SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Patrice PIENKOWSKI
Coup de coeur :
 
 
Gastrointestinal Endoscopy
  2016/01  
 
  2016 Jan;83(1):201-8  
  doi: 10.1016/j.gie.2015.06.058. Epub 2015 Aug 28.  
 
  Endoscopic overestimation of colorectal polyp size.  
 
  Anderson BW, Smyrk TC, Anderson KS, Mahoney DW, Devens ME, Sweetser SR, Kisiel JB, Ahlquist DA  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=Endoscopic+overestimation+of+colorectal+polyp+size.  
 
 

BACKGROUND AND AIMS:

Polyp size ≥1 cm triggers more frequent colonoscopic surveillance, yet size is typically based on subjective endoscopic estimates. We sought to compare contemporary assessments of polyp size by endoscopic estimation and pathology measurement.

METHODS:

Colonoscopy and pathology reports were reviewed from the 2012 medical records at a large institution. Only polyps resected in toto with both endoscopic estimates and pathology measurements were included. Pathology measurements were considered the criterion standard. Factors affecting endoscopic miscall rates were assessed by multivariate analyses.

RESULTS:

From 6067 polyps resected, both endoscopic and pathology sizes were available on 1528. Distribution of polyp size appraised by endoscopy but not by pathology revealed modal clustering, particularly around 1 cm. Among 99 polyps endoscopically called 1 cm, 72% were <1 cm on pathology. Of all 222 polyps estimated as ≥1 cm on endoscopy, 46% were <1 cm on pathology; of 1306 polyps estimated as <1 cm, 3.9% were ≥1 cm on pathology. By histology, 39% of adenomatous, 59% of sessile serrated, and 73% of hyperplastic polyps were overcalled; P = .008. By configuration, 34% of pedunculated, 49% of sessile, and 61% of flat polyps were overcalled; P = .014. Endoscopic overestimation was more common in women (54%) than in men (40%) (P = .03) and with proximal (56%) than distal (40%) sites; P = .02. Miscall rates were unaffected by endoscopist covariates.

CONCLUSIONS:

Substantial discordance exists between endoscopic and pathology-based assessments of polyp size. Almost half of polyps called advanced on endoscopic estimates of size ≥1 cm fell below this threshold on actual pathology measurements.

 

 
Question posée
 
Quelle est la fiabilité de l’estimation endoscopique de la taille des polypes ?
 
Question posée
 
Etude rétrospective comparant les estimations per-endoscopique de taille de 1528 polypes et les données histopathologiques correspondantes. 72% des polypes dits « centimétriques » mesurent en réalité moins et près de la moitié des polypes estimés dits « supracentimétriques » mesurent moins d’un cm (l’erreur inverse est plus rare : 3.9%). La surestimation est fréquente pour les lésions festonnées (59%) et hyperplasiques (73%)
 
Commentaires

Ces données (prévisibles) sont à prendre en considération dans la définition des polypes de haut et bas risque (PHR et PBR), tels que définis dans les dernières recommandations de la HAS sur les critères de surveillance après polypectomie. Globalement, si la taille des lésions est surestimée, la surveillance endoscopique est probablement inappropriée (et excessive) pour certains patients.

 
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