Colon biopsy - Small <1cm

Biopsy

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Screening for polyps or colorectal cancer

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Colon Biopsy - Small (<1cm)

Why is it done?
- To obtain small tissue samples from suspicious lesions, polyps, or abnormal areas of the colon for histopathological examination
- Indications include: investigation of small polyps (<1cm), suspicious mucosal lesions, areas of inflammation, ulcerations, and abnormal tissue appearance noted during colonoscopy
- Common clinical reasons: diagnosis of colorectal cancer, polyp classification (adenomatous vs hyperplastic), inflammatory bowel disease assessment, and evaluation of chronic diarrhea or rectal bleeding
- Timing: Performed during colonoscopy when small lesions requiring tissue diagnosis are identified, typically as part of routine screening or diagnostic endoscopy
Normal Range
- Biopsy findings are qualitative rather than quantitative, reported as descriptive pathological observations
- Normal/Benign findings: Normal colonic mucosa with intact epithelium, no dysplasia, hyperplastic polyp (non-neoplastic), normal lamina propria, absence of inflammation or malignancy
- Negative result: No evidence of dysplasia, malignancy, or significant pathology; tissue appears normal on microscopic examination
- Units of measurement: Not applicable; results are histological classifications based on microscopic morphology and cellular characteristics
- Specimen adequacy: Biopsy should contain sufficient tissue (minimum 2-4 tissue fragments) for reliable pathological assessment
Interpretation
- Benign polyp/Normal mucosa: No dysplasia present; hyperplastic polyp or normal epithelium indicates non-cancerous tissue; requires surveillance as per screening guidelines
- Adenomatous polyp (tubular, tubulovillous, villous): Neoplastic tissue with dysplastic changes; high risk for malignant transformation; requires complete removal and follow-up colonoscopy
- Low-grade dysplasia (LGD): Dysplastic changes limited to lower third of crypts; moderate risk; requires close surveillance and repeat colonoscopy within 3-6 months
- High-grade dysplasia (HGD): Severe dysplastic changes throughout crypts; significant malignancy risk; typically requires complete lesion resection or close endoscopic surveillance
- Carcinoma (invasive cancer): Malignant cells invading beyond muscularis mucosae; indicates established colorectal cancer; requires staging and oncologic treatment planning
- Inflammatory findings: Evidence of acute or chronic inflammation, ulceration, or infection; may indicate inflammatory bowel disease, infectious colitis, or other inflammatory conditions
- Factors affecting interpretation: Adequate tissue sampling, proper fixation and staining, tumor grade and stage (if malignancy present), depth of invasion, margins status, and associated findings like lymphovascular invasion
Associated Organs
- Primary organ: Colon (large intestine), specifically the mucosa and submucosa; may involve rectum, sigmoid, descending, transverse, or ascending colon
- Associated conditions diagnosed: Colorectal adenocarcinoma, adenomatous polyps, sessile serrated polyps, inflammatory bowel disease (Crohn's disease, ulcerative colitis), infectious colitis, diverticulitis, and mucosal dysplasia
- Potential complications from biopsy: Perforation (rare with small biopsies), bleeding (especially if coagulopathy or anticoagulation therapy), infection, and transient abdominal discomfort
- Related organ involvement: Liver (metastatic spread if malignancy), regional lymph nodes (nodal involvement assessment), peritoneum (peritoneal involvement), and distant organs in advanced cancer staging
- Disease complications: Obstruction, perforation, intussusception, toxic megacolon (if ulcerative colitis), systemic infection from perforation, and cancer-related complications including metastatic disease
Follow-up Tests
- If benign findings: Routine colonoscopy screening per guidelines (every 10 years for normal screening, 5-7 years for adenomatous polyp history); no further imaging required
- If high-grade dysplasia or carcinoma: CT abdomen/pelvis (staging and metastasis detection), MRI rectum (for rectal tumors), PET-CT (if invasive cancer), and oncology consultation for treatment planning
- If inflammatory bowel disease suspected: Repeat colonoscopy with extensive biopsies, CT enterography or MR enterography for disease extent, laboratory studies (inflammatory markers), and gastroenterology referral
- Surveillance colonoscopy: Timing depends on findings - high-grade dysplasia (3-6 months), adenomatous polyps (3-5 years), or low-grade dysplasia (12 months)
- Immunohistochemistry and molecular testing: May be recommended for adenocarcinoma (MSI/MMR status, KRAS mutation, BRAF mutation) for prognostic and therapeutic decision-making
- Complementary imaging: Chest X-ray or CT chest (if malignancy for pulmonary metastasis screening), liver ultrasound or CT (hepatic metastasis detection)
- Tumor markers: CEA (carcinoembryonic antigen) if invasive cancer diagnosed; baseline and postoperative levels monitored
Fasting Required?
- Yes - Fasting is required before colonoscopy with biopsy
- Duration: NPO (nothing by mouth) for minimum 6-8 hours before procedure; typically overnight fasting (10-12 hours preferred) for morning procedures
- Clear liquid diet: 24 hours before procedure - water, clear broth, apple juice, white grape juice, ginger ale, sports drinks, and black coffee without cream allowed
- Bowel preparation: Polyethylene glycol (GoLYTELY), sodium phosphate, or magnesium citrate solutions required day before procedure to cleanse colon; follow endoscopist's specific instructions
- Medications to avoid: Continue routine medications unless specifically instructed otherwise by physician; anticoagulants (warfarin, DOACs) and antiplatelet agents (aspirin, clopidogrel) may require adjustment if significant biopsy anticipated
- Other preparation requirements: Arrange transportation home (sedation used during procedure); wear comfortable, loose-fitting clothing; arrive 15-30 minutes early for check-in
- Day of procedure: Take only approved sips of water up to 2 hours before scheduled time; notify endoscopy team of all current medications and allergies

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