A simple tissue-handling technique performed in the endoscopy suite improves histologic section quality and diagnostic accuracy for serrated polyps

Shannon John Morales; Carol A. Bodian; Susan Kornacki; Robert V. Rouse; Robert Petras; Nicholas A. Rouse; Lawrence B. Cohen; Neville D. Bamji; Kenneth M. Miller; Roy M. Soetikno; Tonya Kaltenbach; James Aisenberg

doi:10.1055/s-0033-1344435

Endoscopy, Table of Contents

Endoscopy 2013; 45(11): 897-905
DOI: 10.1055/s-0033-1344435

Original article

A simple tissue-handling technique performed in the endoscopy suite improves histologic section quality and diagnostic accuracy for serrated polyps

Shannon John Morales

¹Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA

,

Carol A. Bodian

²Department of Anesthesiology, Division of Biostatistics, Icahn School of Medicine at Mount Sinai, New York, New York, USA

,

Susan Kornacki

³New York Gastroenterology Associates Gastrointestinal Laboratory, New York, New York, USA

,

Robert V. Rouse

⁴Department of Pathology, Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, Palo Alto, California, USA

,

Robert Petras

⁵AmeriPath Institute of Gastrointestinal Pathology and Digestive Disease, Oakwood Village, Ohio, USA

,

Nicholas A. Rouse

⁶Department of Biostatistics, Columbia University, New York, New York, USA

,

Lawrence B. Cohen

¹Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA

,

Neville D. Bamji

¹Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA

,

Kenneth M. Miller

¹Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA

,

Roy M. Soetikno

⁷Department of Medicine, Division of Gastroenterology, Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, Palo Alto, California, USA

,

Tonya Kaltenbach

⁷Department of Medicine, Division of Gastroenterology, Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, Palo Alto, California, USA

,

James Aisenberg

¹Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA

› Author Affiliations

Abstract

Background and study aims: 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.

Methods: 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.

Results: 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 (P < 0.0001). 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 (P < 0.0001). Inter-pathologist agreement was higher with the modified than the conventional protocol (77.0 % vs. 62.8 %; P = 0.015).

Conclusion: 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.

Full Text

References

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