Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 10, 2015; 7(8): 824-829
Published online Jul 10, 2015. doi: 10.4253/wjge.v7.i8.824
Accuracy of endoscopists’ estimate of polyp size: A continuous dilemma
Manhal Izzy, Muhammad Asif Virk, Avi Saund, Juan Tejada, Faraj Kargoli, Sury Anand
Manhal Izzy, Muhammad Asif Virk, Avi Saund, Juan Tejada, Faraj Kargoli, Sury Anand, Division of Gastroenterology, the Brooklyn Hospital Center/New York Presbyterian Health Care System, Brooklyn, NY 11201, United States
Manhal Izzy, Division of Gastroenterology and Liver Diseases, Montefiore Medical Center, Bronx, NY 10467, United States
Author contributions: Izzy M and Virk MA contributed equally to this article; Izzy M made substantial contributions to conception and design of the study, drafting the article, making critical revisions related to important intellectual content of the manuscript, and final approval of the version of the article to be published; Virk MA made substantial contributions to conception and design of the study, making critical revisions related to important intellectual content of the manuscript, and final approval of the version of the article to be published; Saund A contributed to acquisition of the data and drafting the article; Tejada J contributed to acquisition of the data and making critical revisions related to important intellectual content of the manuscript; Kargoli F contributed to data analysis and interpretation; Anand S contributed to critical revisions related to important intellectual content of the manuscript and final approval of the version of the article to be published.
Institutional review board statement: The study was reviewed and approved by the Brooklyn Hospital Center Institutional Review Board.
Informed consent statement: Not applicable in retrospective studies.
Conflict-of-interest statement: None to be disclosed by study authors.
Data sharing statement: Not applicable.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Manhal Izzy, MD, Division of Gastroenterology and Liver Diseases, Montefiore Medical Center, 111 E210th Street, Bronx, NY 10467, United States. mizzy@montefiore.org
Telephone: +1-201-3778592
Received: September 1, 2014
Peer-review started: September 1, 2014
First decision: December 17, 2014
Revised: January 12, 2015
Accepted: May 5, 2015
Article in press: May 8, 2015
Published online: July 10, 2015
Abstract

AIM: To examine the discrepancy, if any, between the endoscopist’s estimate and pathologist’s measurement of colonic polyp size.

METHODS: We retrospectively studied 88 patients who underwent colonoscopy with a clear unequivocal documentation of polyp size by both endoscopist and pathologist. Endoscopist measurements were based on the visual estimate of polyp size seen on high definition screens. The measurement was done by our pathologists after formalin fixation. We compared the endoscopist estimate of the polyp size to the pathologist measurement in order to explore the discordance between the two readings. Data regarding demographics and method of polypectomy (snare polypectomy vs excisional biopsy) was collected, as well. Statistical analysis software (SAS) was used to analyze the data.

RESULTS: Our cohort included 88 patients from which 111 polyps were removed. Fifty-two (46.8%) of the 111 polyps were excised using biopsy forceps and fifty-nine (53.2%) were removed by snare. In the biopsy forceps group, the mean polyp size documented by the pathologist was 0.38 ± 0.19 cm and the mean polyp size documented by the endoscopist was 0.54 ± 0.16 cm. The mean difference was 0.16 cm (P < 0.001). In the snare group, the mean polyp size documented by the pathologist was 0.54 ± 0.24 cm and the mean polyp size documented by the endoscopist 0.97 ± 0.34 cm. The mean difference was 0.43 cm (P < 0.001). Combining both groups, the mean size documented by pathologist was 0.46 ± 0.23 cm compared to 0.76 ± 0.35 cm documented by the endoscopist. The mean difference was 0.3 cm (95%CI: 0.23-0.36).

CONCLUSION: Post polypectomy measurement by the pathologist are generally smaller than the endoscopist’s estimate.

Keywords: Polyp size estimate, Colonic polyps, Endoscopist estimate

Core tip: Our results suggest wide variance in polyp size documentation. Neither endoscopist estimate nor pathologist measurement accurately reflects colonic polyp size. Inaccurate determination of polyp size can negatively impact advanced adenoma detection. Using a screen cursor like that used in ultrasound and computed tomography scanners may serve as a standardized, accurate technique to solve this issue.