Biopsy of Colorectal Polyps Is Not Adequate for Grading of Neoplasia

Gondal, Ghous; Grotmol, Tom; Hofstad, Bjørn; Bretthauer, Michael; Eide, T. J.; Hoff, Geir

doi:10.1055/s-2005-921031

Cited by 50 publications

(39 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Pugliese et al [13] reported that among 53 patients with 59 colorectal polyps (≥ 5 mm), seven cases had carcinomas that had invaded the submucosa or beyond, and four of these had been underestimated from the cold biopsy specimens. Gondal et al [14] reported that among 442 patients with a total of 532 colorectal adenomas (≥ 2 mm) biopsied by flexible sigmoidoscopy and removed by colonoscopy, the assessment of the intraepithelial neoplasia status was changed in 51 adenomas (10%), and 38 (7%) of these had been underestimated from the cold biopsy diagnoses compared with the diagnoses based on polypectomy samples. Of these lesions, 389 (73%) were < 10 mm in diameter.…”

Section: Discussionmentioning

confidence: 99%

“…Of these lesions, 389 (73%) were < 10 mm in diameter. In addition, four carcinomas invading the submucosa or beyond had been underestimated as being low-grade or high-grade intraepithelial neoplasias [14] . These observations suggest that cold biopsy-based diagnoses underestimate histopathologic diagnoses of the resected lesions in some cases of colorectal epithelial neoplastic lesions.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of the revised Vienna Classification for diagnosing colorectal epithelial neoplasias

Tominaga¹,

Fujinuma²,

Endo³

et al. 2009

WJG

View full text Add to dashboard Cite

AIM:To prospectively investigate the efficacy of the revised Vienna Classification for diagnosing colorectal epithelial neoplastic lesions in cold biopsy specimens. METHODS:Patients were selected for inclusion if they had colorectal epithelial lesions that were not considered suitable for direct endoscopic resection. These included colorectal polyps ≥ 10 mm and lesions suspected of being carcinomas capable of invading the colorectal submucosa or beyond, including strictures, based on the cold biopsies obtained from each lesion prior to resection. We investigated the relationship between diagnoses based on cold biopsy samples using the revised Vienna Classification and resected specimens of the same lesions, and the therapeutic implications of diagnoses made using the revised Vienna Classification. The same cold biopsy specimens were also examined using the Japanese Group Classification guidelines, and compared with the resected specimens of the same lesions for reference. RESULTS:A total of 179 lesions were identified. The sensitivity, specificity, positive and negative predictive values of the revised Vienna Classification for distinguishing between intramucosal lesions and submucosal invasive carcinomas in cold biopsy specimens was 22.2%, 100%, 100%, and 71.4%, r e s p e c t i v e l y, a n d f o r d i s t i n g u i s h i n g b e t w e e n intramucosal lesions and those invading the submucosa or beyond was 59.7%, 100%, 100%, and 37.6%, respectively. The sensitivity, specificity, positive and negative predictive values of the Japanese Group Classification for distinguishing between intramucosal lesions and submucosal invasive carcinomas in cold biopsy specimens was 83.3%, 91.4%, 83.3%, and 91.4%, respectively, and for distinguishing between intramucosal lesions and those invading the submucosa or beyond was 95.1%, 91.4%, 97.9%, and 82.1%, respectively. A total of 137 of 144 carcinomas that had invaded the submucosa or beyond and three high-grade intraepithelial neoplasias were diagnosed as "carcinoma" using the Japanese Group Classification system. CONCLUSION:The revised Vienna Classification for cold biopsy specimens has high positive predictive value in the diagnosis of colorectal carcinoma invasive to the submucosa or beyond.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy of the revised Vienna Classification for diagnosing colorectal epithelial neoplasias

Tominaga¹,

Fujinuma²,

Endo³

et al. 2009

WJG

View full text Add to dashboard Cite

show abstract

“…Several studies have shown that the rate of adenocarcinoma in adenomas in biopsies is underestimated when compared with later total polypectomy (15,16). The excision margins have also been discussed.…”

Section: Introductionmentioning

confidence: 99%

Adenomas with Adenocarcinoma: A Study Evaluating the Risk Of Residual Cancer And Lymph Node Metastasis

Steigen

Isaksen

Skjæveland³

et al. 2013

Scand J Surg

View full text Add to dashboard Cite

Background and Aims:The increasing number of cases with colorectal adenomas with adenocarcinoma necessitates renewed evaluation of classification systems and risk factors. The aim for this retrospective study was to evaluate the potential risk of residual cancer and lymph node metastasis in patients with colorectal adenomas with adenocarcinoma.Material and Methods: An investigation of adenomas with adenocarcinoma in 74 patients was performed on histological slides and compared with clinical characteristics. A total of 44 of the samples were from macroscopically and microscopically completely resected lesions, and cancer at extended surgery was compared with pathology reports, classifications, and histopathological features.Results: In all, 26 cases of adenomas with adenocarcinoma in the rectum and rectosigmoid were among women and 11 in men while 22 men as opposed to 15 women had primary lesions in colon, giving a significant association between gender and localization (p = 0.01). For macroscopically and microscopically fully resected lesions, Haggitt classification or submucosal invasion did not correlate with cancer at extended surgery. The lack of information on resection margins in the primary pathology reports was found to correlate significantly with residual cancer at extended surgery (p < 0.001) with residual cancer in 3 out of the 10 cases with no information, 1 out of the 5 where the resection margins were uncertain, 1 out of the 4 where the resection margins were not free, and none of the 25 cases when the resection margins were reported as free. In colon, 1 case out of the 6 with extended surgery (16.7%) was diagnosed with residual cancer compared with 4 out of the 10 (40%) from rectum.Conclusions: Haggitt or submucosal classifications were not found to be predictors for residual cancer in the remaining bowel tissue or lymph node metastasis. The only significant factor indicating increased risk of residual cancer was the lack of information on resection margins in the pathology report. Surgeons should therefore be alert when adenomas with adenocarcinomas are not confirmed as microscopically free in the pathology report.

show abstract

“…In a recent study, biopsybased diagnosis has underestimated histopathological diagnosis in about 10% of colorectal adenomas and more than 60% of advanced neoplasia. So it is important to obtain whole polypectomy specimens to get a correct diagnosis [29].…”

Section: Discussionmentioning

confidence: 99%

Should We Perform Polypectomy for All Colorectal Polyps, or Follow-Up?

Öztürk¹,

Köklü²,

Basat³

et al. 2008

Chir Gastroenterol

View full text Add to dashboard Cite

Background: There is controversy as to whether all colorectal polyps detected on colonoscopy should be removed. This study evaluated the histopathological characteristics of colorectal polyps in Turkish patients, and further determined their relationship to age, gender, size, and location. We aimed to determine the risk of neoplasms in patients with small polyps (≤5 mm), and emphasize the importance of polyp removal. Materials and Methods: Of 4,145 colonoscopies reviewed between July 2004 and June 2006, 791 polypectomies and 211 polyp biopsies were performed in 576 patients. Results: Of the 1,002 polyps histologically analyzed, 586 (58.5%) were non-neoplastic, and 396 (39.5%) were neoplastic. For the remaining 20 (2%), data are missing. Among the neoplastic polyps, 311 (78.5%) were tubular, 41 (10.4%) were tubulovillous, 31 (7.8%) were villous, and 13 (3.3%) showed a malignant transformation. 63% of the non-neoplastic polyps were hyperplastic, and the remaining 37% were inflammatory polyps. Both neoplastic and non-neoplastic polyps were located predominantly in the left colon (rectum, sigmoid, descending colon). Though only 31.7% of the polyps measuring <5 mm were neoplastic, 82.4% of the polyps >20 mm in size were neoplastic. There was no significant gender difference in distribution of either neoplastic or non-neoplastic polyps. The peak prevalence of both neoplastic and non-neoplastic polyps occurred in the 50–70-year age group. Conclusion: About half of the colorectal polyps are neoplastic in patients more than 50 years old. Even small polyps seen during colonoscopy should be removed and subjected to histological analysis. Western guidelines regarding colorectal polyps may also be applicable for the Turkish population.

show abstract

Biopsy of Colorectal Polyps Is Not Adequate for Grading of Neoplasia

Abstract: Biopsy-based diagnosis underestimated histopathological diagnosis in about 10% of colorectal adenomas detected by flexible sigmoidoscopy screening, but advanced neoplasia was underestimated in more than 60%. Efforts must be made to obtain polypectomy specimens to secure precise diagnosis.

Cited by 50 publications

References 7 publications

Efficacy of the revised Vienna Classification for diagnosing colorectal epithelial neoplasias

Efficacy of the revised Vienna Classification for diagnosing colorectal epithelial neoplasias

Adenomas with Adenocarcinoma: A Study Evaluating the Risk Of Residual Cancer And Lymph Node Metastasis

Should We Perform Polypectomy for All Colorectal Polyps, or Follow-Up?

Contact Info

Product

Resources

About