Nonadvanced Adenoma Number and Size as Predictors of Metachronous Advanced Colorectal Neoplasm: Implications for Surveillance Guidelines.

Having 5 to 10 nonadvanced adenomas is linked to a 10.1% 5-year risk of advanced colorectal neoplasm, the highest among studied groups.

• Why it matters: Accurate risk stratification for surveillance of nonadvanced adenomas is limited, especially for individuals with 3 to 4 or 5 to 10 lesions and based on size, which affects clinical guidelines.
• What they did: Researchers analyzed 16,870 adults aged 50 to 75 with at least two colonoscopies from 2004 to 2023, categorizing them by adenoma count and size, and assessed 5-year ACN risk using Cox regression and inverse probability weighting.
• The result: The study found that ACN risk increased with adenoma count, reaching 10.1% for 5 to 10 NAAs, and that small adenomas elevated risk within count groups, suggesting both number and size should inform surveillance strategies.