The utility of submitting fibroepithelial polyps for histological examination
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Published on: July 25, 2017
T J Eads1, T Y Chuang, V C Fabré
1Department of Dermatology, Indiana University Medical Center, Indianapolis, USA.
Background:
The fibroepithelial polyp (FEP) is a common cutaneous lesion that is often removed for medical or cosmetic reasons. We examined the utility of submitting clinically diagnosed FEPs for routine microscopic examination.
Design:
We reviewed 11500 consecutive cutaneous pathology reports. Materials submitted with the clinical diagnosis of FEP or a synonym were reviewed and the histopathologic slides were examined. A comparison group of specimens submitted with the clinical diagnosis of melanocytic nevus was reviewed.
Setting:
The biopsy reports were generated at a regional non-hospital-based dermatopathology laboratory providing service to physicians (dermatologists and nondermatologists) practicing ambulatory medicine predominantly within a 4-state region (Ind, Ky, Tenn, and WVa).
Results:
Of 1335 clinical specimens submitted as FEPs, there were 5 malignant tumors. In the comparison group of 697 clinically diagnosed melanocytic nevi, there were 6 malignant tumors. In comparison with clinically diagnosed melanocytic nevi, the likelihood that a lesion clinically diagnosed as FEP would be a malignant tumor on histological examination is very low (relative risk, 0.4). None of the lesions clinically diagnosed as FEPs by dermatologists proved to be malignant.
Conclusions:
Our data suggest there is an extremely low prevalence of malignancy in lesions clinically diagnosed as FEPs. We conclude that cutaneous lesions diagnosed as typical FEPs by dermatologists need not be submitted for microscopic examination.
Insights
Routine microscopic examination of fibroepithelial polyps (FEPs) is often unnecessary. Studies show a very low malignancy rate in FEPs, especially when diagnosed by dermatologists, suggesting clinical diagnosis may suffice.
Area of Science:
- Dermatopathology
- Cutaneous Oncology
Background:
- Fibroepithelial polyps (FEPs) are common skin lesions frequently removed for medical or cosmetic reasons.
- The necessity of routine microscopic examination for clinically diagnosed FEPs was investigated.
Purpose of the Study:
- To evaluate the diagnostic yield and clinical utility of submitting presumed fibroepithelial polyps for histopathological analysis.
- To determine the prevalence of malignancy in lesions clinically diagnosed as FEPs.
Main Methods:
- A retrospective review of 1335 cutaneous pathology reports for lesions clinically diagnosed as FEPs.
- Histopathological examination of slides from these specimens.
- Comparison with a control group of 697 clinically diagnosed melanocytic nevi.
Main Results:
- Only 5 malignant tumors were identified among 1335 FEP submissions.
- The likelihood of malignancy in FEPs was significantly lower than in melanocytic nevi (relative risk, 0.4).
- No malignant tumors were found in FEPs clinically diagnosed by dermatologists.
Conclusions:
- The prevalence of malignancy in clinically diagnosed fibroepithelial polyps is extremely low.
- Cutaneous lesions with a typical FEP diagnosis by dermatologists may not require routine microscopic examination.
- This finding can potentially streamline dermatopathological workflows and reduce unnecessary testing.
