematic review registration: http://www.chictr.org.cn, identifier ChiCTR1900025235, ChiCTR1800017675, ChiCTR1800018058, and ChiCTR1900023086.

Keywords: CRC screening; colorectal cancer; composition ratio; high-grade dysplasia (HGD); small polyp.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Size distribution and proportion of HGD polyps at the per-polyp level. (A) The distribution of HGD among all confirmed polyps of different sizes in the entire colon. (B) The distribution of HGD among all confirmed polyps of different sizes within the rectosigmoid colon. (C) Significant positive correlation between polyp size and HGD in the entire colon. (D) The significant positive correlation between polyp size and HGD within the rectosigmoid colon. *HGD, high-grade dysplasia.
Figure 2
Figure 2
The number of HGD polyps at different size categories and their correlation. (A) The number of HGD polyps of different sizes, and the correlation analysis shows a trend that the number of HGD polyps is more related to small/diminutive polyps. (B) The number of HGD polyps of different sizes, and the correlation analysis shows a trend that the number of HGD polyps is more related to small/diminutive polyps within the rectosigmoid colon. *HGD, high-grade dysplasia.
Figure 3
Figure 3
The number of HGD polyps at different size categories at the per-patient level. (A) The relationship between the average number of HGD polyps per patient and the size of HGD polyps per patient. It can be seen that the vast majority of patients with HGD polyps originate from a small/diminutive polyp. (B) A similar trend within the rectosigmoid colon. *HGD, high-grade dysplasia.
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