Clinical, endoscopic, and histopathological determinants of advanced histology in colonoscopically detected colorectal polyps

INTRODUCTION: Advanced histology in colorectal polyps is central to post-polypectomy risk stratification. This study aimed to identify clinical, endoscopic, and histopathological determinants of advanced histology among patients with colonoscopically detected colorectal polyps.
METHODS: Adult patients who underwent colonoscopy between 2 January 2024 and 30 January 2025 were retrospectively evaluated. The analysis included 402 patients with detected colorectal polyps. Advanced histology was defined as tubulovillous adenoma, villous adenoma, or adenocarcinoma. Demographic variables, polyp size, burden, location, morphology, resection technique, bowel preparation quality, and cecal intubation were analyzed. Independent determinants were assessed using multivariable logistic regression.
RESULTS: Advanced histology was detected in 70 patients (17.4%). Its rate increased with polyp size: 0% in polyps <5 mm, 9.4% in 6–9 mm polyps, and 67.8% in polyps ≥10 mm (p<0.001). Advanced histology also increased with polyp burden, from 14.1% in solitary polyps to 43.8% in patients with ≥5 polyps (p=0.003). Polyp location, morphology, resection technique, bowel preparation adequacy, and cecal intubation were not significantly associated with advanced histology. In multivariable analysis, polyp size ≥10 mm was the only independent determinant of advanced histology (adjusted OR: 58.64, 95% CI: 27.03–127.21, p<0.001).
DISCUSSION AND CONCLUSION: Polyp size was the dominant determinant of advanced histology. Careful size estimation, complete resection, and appropriate pathological evaluation of larger colorectal polyps remain essential for post-polypectomy risk stratification.

Keywords: Adenoma, advanced histology, colonoscopy, colorectal polyp, polyp size, adenocarcinoma, polypectomy