S842 Risk of Metachronous Findings After Detection of Serrated Lesions With Surveillance Delay: A Prospective Study
Bibliographic record
Abstract
Introduction: Serrated lesions (SL), including sessile serrated lesions (SSL) and traditional serrated adenomas (TSA), have become subject of increased interest for their role as colorectal cancer (CRC) precursors. Multiples guidelines have established diverging recommendations concerning the optimal timing of follow-up colonoscopies after finding these lesions at index colonoscopy. We were interested in evaluating the risk at follow-up for patients with SLs detected at index colonoscopy and lacking follow-up within or beyond the surveillance interval recommended by the 2012 United States Multi-Society Task Force (USMSTF) guidelines. Methods: We conducted a single-center prospective cohort study of patients 45-80 years old who presented with SLs from 2010 to 2019 at the Montreal University Hospital Center (CHUM) without follow-up. Patients were contacted to undergo follow-up coloscopy as part of the study. Primary outcome was the rate of total metachronous advanced neoplasia (T-MAN) at follow-up. Secondary outcomes were the rate of advanced adenomas (AA) and advanced serrated lesions (ASL) at follow-up colonoscopy. Results: Two hundred and twenty patients were included in this study (mean age 65.1, 50.4% female). Sessile serrated lesions were the most prevalent at index (n = 211, 95.9%). The mean follow-up duration was 5.7 years (SD: 2.2), with 20 patients (9%) with an interval of > 10 years. At follow-up colonoscopy, 45 cases of T-MAN were detected (20.5%; 95% CI 15.3-26.4), 8 cases of Laterally Spreading Tumours ≥ 20 mm (3.6%; 95% CI 1.6-7.0), 1 case of CRC (0.5%; 95% CI 0.0-2.5), 25 cases of advanced adenomas (11.3%; 95% CI 7.5-16.3), and 24 cases of advanced SLs (10.9%; 95% CI 7.1-15.8). There was a greater risk of T-MAN (28,8%; 95% CI 17.1-43.0) and advanced SLs (21.1%; 95% CI 11.1-34.7) after index detection of SSLs ≥ 10 mm. Conclusion: Patients with SLs at index have a greater risk of developing high-risk findings at follow-up. Rates of advanced adenomas and advanced SLs were both high after index detection of SLs and a significant proportion of patients had lesions ≥ 20 mm at follow-up (Figure 1).Figure 1.: Study Flow Chart.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".