Diminutive polyps among black and Latino populations undergoing screening colonoscopy: evidence supporting a resect and discard approach

Background A resect and discard strategy for diminutive (≤5 mm) colon polyps has been proposed to save costs of screening colonoscopy (SC). Prior studies on neoplasia prevalence based on polyp size have involved mostly white patients. Objective To determine the prevalence of adenomas and advanced histologic features by size among primarily black and Latino patients enrolled in a prospective SC study. Design Retrospective analysis of data from a prospective clinical trial. Setting Urban academic medical center. Patients Average risk, asymptomatic, minority patients aged ≥50 years undergoing SC. Interventions Screening colonoscopy. Main Outcome Measurements Rates of neoplasia and advanced histologic features (villous histology, high-grade dysplasia, or cancer) by polyp size and location. Results A total of 566 polyps from 295 patients were analyzed. Diminutive polyps and small (6-9 mm) polyps had lower prevalence of ≥1 advanced feature compared with large (≥10 mm) polyps (0.9% and 2.7%, respectively, vs 13.6%; P < .001 for both comparisons). Distal polyps were less likely to be neoplastic (31.7% vs 61.4%; P < .001) than proximal polyps in all size categories ( P < .001 for all comparisons). After adjusting for sex, ethnicity, age, and location, large polyps were more likely to have ≥1 advanced feature than diminutive polyps (adjusted odds ratio [OR] 19.5; 95% CI, 4.4-85.6) or small polyps (adjusted OR 6.1; 95% CI, 2.2-16.9). Limitations Use of pathology reports for polyp size. Conclusion Among a cohort of minority patients, advanced histologic features were very rare in diminutive polyps. Distal polyps were less likely to be neoplastic than proximal polyps in all size categories. This supports a resect and discard strategy for diminutive polyps, especially in the distal colon.