Are Upfront Levels for Colon “Polyps” Necessary? A Pragmatic Review

Introduction. Colon biopsies are among the most frequently examined specimens by pathologists. Many pathology practices, ours included, review upfront levels on all gastrointestinal biopsies. In our experience, when a lesion is present on specimens labeled “colon polyp,” it is readily identified on the first level. To test our hypothesis, we re-reviewed 500 cases in which a lesion was identified histologically and determined if the diagnosis could be made on the first level. Furthermore, we examined 50 additional cases of high-grade dysplasia/carcinoma to determine if the higher-grade component was also present on the first level. Materials and Methods. Cases were retrieved for lesions that could account for a colon polyp clinically, and the first level was examined to determine if lesional tissue was present on the first level. Fifty additional cases of higher-grade lesions were included to ensure higher-grade lesions were present on the first level. Results. Overall, 497/500 (99.4%) of the non–high-grade lesions were present on the first level, whereas 3/500 (0.6%) required the additional level for diagnosis. All 50 high-grade lesions were present on the first level examined. Discussion. Many pathology practices routinely order upfront levels on all gastrointestinal biopsies, often generating 2 or 3 slides. Additional slides increase costs, increase the likelihood of laboratory-generated errors, and can waste limited tissue on small biopsies for which ancillary studies may be necessary. Our study showed that a single level is sufficient in the overwhelming majority of cases in which a lesion is identified histologically.

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MISMATCH REPAIR PROTEINS AND SURVIVIN IN ADENOMATOUS COLON POLYPS WITH LOW GRADE AND HIGH GRADE DYSPLASIA: AN IMMUNOHISTOCHEMICAL STUDY. Las proteínas para la reparación de desajustes y survivin en pólipos adenomatosos de colon con displasias de bajo y a

Revista Argentina de Anatomía Clínica ◽

10.31051/1852.8023.v10.n3.20923 ◽

2018 ◽

Vol 10 (3) ◽

pp. 98-111

Author(s):

Marian Adamkov ◽

Desanka Výbohová ◽

Slávka Drahošová ◽

Štefan Galbavý

Keyword(s):

Mismatch Repair ◽

Survivin Expression ◽

High Grade Dysplasia ◽

Low Grade ◽

Colon Polyps ◽

High Grade ◽

Immunohistochemical Expression ◽

Significant Relation ◽

Colon Adenomas ◽

Mismatch Repair Proteins

Objective: The aim of our study was to observe the immunohistochemical expression pattern of mismatch repair proteins (MMRP) MLH1, MSH2, MSH6 and PMS2, as well as survivin, in colon polyps. Methods: We assessed above mentioned proteins in a unified group of 124 tubular adenomatous colon polyps with regard to the presence of dysplastic abnormalities in order to explore their relationship. Furthermore, we studied their relation to such clinicomorphological parameters as the age of patients, size of adenoma, degree of dysplastic changes and localization of the lesion. Results: Survivin was expressed in 97 cases (78.2%), MLH1 was found in 111 cases (89.5%), MSH2 in 115 cases (92.7%), MSH6 in 118 cases (95.2%) and PMS2 in 105 cases (84.7%). The majority of absent MMRP cases was detected where the adenoma size was less than 10 mm with LGD (low-grade dysplasia). Survivin expression significantly correlated with the adenoma size and dysplasia grade. Subcellular survivin compartmentalization was statistically associated with the adenoma size, dysplasia grade and adenoma localization. Furthermore, we confirmed a significant relation between survivin expression and MMRP. In general, the intensity of immunoreaction was stronger in the MMRP than in survivin. Conclusions: Our recent results suggest that MMRP may suppress the antiapoptotic activity of survivin in LGD and HGD (high grade dysplasia) colon adenomas. Antecedentes: Las proteínas de reparación de desajustes (MMRP) y survivin representan señales diametralmente opuestas que pueden controlar las vías apoptóticas. Además, se sabe que tanto MMRP como survivin son poderosos parámetros pronósticos. Material y métodos: El objetivo de nuestro estudio fue observar el patrón de expresión inmunohistoquímica de MMRP MLH1, MSH2, MSH6 y PMS2, y survivin en un grupo unificado de 124 adenomatosos pólipos tubulares de colon con respecto a la presencia de anomalías displásicas para explorar sus relaciones. Además, estudiamos su relación con los parámetros clinicomorfológicos, como la edad de los pacientes, el tamaño del adenoma, el grado de cambios displásicos y la localización de la lesión. Resultados: Survivin se expresó en 97 casos (78.2%), MLH1 se encontró en 111 casos (89.5%), MSH2 en 115 casos (92.7%), MSH6 en 118 casos (95.2%) y PMS2 en 105 casos (84.7%). La mayoría de los casos ausentes de MMRP se detectaron en un tamaño de adenoma inferior a 10 mm, estos casos se asociaron principalmente con displasia de bajo grado y fueron más frecuentes en el colon distal. La expresión de survivin se correlacionó significativamente con el tamaño del adenoma y el grado de displasia. La compartimentalización de survivin subcelular se asoció estadísticamente con el tamaño del adenoma, el grado de displasia y localización del adenoma. Además, confirmamos una relación significativa entre la expresión de survivin y el MMRP. En general, la intensidad de la inmunorreacción fue más fuerte en MMRP en comparación con la intensidad del survivin. Conclusiones: Con base en nuestros resultados recientes, sugerimos que el MMRP puede suprimir la actividad antiapoptótica del survivin en los adenomas de colon con displasias de bajo y alto grado.

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Long term outcomes of colon polyps with high grade dysplasia following endoscopic resection

BMC Gastroenterology ◽

10.1186/s12876-020-01499-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jia-Jang Chang ◽

Cheng-Hung Chien ◽

Shuo-Wei Chen ◽

Li-Wei Chen ◽

Ching-Jung Liu ◽

...

Keyword(s):

High Grade Dysplasia ◽

Advanced Adenoma ◽

Colon Polyps ◽

High Grade ◽

Colonic Adenoma ◽

Screen Colonoscopy ◽

Colon Adenomas ◽

Advanced Adenomas

Abstract Background The risk of recurrent colonic adenoma associated with high-grade dysplasia (HGD) colon polyps at baseline colonoscopy remains unclear. We conducted a clinical cohort study with patients who underwent polypectomy during screen colonoscopy to assess recurrent colonic adenoma risk factors. Methods 11,565 patients at our facility underwent screen colonoscopy between September 1998 and August 2007. Data from patients with HGD colon polyps who had undergone follow-up colonoscopy were included for analysis. Results Data from 211 patients was included. Rates of metachronous adenoma and advanced adenoma at follow-up were 58% and 20%, respectively. Mean follow-up period was 5.5 ± 1.8 (3–12) years. Univariate logistic regression analysis revealed that an adenoma count of ≥ 3 at baseline colonoscopy was strongly associated with overall recurrence, multiple recurrence, advanced recurrence, proximal recurrence, and distal adenoma recurrence with odds ratios of 4.32 (2.06–9.04 95% CI), 3.47 (1.67–7.22 95% CI), 2.55 (1.11–5.89 95% CI), 2.46 (1.16–5.22 95% CI), 2.89 (1.44–5.78 95% CI), respectively. Multivariate analysis revealed gender (male) [P = 0.010; OR 3.09(1.32–7.25 95% CI)] and adenoma count ≥ 3 [P = 0.002; OR 3.08(1.52–6.24 95% CI)] at index colonoscopy to be significantly associated with recurrence of advanced adenoma. Conclusion Recurrence of colonic adenoma at time of follow-up colonoscopy is common in patients who undergo polypectomy for HGD colon adenomas during baseline colonoscopy. Risk of further developing advanced adenomas is associated with gender and the number of colon adenomas present.

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Invasive carcinoma versus pseudoinvasion: interobserver variability in the assessment of left-sided colorectal polypectomies

Journal of Clinical Pathology ◽

10.1136/jclinpath-2021-207406 ◽

2021 ◽

pp. jclinpath-2021-207406

Author(s):

Michael Lee ◽

Satoru Kudose ◽

Armando Del Portillo ◽

Huaibin Mabel Ko ◽

Hwajeong Lee ◽

...

Keyword(s):

Lamina Propria ◽

Invasive Carcinoma ◽

Interobserver Variability ◽

High Grade Dysplasia ◽

Colon Polyps ◽

High Grade ◽

Histological Findings ◽

Invasive Adenocarcinoma ◽

Perfect Agreement ◽

Intramucosal Adenocarcinoma

ObjectivesMisplaced epithelium in adenomas can occasionally be difficult to distinguish from invasive adenocarcinoma. We evaluated interobserver variability in the assessment of left-sided colon polypectomies for pseudoinvasion versus invasive adenocarcinoma and further investigated relevant histological findings.Methods28 consecutive left-sided colon polyps with the keywords “pseudoinvasion”, “epithelial misplacement”, “herniation”, “prolapse” or “invasive adenocarcinoma” were collected from 28 patients and reviewed by eight gastrointestinal pathologists. Participants assessed stromal hemosiderin, lamina propria/eosinophils surrounding glands, desmoplasia, high grade dysplasia/intramucosal adenocarcinoma and margin status and rendered a diagnosis of pseudoinvasion, invasive adenocarcinoma, or both.ResultsAgreement among pathologists was substantial for desmoplasia (κ=0.70), high grade dysplasia/intramucosal adenocarcinoma (κ=0.66), invasive adenocarcinoma (κ=0.63) and adenocarcinoma at the margin (κ=0.65). There was moderate agreement for hemosiderin in stroma (κ=0.53) and prolapse/pseudoinvasion (κ=0.50). Agreement was low for lamina propria/eosinophils around glands (κ=0.12). For invasive adenocarcinoma, seven or more pathologists agreed in 24 of 28 cases (86%), and there was perfect agreement in 19/28 cases (68%). For pseudoinvasion, seven or more pathologists agreed in 19 of 28 cases (68%), and there was perfect agreement in 16/28 cases (57%).ConclusionModerate to substantial, though imperfect, agreement was achieved in the distinction of pseudoinvasion from invasive carcinoma.

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The Incidence of and Risk Factors for Local Recurrence With Malignancy After Endoscopic Resection of Large Colon Polyps With High Grade Dysplasia

The American Journal of Gastroenterology ◽

10.14309/00000434-201810001-00113 ◽

2018 ◽

Vol 113 (Supplement) ◽

pp. S60-S61

Author(s):

Ashraf Abushahin ◽

Dhairya Mehta ◽

Prabhleen Chahal ◽

Tyler Stevens ◽

Emre Gorgun ◽

...

Keyword(s):

Risk Factors ◽

Local Recurrence ◽

Endoscopic Resection ◽

High Grade Dysplasia ◽

Colon Polyps ◽

High Grade

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The Optimal Surveillance Interval for Colon Polyps with High Grade Dysplasia (HGD): Not All Adenomas Are Equal

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2007.03.067 ◽

2007 ◽

Vol 65 (5) ◽

pp. AB100

Author(s):

Madhavi Rudraraju ◽

Derek M. Blankenship ◽

Barbara Neas ◽

William M. Tierney

Keyword(s):

High Grade Dysplasia ◽

Colon Polyps ◽

High Grade ◽

Surveillance Interval

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Long Term Outcomes of Colon Polyps with High Grade Dysplasia after Endoscopic Resection

10.21203/rs.3.rs-39348/v1 ◽

2020 ◽

Author(s):

Jia-Jang Chang ◽

Cheng-Hung Chien ◽

Shuo-Wei Chen ◽

Li-Wei Chen ◽

Ching-Jung Liu ◽

...

Keyword(s):

Male Gender ◽

High Grade Dysplasia ◽

Screening Colonoscopy ◽

Colon Polyps ◽

High Grade ◽

Surveillance Colonoscopy ◽

Colon Adenomas ◽

Colonic Adenomas ◽

Advanced Adenomas

Abstract Background The clinical characteristics of patients with high-grade dysplasia (HGD) in colon polyps at baseline colonoscopy in relation to the risk of recurrent colonic adenomas have been unclear. We conducted this hospital- based cohort study recruiting patients who had undergone polypectomy at screening colonoscopy to assess the risk factors of recurrent colonic adenomas. Methods 11,565 subjects had undergone screening colonoscopic examinations between September 1998 and August 2007. The patients who had HGD in colon polyps and had undergone surveillance colonoscopy were eligible. Results A total of 211 patients were recruited. The rates of metachronous adenomas and advanced adenomas at surveillance colonoscopy were 58% and 20%, respectively, during the mean follow-up period of 5.5 ± 1.8 (3–12) years. On univariate logistic regression analysis, the number of adenomas ≥ 3 at baseline colonoscopy was strongly associated with the rates of overall recurrence, multiple recurrence, advanced recurrence, proximal recurrence, and distal adenoma recurrence with odds ratios of 4.32 (2.06–9.04 95%CI), 3.47 (1.67–7.22 95%CI), 2.55 (1.11–5.89 95%CI), 2.46 (1.16–5.22 95%CI), 2.89 (1.44–5.78 95%CI), respectively. On multivariate analysis, male gender [P = 0.010; OR 3.09(1.32–7.25 95% CI)] and number of adenomas ≥ 3 [P = 0.002; OR 3.08(1.52–6.24 95%CI)] at index colonoscopy were significantly associated with recurrent advanced adenomas. Conclusions Recurrence of colonic adenomas at surveillance colonoscopy is common in patients who had undergone polypectomy for colon adenomas with HGD at baseline colonoscopy. The risk of developing future advanced adenomas is associated with the number of colon adenomas and male gender.

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Prevalence of High-Grade Dysplasia in Diminutive Colon Polyps at a Community-Based Endoscopy Center: A Retrospective Analysis and Literature Review

The American Journal of Gastroenterology ◽

10.14309/00000434-201610001-00275 ◽

2016 ◽

Vol 111 ◽

pp. S129

Author(s):

Victor Guharoy ◽

Robert J Evans ◽

Mary Lamoureux ◽

Sultan M. Mohammad

Keyword(s):

Literature Review ◽

Retrospective Analysis ◽

High Grade Dysplasia ◽

Colon Polyps ◽

High Grade ◽

Community Based

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Recurrence with malignancy after endoscopic resection of large colon polyps with high-grade dysplasia: incidence and risk factors

Surgical Endoscopy ◽

10.1007/s00464-020-07660-y ◽

2020 ◽

Author(s):

Neal Mehta ◽

Ashraf Abushahin ◽

Meena Sadaps ◽

Mohammad Alomari ◽

John Vargo ◽

...

Keyword(s):

Risk Factors ◽

Endoscopic Resection ◽

High Grade Dysplasia ◽

Colon Polyps ◽

High Grade

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Long Term Outcomes of Colon Polyps with High Grade Dysplasia Following Endoscopic Resection

10.21203/rs.3.rs-39348/v2 ◽

2020 ◽

Author(s):

Jia-Jang Chang ◽

Cheng-Hung Chien ◽

Shuo-Wei Chen ◽

Li-Wei Chen ◽

Ching-Jung Liu ◽

...

Keyword(s):

High Grade Dysplasia ◽

Advanced Adenoma ◽

Colon Polyps ◽

High Grade ◽

Colonic Adenoma ◽

Screen Colonoscopy ◽

Colon Adenomas ◽

Advanced Adenomas

Abstract Background The risk of recurrent colonic adenoma associated with high-grade dysplasia (HGD) colon polyps at baseline colonoscopy remains unclear. We conducted a clinical cohort study with patients who underwent polypectomy during screen colonoscopy to assess recurrent colonic adenoma risk factors. Methods 11,565 patients at our facility underwent screen colonoscopy between September 1998 and August 2007. Data from patients with HGD colon polyps who had undergone follow-up colonoscopy were included for analysis. Results Data from 211 patients was included. Rates of metachronous adenoma and advanced adenoma at follow-up were 58% and 20%, respectively. Mean follow-up period was 5.5 ± 1.8 (3-12) years. Univariate logistic regression analysis revealed that an adenoma count of ≥ 3 at baseline colonoscopy was strongly associated with overall recurrence, multiple recurrence, advanced recurrence, proximal recurrence, and distal adenoma recurrence with odds ratios of 4.32 (2.06-9.04 95%CI), 3.47 (1.67-7.22 95%CI), 2.55 (1.11-5.89 95%CI), 2.46 (1.16-5.22 95%CI), 2.89 (1.44-5.78 95%CI), respectively. Multivariate analysis revealed gender (male) [P=0.010; OR 3.09(1.32-7.25 95% CI)] and adenoma count ≥ 3 [P=0.002; OR 3.08(1.52-6.24 95%CI)] at index colonoscopy to be significantly associated with recurrence of advanced adenoma. Conclusion Recurrence of colonic adenoma at time of follow-up colonoscopy is common in patients who undergo polypectomy for HGD colon adenomas during baseline colonoscopy. Risk of further developing advanced adenomas is associated with gender and the number of colon adenomas present.

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