A simple tissue-handling technique performed in the endoscopy suite improves histologic section quality and diagnostic accuracy for serrated polyps
| Autor: | Susan Kornacki, Lawrence B. Cohen, Shannon John Morales, Kenneth M. Miller, Neville D. Bamji, Robert Petras, Tonya Kaltenbach, Roy Soetikno, Robert V. Rouse, Carol A. Bodian, James Aisenberg, Nicholas A. Rouse |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Biopsy medicine.medical_treatment Colonic Polyps Colonoscopy Diagnostic accuracy Tissue handling Specimen Handling Resection Diagnosis Differential Adenomatous Polyps otorhinolaryngologic diseases medicine Humans Single-Blind Method Intestinal Mucosa Aged Observer Variation Splenic flexure medicine.diagnostic_test business.industry Gastroenterology Middle Aged digestive system diseases Polypectomy Surgery Endoscopy surgical procedures operative Hyperplastic Polyp Female Radiology business |
| Zdroj: | Endoscopy. 45:897-905 |
| ISSN: | 1438-8812 0013-726X |
| DOI: | 10.1055/s-0033-1344435 |
| Popis: | Surveillance intervals after colonoscopic resection of serrated polyps are partially predicated on the histology of the polyp(s) removed during the index exam. Histologic discrimination between sessile serrated adenomas/polyps (SSA/P) and hyperplastic polyps is challenging. We devised and tested a simple tool--an envelope--that gastroenterologists can integrate into routine colonoscopy practice to address this problem.In the "modified protocol," immediately after polypectomy each serrated polyp was flattened and enclosed in a paper envelope before being placed in formalin. In the pathology laboratory, each polyp was sectioned after processing. A two-site, prospective, randomized, single-blinded trial was performed to compare this modified protocol with the conventional protocol. Serrated polyps located proximal to the splenic flexure and 5-20 mm in diameter were included. A novel orientation score that measured the number of well-oriented crypts per unit area of polyp (higher orientation score = better orientation) was validated. Orientation score, SSA/P diagnosis rate, and inter-pathologist agreement were measured.A total of 375 polyps were enrolled, of which 264 were identified for analysis. The mean orientation scores in the modified and conventional protocol groups were 3.11 and 1.13, respectively (P0.0001). SSA/Ps were diagnosed in 103/135 cases (76.3%) in the modified protocol group vs. 54/129 (41.9%) in the conventional protocol group (P0.0001). Inter-pathologist agreement was higher with the modified than the conventional protocol (77.0% vs. 62.8%; P = 0.015).Standard polyp handling techniques may be sub-optimal for interpretation of serrated polyps resected at colonoscopy, and may lead to inadvertent histologic "under-grading" of many lesions. Our intervention improved histopathologic interpretation and increased the SSA/P diagnosis rate. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|