Lindsey A. Bierle, DO1, Mohamad Mouchli, MD1, Shravani R. Reddy, MD1, Christopher Walsh, MD2, Adil S. Mir, MD1, Paul Yeaton, MD2; 1Carilion Clinic, Roanoke, VA; 2Virginia Tech Carilion, Roanoke, VA
Introduction: Accurate measurement of colon polyp size can be challenging since there is not an easily identifiable way to provide precise measurements, as most are based on uncertain visual estimation. The actual size can sometimes not be accurately estimated due to many reasons including inter-endoscopist variability. We aimed to compare the frequency and recurrence rates among underestimated and overestimated polyp sizes by comparing endoscopist and pathologist measurements. Methods: We randomly selected patients with colon polyps (measuring < 2 cm) treated at Carilion Clinic, Roanoke, between 01/01/2014-12/31/2017, with follow-up through 10-2018. Information on demographics, polyp size reported in endoscopy documentation, pathological features of polyps (i.e., size, histology, site, and degree of dysplasia), and number and timing of surveillance endoscopies were extracted. The cumulative risks of polyp recurrence were estimated using Kaplan-Meier curves. Results: One-hundred and twenty-eight (Mean age, 63.6±11.3 years; 47.3% males) with colon polyps were identified. Comparing the polyp size in the endoscopy report with the size in the pathology report, 37.5% had the same size, 21.9% were smaller, and 40.6% were bigger in the endoscopy reports. Advanced endoscopists underestimated the size in 33.3% and overestimated the size in 29.6% (compared to 13.5% and 48.7% among non-advanced endoscopists). The size was underestimated in polyps removed in piecemeal fashion by 30.5% and overestimated in 25.6% (compared to 6.3% and 67.4% via en bloc). The discrepancy would change the surveillance interval in 35.7% in underestimated polyps and 26.9% in overestimated polyps. The recurrence rates were not different between polyps with underestimated and overestimated sizes (0.43). Discussion: There is discrepancy between endoscopists and pathologists regarding the actual size of colon polyps in roughly 60% of the reports reviewed. This is a very important issue to resolve given its effect on surveillance intervals in polyps measuring around one centimeter.
Polyp Size in Relation to Time to Recurrence
Disclosures: Lindsey Bierle indicated no relevant financial relationships. Mohamad Mouchli indicated no relevant financial relationships. Shravani Reddy indicated no relevant financial relationships. Christopher Walsh indicated no relevant financial relationships. Adil Mir indicated no relevant financial relationships. Paul Yeaton indicated no relevant financial relationships.