From the Guidelines
The recommended follow-up for a tubulovillous adenoma is a surveillance colonoscopy in 3 years. This is based on the strongest and most recent evidence from the US Multi-Society Task Force on colorectal cancer, which recommends a 3-year surveillance interval for adenomas with tubulovillous or villous histology 1. The guidelines assume a complete resection of the adenoma and adequate bowel preparation to detect lesions greater than 5 mm in size.
Some key points to consider in the follow-up of tubulovillous adenomas include:
- The size and number of adenomas: larger adenomas (≥10 mm) or multiple adenomas may require more frequent surveillance
- The presence of high-grade dysplasia: this may also require more frequent surveillance
- The completeness of the resection: if the resection is uncertain, a repeat colonoscopy may be recommended in 1 year
- Patient preferences and factors such as quality of baseline examination and polyp history: these may influence the decision to extend or shorten the surveillance interval
It is essential to note that these recommendations do not apply to individuals with a hereditary CRC syndrome, personal history of inflammatory bowel disease, personal history of hereditary cancer syndrome, serrated polyposis syndrome, malignant polyp, personal history of CRC, or family history of CRC. For such individuals, the recommendations must be judiciously applied, favoring the shortest indicated interval based on either history or polyp findings 1.
The follow-up schedule is crucial because tubulovillous adenomas have a higher risk of progression to colorectal cancer compared to tubular adenomas due to their mixed histology. Proper surveillance allows for early detection of recurrent adenomas or new lesions, significantly reducing colorectal cancer risk. Patients should also be advised to report any new symptoms such as rectal bleeding, change in bowel habits, or abdominal pain between surveillance intervals.
From the Research
Follow-up Recommendations for Tubulovillous Adenoma
The recommended follow-up for a tubulovillous adenoma (tubular adenoma with villous features) is as follows:
- A three-year follow-up is recommended for patients considered to be at high risk, which includes those with at least three adenomas, an adenoma ≥ 1 cm, villous or high-grade features 2.
- The risk of new adenomas and significant neoplasia increases over time, and follow-up colonoscopic examinations may be warranted in patients with tubulovillous, villous, or large adenomas in the rectosigmoid, particularly if the adenomas are also multiple 3.
- A study found that the cumulated risk of a patient having new adenomas was 35.0% after 48 months, and the risk of significant neoplasia was 5.2% after 48 months, suggesting that follow-up colonoscopy at 4 years may be sufficient for some patients 4.
- However, another study found that patients with ≥3 adenomas and/or ≥1 adenoma with villous/tubulovillous histology may require more frequent follow-up, with a recommended interval of 3 years 5.
Factors Associated with Follow-up
Several factors are associated with the likelihood of follow-up, including:
- Age: patients ages 60-74 were more likely to undergo subsequent colonoscopy than those ages 50-54 or 80-89 5.
- Number of adenomas: patients with ≥3 adenomas were more likely to undergo subsequent colonoscopy than those with 1-2 villous/tubulovillous adenomas 5.
- Histological features: adenomatous polyps with dysplasia were more likely to develop malignancy, highlighting the importance of follow-up in these cases 6.