Pathological reporting of malignant colorectal polyps

The pathological reporting of malignant colorectal polyps plays an important role in determining whether definitive surgical resection is required following endoscopic polypectomy. This study aims to assess the adequacy of reporting on malignant polyp specimens at Auckland Hospital and whether synoptic reporting results in an improvement.

The pathology database at Auckland Hospital was accessed using a search strategy to identify all malignant polyps diagnosed between 1999 and 2011. Pathology reports were reviewed retrospectively.

In total 121 malignant polyps were found. Of these, 73 were colonoscopic polypectomies, 41 were colectomy specimens, and seven transanal resections. Of the 41 colectomy specimens, 19 (46%) were reported in synoptic format compared with none of the colonoscopic polypectomies or transanal resections. The status of the margin of excision, differentiation, and presence of lymphovascular invasion were given in 100% of synoptic reports compared with 51% of non-synoptic reports.

Synoptic reporting does improve the completeness of pathological reporting in malignant colorectal polyps. Currently none of the colonoscopically excised malignant polyps are reported in this format at Auckland Hospital. The development and routine use of a synoptic system for reporting on malignant polyps would give clinicians more information on which to base decisions.