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@ARTICLE{Rsch:141257,
      author       = {T. Rösch and L. Altenhofen and J. Kretschmann and B. Hagen
                      and H. Brenner$^*$ and C. Pox and W. Schmiegel and A.
                      Theilmeier and J. Aschenbeck and A. Tannapfel and D. von
                      Stillfried and K. Zimmermann-Fraedrich and K. Wegscheider},
      title        = {{R}isk of {M}alignancy in {A}denomas {D}etected {D}uring
                      {S}creening {C}olonoscopy.},
      journal      = {Clinical gastroenterology and hepatology},
      volume       = {16},
      number       = {11},
      issn         = {1542-3565},
      address      = {New York, NY},
      publisher    = {Elsevier Science},
      reportid     = {DKFZ-2018-01777},
      pages        = {1754 - 1761},
      year         = {2018},
      abstract     = {A higher incidence of proximal interval cancers after
                      colonoscopy has been reported in several follow-up studies.
                      One possible explanation for this might be that proximally
                      located adenomas have greater malignant potential. The aim
                      of the present study was to assess the risk of malignancy in
                      proximal versus distal adenomas in patients included in a
                      large screening colonoscopy database; adenoma shape and the
                      patients' age and sex distribution were also analyzed.Data
                      for 2007-2012 from the German National Screening Colonoscopy
                      Registry, including 594,614 adenomas identified during
                      2,532,298 screening colonoscopies, were analyzed
                      retrospectively. The main outcome measure was the rate of
                      high-grade dysplasia (HGD) in adenomas, used as a surrogate
                      marker for the risk of malignancy. Odds ratios (ORs) for the
                      rate of HGD found in adenomas were analyzed in relation to
                      patient- and adenoma-related factors using multivariate
                      analysis.HGD histology was noted in 20,873 adenomas
                      $(3.5\%).$ Proximal adenoma locations were not associated
                      with a higher HGD rate. The most significant risk factor for
                      HGD was adenoma size (OR 10.36 ≥1 cm vs <1 cm), followed
                      by patient age (OR 1.26 and 1.46 for age groups 65-74 and
                      75-84 vs 55-64 years) and sex (OR 1.15 male vs female). In
                      comparison with flat adenomas as a reference lesion, sessile
                      lesions had a similar HGD rate (OR 1.02) and pedunculated
                      adenomas had a higher rate (OR 1.23). All associations were
                      statistically significant (P ≤ .05).In this large
                      screening database, it was found that the rates of adenomas
                      with HGD are similar in the proximal and distal colon. The
                      presence of HGD as a risk marker alone does not explain
                      higher rates of proximal interval colorectal cancer. We
                      suggest that certain lesions (flat, serrated lesions) may be
                      missed in the proximal colon and may acquire a more
                      aggressive biology over time. A combination of
                      endoscopy-related factors and biology may therefore account
                      for higher rates of proximal versus distal interval
                      colorectal cancer.},
      cin          = {C070 / G110 / L101},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331 / I:(DE-He78)G110-20160331 /
                      I:(DE-He78)L101-20160331},
      pnm          = {313 - Cancer risk factors and prevention (POF3-313)},
      pid          = {G:(DE-HGF)POF3-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:29902640},
      doi          = {10.1016/j.cgh.2018.05.043},
      url          = {https://inrepo02.dkfz.de/record/141257},
}