Polyp biopsy - Medium 1-3 cm

Biopsy

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Histology of polyps.

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Polyp Biopsy - Medium 1-3 cm: Complete Medical Test Guide

Why is it done?
- Test Purpose: A polyp biopsy of medium-sized polyps (1-3 cm) involves tissue sampling during colonoscopy or other endoscopic procedures to determine the histological nature of the growth and assess for malignancy or premalignant changes.
- Detection of Cancer Risk: Identifies adenomatous polyps, serrated polyps, and other premalignant lesions that may progress to colorectal cancer if left untreated.
- Primary Indications: Screening during routine colonoscopy, evaluation of abnormal imaging findings, assessment of polyps in high-risk patients, and surveillance of recurrent polyps.
- Timing: Performed during colonoscopy, flexible sigmoidoscopy, or other endoscopic procedures when polyps are visualized and require histological evaluation.
- Clinical Significance: Medium-sized polyps carry intermediate risk for malignancy and require pathological examination to guide treatment and surveillance decisions.
Normal Range
- Negative/Normal Result: Benign tissue with no dysplasia, malignancy, or premalignant changes. Examples include hyperplastic polyps, inflammatory polyps, or normal mucosa.
- Reference Classification: Results are reported using the WHO classification system and Bethesda criteria, categorizing findings from benign to malignant.
- Benign Polyp Categories: Hyperplastic polyps, sessile serrated polyps (SSP) without dysplasia, traditional adenomas without high-grade dysplasia, mucosal inflammation.
- Units of Measurement: Histopathological diagnosis reported as categorical results (benign, dysplastic, malignant) with descriptive pathology noting polyp type, grade of dysplasia if present, and presence/absence of invasion.
- What Normal Means: Normal findings indicate the polyp is benign and does not require removal or follow-up beyond standard screening intervals, though surveillance may still be recommended based on polyp characteristics.
Interpretation
- Hyperplastic Polyp: Benign lesion with low malignant potential; requires standard surveillance colonoscopy in 10 years if polyp completely removed.
- Tubular Adenoma: Low-grade dysplasia adenoma; follow-up colonoscopy recommended in 5-10 years depending on other polyp characteristics and patient risk factors.
- Tubulovillous or Villous Adenoma: Intermediate to high-grade dysplasia; carries increased risk for progression to cancer; surveillance colonoscopy in 3-5 years recommended.
- High-Grade Dysplasia (HGD): Severe cellular abnormalities with significant cancer risk; typically requires complete removal and close surveillance colonoscopy in 3-6 months.
- Intramucosal Carcinoma: Cancer limited to mucosa without invasion into submucosa; may require additional endoscopic therapy or surgical consultation depending on completeness of resection.
- Invasive Carcinoma: Cancer invading submucosa or deeper layers; requires surgical consultation and likely colectomy depending on invasion depth and grade.
- Sessile Serrated Polyp (SSP): Intermediate risk lesion requiring surveillance colonoscopy in 3-5 years due to risk of interval cancer development.
- Factors Affecting Results: Incomplete polyp removal, sampling error, inflammation obscuring dysplasia, histological overlap between polyp types, and pathologist interpretation variability.
Associated Organs
- Primary Organ: Colon and rectum; polyp biopsy specifically evaluates tissue from the large intestine/bowel.
- Related Organ Systems: Gastrointestinal tract, including small intestine and stomach if polyps present elsewhere; lymphatic system if metastatic disease present.
- Diseases Diagnosed: Colorectal cancer, adenomatous polyps, sessile serrated polyps, hereditary polyposis syndromes, inflammatory bowel disease-associated dysplasia, and familial adenomatous polyposis (FAP).
- Associated Medical Conditions: Type 2 diabetes, obesity, metabolic syndrome, smoking history, alcohol use, family history of colorectal cancer, and inflammatory bowel disease.
- Potential Complications from Procedure: Bleeding (usually minor and self-limited), perforation (rare with biopsy alone, more common with polypectomy), infection, and post-polypectomy syndrome.
- Risks if Results Abnormal: Increased risk of colorectal cancer development; need for aggressive surveillance, possible surgical intervention, and potential systemic spread if invasive carcinoma present.
Follow-up Tests
- Follow-up Colonoscopy: Recommended at intervals based on biopsy results (3-10 years) for surveillance and early detection of recurrent or new polyps.
- High-Grade Dysplasia or Carcinoma: Repeat colonoscopy in 2-6 months for complete polyp assessment; consider endoscopic ultrasound (EUS) to assess invasion depth.
- Invasive Carcinoma: CT abdomen/pelvis for staging, possible MRI for local staging, carcinoembryonic antigen (CEA) level assessment, and surgical consultation.
- Genetic Testing: Consider if polyp results suggest hereditary syndrome (FAP, Lynch syndrome) based on patient age and polyp characteristics.
- Fecal Immunochemical Test (FIT): May be used for surveillance between colonoscopies in selected patients, though colonoscopy remains gold standard.
- Immunohistochemistry: May be performed on biopsy tissue to assess for mismatch repair deficiency suggesting Lynch syndrome.
- Molecular Testing: Microsatellite instability (MSI) or hypermethylation analysis may be performed on adenocarcinoma tissue for prognostic and therapeutic planning.
- Monitoring Frequency: Low-grade dysplasia adenomas typically require surveillance in 5-10 years; high-grade dysplasia in 2-6 months; normal colonoscopy in 10 years.
Fasting Required?
- Fasting: YES - Fasting is required for polyp biopsy procedures, typically requiring 8-12 hours of fasting before the procedure.
- Duration: Typically NPO (nothing by mouth) for minimum 6-8 hours before procedure, with most recommendations suggesting 8-12 hours overnight fasting.
- Bowel Preparation: Mandatory polyethylene glycol (PEG) solution or other colon cleansing preparation the day before procedure to ensure adequate visualization of polyps.
- Medications to Avoid: Aspirin and NSAIDs should be stopped 5-7 days before procedure if possible; anticoagulants may require adjustment based on bleeding risk.
- Special Instructions: Do not take iron supplements 3-5 days before procedure; take regular medications with small sips of water up to 2 hours before colonoscopy.
- Anesthesia: Conscious sedation or general anesthesia typically administered; patient will not be able to drive or operate machinery for 24 hours post-procedure.
- Post-Procedure: Clear liquids only initially, advancing to regular diet as tolerated; may resume medications per physician instructions.
- Arrangement: Patient must arrange for transportation home after procedure due to sedation effects.

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