Clinicopathologic characteristics and malignant potential of colorectal flat neoplasia compared with that of polypoid neoplasia

Dong Hun Park, Hyun Soo Kim, Won Ho Kim, Tae Il Kim, Young Ho Kim, Dong Il Park, Hyo Jong Kim, Suk Kyun Yang, Jeong Sik Byeon, Moon Sung Lee, Il Kwun Chung, Sung Ae Jung, Yoon Tae Jeen, Jai Hyun Choi, Hwang Choi, Dong Soo Han

Research output: Contribution to journalArticlepeer-review

55 Scopus citations


PURPOSE: Because of their potential for malignancy, flat colorectal neoplasias are a current topic of debate. This study was designed to investigate the clinicopathologic features of flat neoplasia and to compare them with those of polypoid neoplasia, as well as to identify the determinants of malignant transformation of both flat and polypoid colorectal neoplasia. METHODS: A prospective, cross-sectional study of 3,360 patients diagnosed with adenomas via total colonoscopy and polypectomy was performed at 11 tertiary medical centers between July 2003 and July 2004. In this study, potential risk factors for malignant transformation were analyzed. If multiple adenomas were identified, then only the adenoma with the most advanced degree of histology was recorded for the patient. RESULTS: Of a total of 3,360 neoplasias identified, we found that the incidence of flat and polypoid neoplasias were 207 (6.2 percent) and 3,153 (93.8 percent), respectively. Patients with flat neoplasias tended to be older (59.6 vs. 57.1, P < 0.01), with the neoplaisa located more frequently in the right colon than polypoid neoplasias (49.3 percent vs. 32 percent, P < 0.01). The incidence of high-grade dysplasia or cancer in flat neoplasias was similar to that of polypoid neoplasias (5.4 percent vs. 4.6 percent, P = 0.36). Multivariate analysis revealed that a size of ≥11 mm (odds ratio, 6.8; 95 percent confidence interval, 4.8-9.7) and location in the left colon (odds ratio, 1.6; 95 percent confidence interval, 1.1-2.4) were significant determinants for the malignancy potential of colonic neoplasias. CONCLUSIONS: The clinicopathologic indices for the propensity of malignant transformation in colorectal neoplasias were a size ≥11 mm and location in the left colon rather than flat gross morphology.

Original languageEnglish
Pages (from-to)43-49
Number of pages7
JournalDiseases of the Colon and Rectum
Issue number1
StatePublished - Jan 2008


  • Colonoscopy
  • Flat neoplasia
  • Malignant potential
  • Polypectomy


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