Παρότι είναι γνωστό ότι οι μεγάλοι πολύποδες (> 1cm) ενέχουν μεγάλο κίνδυνο εξαλλαγής και πρέπει να αφαιρούνται άμεσα ενδοσκοπικά ή χειρουργικά, ενώ εκείνοι που είναι μικροί (<5mm) έχουν μια σχετικά καλοήθη πορεία, λιγότερα είναι γνωστά για την συμπεριφορά των ενδιάμεσων πολυπόδων διαμέτρου 6-9mm. Στο ενδιαφέρον άρθρο που ακολουθεί αναφέρεται ότι η πλειοψηφία των πολυπόδων αυτού του μεγέθους δεν θα εξελιχθεί μέσα στην επόμενη τριετία, ενώ η χρήση της αξονικής κολογραφίας θα μπορούσε να βοηθήσει στην ταυτοποίηση αυτών που αυξάνουν σε μεγέθος και άρα είναι περισσότερο επικίνδυνοι.

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Charlotte J Tutein Nolthenius MD, Thierry N Boellaard MD, PhD, Margriet C de Haan MD, PhD, C Yung Nio MD, Maarten G J Thomeer MD, Shandra Bipat PhD, Alexander D Montauban van Swijndregt MD, PhD, Marc J van de Vijver MD, PhD, Katharina Biermann MD, PhD, Ernst J Kuipers MD, PhD, Evelien Dekker MD, PhD and Jaap Stoker MD, PhD

Objectives: Volumetric growth assessment has been proposed for predicting advanced histology at surveillance computed tomography (CT) colonography (CTC). We examined whether is it possible to predict which small (6–9 mm) polyps are likely to become advanced adenomas at surveillance by assessing volumetric growth.

Methods: In an invitational population-based CTC screening trial, 93 participants were diagnosed with one or two 6–9 mm polyps as the largest lesion(s). They were offered a 3-year surveillance CTC. Participants in whom surveillance CTC showed lesion(s) of ≥6 mm were offered colonoscopy. Volumetric measurements were performed on index and surveillance CTC, and polyps were classified into growth categories according to ±30% volumetric change (>30% growth as progression, 30% growth to 30% decrease as stable, and >30% decrease as regression). Polyp growth was related to histopathology.

Results: Between July 2012 and May 2014, 70 patients underwent surveillance CTC after a mean surveillance interval of 3.3 years (s.d. 0.3; range 3.0–4.6 years). In all, 33 (35%) of 95 polyps progressed, 36 (38%) remained stable, and 26 (27%) regressed, including an apparent resolution in 13 (14%) polyps. In 68 (83%) of the 82 polyps at surveillance, histopathology was obtained; 15 (47%) of 32 progressing polyps were advanced adenomas, 6 (21%) of 28 stable polyps, and none of the regressing polyps.

Conclusions: The majority of 6–9 mm polyps will not progress to advanced neoplasia within 3 years. Those that do progress to advanced status can in particular be found among the lesions that increased in size on surveillance CTC.

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