Wong et al reported a score for predicting advanced neoplasia in the proximal colon for a patient in the Asia-Pacific region. This can help to identify a patient who may benefit from more aggressive screening. The authors are from multiple institutions in China, Korea, Malaysia, Pakistan, Philippines, Taiwan and Thailand.
Patient selection: asymptomatic adult from 50 to 75 years of age
Parameters:
(1) age in years
(2) family history for a first-degree relative
(3) smoking
(4) findings in distal colon
Parameter
Finding
Points
age in years
<= 60 years
0
61 to 69.99 years
3
>= 70 years
4
family history
no
0
yes
2
smoking
never
0
former
2
current
2
distal findings
normal
0
hyperplastic polyps
0
nonadvanced adenoma LT 4 mm in diameter
0
nonadvanced adenoma 5-9 mm
2
advanced neoplasia
7
where:
• Advanced neoplasia: a polyp >= 10 mm in diameter, high-grade dysplasia, villous or tubulovillous adenoma.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 15
• A score >= 4 is associated with high risk for an advanced proximal neoplasia.
Score
Advanced Proximal Neoplasia
0 to 3
2 to 3%
4 to 6
4 to 6%
7 to 9
12 to 16%
10 to 12
19 to 22%
13
33%
14 or 15
40%
Performance:
• The area under the ROC curve is 0.74.
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