How Should We Manage Patients with 6- to 9-mm Polyps Detected by CT Colonography?

A controversy in screening with computed tomography (CT) colonography is whether people with small polyps can be followed safely instead of undergoing immediate colonoscopy. In part, this choice depends on the probability of advanced neoplasia in patients with small polyps.

In a multicenter study, nearly 14,000 asymptomatic patients underwent screening colonoscopy; about 6000 had one or more polyps. The prevalence of advanced neoplasia (i.e., cancer, high-grade dysplasia, or villous or serrated histology), according to size of each patient’s largest polyp, was:

• 1.7% of 3744 patients whose largest polyps were 1 mm to 5 mm

• 6.6% of 1198 patients whose largest polyps were 6 mm to 9 mm

• 30.6% of 949 patients whose largest polyps were ≥10 mm