• Dis. Colon Rectum · Jan 2008

    Multicenter Study Comparative Study

    Clinicopathologic characteristics and malignant potential of colorectal flat neoplasia compared with that of polypoid neoplasia.

    • Dong Hun Park, Hyun Soo Kim, Won Ho Kim, Tae Il Kim, Young Ho Kim, Dong Il Park, Hyo Jong Kim, Suk-Kyun Yang, Jeong-Sik Byeon, Moon Sung Lee, Il Kwun Chung, Sung Ae Jung, Yoon Tae Jeen, Jai Hyun Choi, Hwang Choi, and Dong Soo Han.
    • Department of Internal Medicine and Institute of Lifelong Health, Yonsei University, Wonju College of Medicine, 162 Ilsan-dong, Wonju, South Korea.
    • Dis. Colon Rectum. 2008 Jan 1; 51 (1): 43-9; discussion 49.

    PurposeBecause of their potential for malignancy, flat colorectal neoplasias are a current topic of debate. This study was designed to investigate the clinicopathologic features of flat neoplasia and to compare them with those of polypoid neoplasia, as well as to identify the determinants of malignant transformation of both flat and polypoid colorectal neoplasia.MethodsA prospective, cross-sectional study of 3,360 patients diagnosed with adenomas via total colonoscopy and polypectomy was performed at 11 tertiary medical centers between July 2003 and July 2004. In this study, potential risk factors for malignant transformation were analyzed. If multiple adenomas were identified, then only the adenoma with the most advanced degree of histology was recorded for the patient.ResultsOf a total of 3,360 neoplasias identified, we found that the incidence of flat and polypoid neoplasias were 207 (6.2 percent) and 3,153 (93.8 percent), respectively. Patients with flat neoplasias tended to be older (59.6 vs. 57.1, P < 0.01), with the neoplasia located more frequently in the right colon than polypoid neoplasias (49.3 percent vs. 32 percent, P < 0.01). The incidence of high-grade dysplasia or cancer in flat neoplasias was similar to that of polypoid neoplasias (5.4 percent vs. 4.6 percent, P = 0.36). Multivariate analysis revealed that a size of > or =11 mm (odds ratio, 6.8; 95 percent confidence interval, 4.8-9.7) and location in the left colon (odds ratio, 1.6; 95 percent confidence interval, 1.1-2.4) were significant determinants for the malignancy potential of colonic neoplasias.ConclusionsThe clinicopathologic indices for the propensity of malignant transformation in colorectal neoplasias were a size > or =11 mm and location in the left colon rather than flat gross morphology.

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