Do all colorectal polyps require pathological examination?



DENIS B, BOTTLAENDER J, WEISS AM, PETER A, BREYSACHER G, CHIAPPA P, GENDRE I, PERRIN P

Pathological examination of removed colorectal polyps places a huge burden on pathologists and represents a non negligible cost. It is of value only if clinical management is affected eg if colorectal cancer (CRC) is detected or if the post-polypectomy surveillance interval is guided.


Aim        

to assess whether it is possible to omit the pathological examination of some polyps without any risk for the patient.


Methods        

retrospective assessment of all polyps removed from September 2003 to August 2008 within the organized gFOBT CRC screening program implemented in the Haut-Rhin and prospective assessment of all polyps removed from January to August 2008 in a hospital endoscopy unit.


Results        

The results of the retrospective study involving 4360 polyps are presented in the table. In the prospective study, 355 polyps were removed during 175 colonoscopic procedures. 47.4% of them were a 1st procedure and 46.5% a surveillance procedure after surgery for CRC or polypectomy. A family history of CRC was present in 13.9% of cases. 263 (74.1%) polyps were ≤ 5 mm and 54 (15.2%) were ≥ 10 mm. 90 (25.7%) polyps were non adenomatous, 76 (21.4%) advanced adenoma and 2 (0.6%) invasive carcinoma. The pathological examination was considered useful by the endoscopist for 148 (41.7%) polyps. This rate of useful examinations varied according to the polyps’ size (26.1% for polyps ≤ 5 mm, 73.7% for 6-9 mm and 92.5% for ≥ 10 mm)(p<0.001) and to the context (57.1% in case of a 1st procedure and 23.4% in case of a surveillance procedure). The pathological examination was necessary for the determination of the surveillance interval in 24.0% of patients and modified the surveillance interval proposed by the endoscopist in 8.6% of patients. It had no impact on the surveillance interval in 67.4% of patients. If isolated polyps ≤ 5 mm had not been examined in patients with either personal or family history of CRC or adenoma (37.5% of polyps in our prospective study) one patient out of 44 would have had a surveillance interval of 5 years instead of 3 years.


Conclusion        

Due to the risk of invasive carcinoma, all polyps > 5 mm require pathological examination. The pathological examination of diminutive polyps ≤ 5 mm either associated with a CRC or a polyp ≥ 10 mm or removed in very old patients can be omitted without any risk for the patient. They represent 13.8% of polyps in case of a diversified recruitment and 22.3% in an organized gFOBT CRC screening program. Top of Form 1 Bottom of Form 1



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