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Endoscopists frequently overestimated polyp size during colonoscopy
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LAS VEGAS — Endoscopists’ estimates of polyp size during colonoscopy were often larger than the measurements obtained by pathologists in a recent study presented at the 2012 American College of Gastroenterology Annual Scientific Meeting.
Researchers performed a retrospective review of 88 patients (63% women) who underwent colonoscopy within a 2-year period. Clear documentation from both an endoscopist and a pathologist had been provided for all patients. Endoscopists removed 112 polyps among the cohort, 53 via forceps and 59 by snare.
“It is well known that the endoscopic measurements of colonic polyps are frequently underestimated,” researcher Juan Tejada, MD, department of internal medicine, division of gastroenterology and hepatology at the Brooklyn Hospital Center in New York, told Healio.com. “But one should also consider the frequency of overestimation of the size of a polyp, since this can impact how the patient is managed, the risks imposed on the patient and the cost of care.”
The cohort was 75% African-American, 20.5% Hispanic, 3.4% Caucasian and 1.1% Asian-American. Mean polyp size for this group, as measured by the pathologist, was 0.46 ± 0.23 cm, compared with 0.76 ± 0.35 cm as estimated by the endoscopist (P<.0001 for mean difference). Polyp size was overestimated by approximately 65% compared with pathologic measurement, but endoscopist estimations were accurate within 2 mm of pathologist measurements in 71% of cases, including 25% of cases within 1 mm. Investigators noted a wide variance between estimates and measurements for the remaining 29% of polyps.
“Measurements determined by the endoscopist can vary depending on the clinician’s impression and experience, the use of biopsy forceps as a measurement guide and positional errors of the scope,” Tejada said. “The pathologist’s measurements can vary depending on tissue damage and how the specimen was prepped. Pathologic measurements are more reliable, and should be the measurement for the need of further care and future colonoscopies. But also, the invention of new devices that can … facilitate the measurement of specimens during the procedure will be very helpful.”
For more information:
Mazumder M. P290: Polyp Size Matters — A Study Comparing the Size Estimates by the Endoscopist to the Measurements by the Pathologist. Presented at: the 2012 American College of Gastroenterology Annual Scientific Meeting; Oct. 19-24, Las Vegas.