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Endoscopically removed malignant colorectal polyps: clinicopathologic correlations

H S Cooper1, L M Deppisch, W K Gourley

  • 1Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.

Gastroenterology
|June 1, 1995
PubMed
Summary
This summary is machine-generated.

Histopathologic factors in malignant colorectal polyps guide treatment. Unfavorable histology, including margin involvement or invasion, predicts adverse outcomes, suggesting surgery post-polypectomy.

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Pathology

Background:

  • Malignant colorectal polyps present treatment dilemmas: polypectomy alone versus additional surgery.
  • Defining histopathologic criteria is crucial for informed clinical decisions.

Purpose of the Study:

  • To identify histopathologic parameters for guiding treatment decisions in patients with endoscopically removed malignant colorectal polyps.
  • To correlate specific histopathologic features with patient outcomes.

Main Methods:

  • Five pathologists reviewed 140 polyps, assessing for unfavorable histology.
  • Unfavorable histology defined as tumor at/near margin (<1.0 mm), grade III, or lymphatic/venous invasion.
  • Adverse outcomes included recurrence, local cancer, lymph node metastasis, or death from disease.

Main Results:

  • Adverse outcomes occurred in 19.7% of cases with unfavorable histology versus 0% without (P < 0.0005).
  • Interobserver agreement was substantial to almost perfect for margin, grade, and venous invasion.
  • Distant metastases and death from disease were observed, even in some cases with initially negative margins.

Conclusions:

  • A histopathologic assessment system is clinically applicable for malignant colorectal polyps.
  • Patients with unfavorable histology likely benefit from resection post-polypectomy.
  • Polypectomy alone may suffice for patients without unfavorable histology.