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Polyp - Large Biopsy 3-6 cm
Biopsy
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Histology of polyps.
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Polyp - Large Biopsy 3-6 cm
- Why is it done?
- Histological diagnosis of large colorectal polyps (3-6 cm) to determine if tissue is benign, dysplastic, or malignant
- Assessment of polyp characteristics including grade of dysplasia, type, and cancer risk stratification
- Determination of adequate biopsy margins and complete polyp removal when therapeutic resection is performed
- Evaluation of patients with abnormal screening colonoscopy findings or positive family history of colorectal cancer
- Investigation of gastrointestinal bleeding or positive fecal occult blood tests in patients with known polyps
- Typically performed during colonoscopy when a polyp 3-6 cm in size is identified that requires tissue sampling or removal
- Normal Range
- Normal Finding: Benign epithelial tissue without dysplasia, inflammation, or malignancy; normal colonic mucosa with intact epithelium
- Normal Pathology Classification: Hyperplastic polyp, tubular adenoma (tubular type), or inflammatory polyp without dysplasia
- Negative Result: No evidence of dysplasia, cancer, or high-risk features; no abnormal mitotic activity
- Units of Measurement: Specimen size measured in centimeters (3-6 cm for large biopsy); histologic findings described qualitatively
- Interpretation Context: Normal results do not eliminate future cancer risk; surveillance colonoscopy at recommended intervals is still required based on adenoma characteristics and family history
- Interpretation
- Benign Polyps: Hyperplastic polyps, inflammatory polyps, or hamartomas carry minimal malignant potential; routine surveillance colonoscopy recommended per guidelines
- Tubular Adenoma: Most common type of colorectal adenoma; increased dysplasia risk with increasing size; surveillance interval typically 3-5 years
- Tubulovillous Adenoma: Mixed features with increased malignant potential compared to tubular type; higher dysplasia rates; closer surveillance and more aggressive management recommended
- Villous Adenoma:
- Highest risk for malignancy and dysplasia; villous morphology increases cancer progression risk; may require more aggressive treatment and shorter surveillance intervals (2-3 years); consideration for referral to colorectal surgery if invasive cancer present
- Low-Grade Dysplasia (LGD): Abnormal cells present but confined to epithelium; progression to high-grade dysplasia or cancer is slow; surveillance colonoscopy in 2-3 years recommended
- High-Grade Dysplasia (HGD): Significant abnormality with loss of cellular organization and increased mitotic activity; high risk of progression to invasive cancer; requires complete resection confirmation and close follow-up in 3-6 months or possible referral to colorectal surgery
- Invasive Cancer: Malignant cells penetrating through muscularis mucosae into submucosa or deeper; requires complete staging with imaging, oncology consultation, and surgical evaluation; prognosis depends on depth of invasion, grade, and lymph node involvement
- Serrated Polyps (Including Sessile Serrated Adenomas): Can have significant dysplasia potential; associated with microsatellite instability pathway to cancer; may require shorter surveillance intervals and more aggressive management
- Factors Affecting Interpretation: Specimen adequacy and complete removal confirmation, margin status, presence of background chronic inflammation, family history of colorectal cancer, prior polyp history, and completeness of biopsy sampling
- Associated Organs
- Primary Organ System: Colon and rectum (large intestine); gastrointestinal tract; lower digestive system
- Related Organs at Risk: Regional lymph nodes (potential metastasis), liver (common site of colorectal cancer spread), peritoneum, distant organs if advanced cancer present
- Conditions Commonly Associated with Abnormal Results: Colorectal adenocarcinoma, familial adenomatous polyposis (FAP), hereditary non-polyposis colorectal cancer (HNPCC/Lynch syndrome), inflammatory bowel disease (ulcerative colitis and Crohn's disease), sessile serrated adenomas, traditional serrated adenomas
- Diagnostic Value: Critical for diagnosis of colorectal cancer and precancerous lesions; helps determine extent of disease (TNM staging) and guides treatment decisions; identifies patients requiring genetic counseling if hereditary syndromes suspected
- Potential Complications: Colonic perforation (rare, 0.1-0.2%), post-polypectomy bleeding (1-6% depending on size and resection technique), bacteremia, diverticulitis if perforation occurs, aspiration pneumonia, cardiovascular events during procedure
- Systemic Impact of Abnormal Findings: Invasive cancer may require systemic chemotherapy, immunotherapy, or hormone therapy; may necessitate surgical resection with lymph node dissection; significantly affects overall health prognosis and life expectancy if advanced disease present
- Follow-up Tests
- Colonoscopy Surveillance: Repeated colonoscopy at intervals of 3-10 years based on polyp histology, number, and size; high-grade dysplasia or cancer requires follow-up in 3-6 months or sooner
- Staging Imaging (if cancer diagnosed): CT abdomen/pelvis with contrast, CT chest for metastatic workup, MRI pelvis if rectal cancer to assess local invasion, PET-CT scan in selected cases
- Laboratory Tests: Carcinoembryonic antigen (CEA) baseline if cancer present, complete metabolic panel, liver function tests, complete blood count for anemia assessment, prothrombin time if bleeding complications
- Molecular/Genetic Testing: Microsatellite instability (MSI) testing, mismatch repair (MMR) protein immunohistochemistry, KRAS and TP53 mutations in selected cancer cases, Lynch syndrome screening if age <50 or family history concerning
- Fecal Tests: Fecal immunochemical test (FIT) after complete polyp removal for ongoing surveillance, repeat after treatment completion
- Specialty Consultations: Colorectal surgery consultation if invasive cancer or high-risk features, oncology consultation for treatment planning in advanced disease, genetic counselor if hereditary syndrome suspected
- Monitoring Frequency: 3 years for adenomatous polyps or 1-2 adenomas <1 cm; 5-10 years for small hyperplastic polyps; 2-3 years for large adenomas, high-grade dysplasia, or multiple polyps; annual for extensive polyp disease or high-risk features
- Related Complementary Tests: Capsule endoscopy for small bowel surveillance in Lynch syndrome, virtual colonoscopy if optical colonoscopy cannot be completed, sigmoidoscopy for lower colonic polyps in selected cases
- Fasting Required?
- Fasting: Yes
- Fasting Duration: NPO (nothing by mouth) for 6-8 hours before procedure, typically overnight fast is recommended
- Fluid Restrictions: Clear liquids (water, broth, apple juice without pulp) may be permitted up to 2-4 hours before procedure; specific instructions from facility must be followed
- Bowel Preparation: Mandatory colonic cleansing with polyethylene glycol (PEG) solution, sodium phosphate, magnesium citrate, or other approved bowel prep agents started 1 day prior; typically begins evening before procedure or day-of split dosing regimen
- Medications to Avoid/Modify: Discontinue anticoagulants (warfarin, dabigatran, apixaban, rivaroxaban) 3-7 days before procedure or per anticoagulation protocol; hold aspirin and NSAIDs 5-7 days prior; continue beta-blockers and other cardiac medications with small sip of water; temporarily hold metformin on day of procedure if contrast used for imaging; avoid iron supplements 3 days before
- Anesthesia Considerations: Moderate or conscious sedation typically used; requires NPO status to prevent aspiration; patient cannot drive or operate machinery for 24 hours after sedation
- Additional Preparation Requirements: Inform physician of allergies, current medications, and medical conditions; baseline vital signs and weight recorded; IV access established; informed consent obtained; arrange transportation as patient cannot drive after sedation; wear comfortable, removable clothing
- Post-Procedure Instructions: Resume normal diet after recovery if no complications; restart anticoagulants per protocol (typically 24 hours post-procedure); avoid strenuous activity for 24 hours; report severe pain, significant bleeding, fever, or signs of perforation immediately
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