To step or not to step: an approach to clinically diagnosed polyps with no initial pathologic finding

Area of Science:

• Gastroenterology
• Pathology
• Colorectal Cancer Screening

Background:

• Colorectal polyps require accurate pathologic diagnosis for appropriate management.
• Initial examination of polyp biopsy specimens may not always yield a definitive diagnosis.

Purpose of the Study:

• To investigate the diagnostic yield of additional tissue sectioning (leveling) for colorectal polyps.
• To determine the optimal level for identifying diagnostic findings in challenging polyp cases.

Main Methods:

• Retrospective review of 733 colorectal polyp biopsy specimens.
• Initial 3-level sectioning, with further levels examined if no diagnosis or only lymphoid aggregates were found.
• Recording of diagnostic findings and the specific tissue level at which they were identified.

Main Results:

• A definitive cause for the polyp was identified in routine sections in 78.3% of cases.
• Additional levels revealed diagnostic findings in 22.8% of polyps initially lacking a diagnosis or showing only lymphoid aggregates.
• Neoplastic findings were identified in 9.6% of these stepped specimens, with some tubular adenomas diagnosed at deeper levels (7-8).

Conclusions:

• Level sectioning of colorectal polyps with no pathologic diagnosis or lymphoid aggregates on initial examination increases diagnostic yield.
• This approach is valuable for uncovering subtle or deeper pathological changes, including neoplastic lesions.