Histopathology 2015, 66, 485–490. DOI: 10.1111/his.12472
The correlation between endoscopic and histopathological measurements in colorectal polyps Yasmin Levene, John M Hutchinson,1 Emma Tinkler-Hundal, Philip Quirke & Nicholas P West Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, and 1Molecular Gastroenterology, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK Date of submission 11 March 2014 Accepted for publication 2 June 2014 Published online Article Accepted 4 June 2014
Levene Y, Hutchinson J M, Tinkler-Hundal E, Quirke P, West N P (2015) Histopathology 66, 485–490. DOI: 10.1111/his.12472
The correlation between endoscopic and histopathological measurements in colorectal polyps Aims: Colorectal adenomas measuring 10 mm or more are at increased neoplastic risk and therefore undergo more rigorous follow-up. Currently there is no standardized method of assessing polyp size. We aimed to examine the correlation between endoscopic and histopathological measurements to determine the most appropriate method for clinical use. Methods and results: Colorectal polyps removed between November 2008 and January 2009 were identified. Routine endoscopic and histopathological measurements were determined retrospectively from the reports. Glass slide measurements using a ruler and magnified graticule were performed prospectively on all cases. Fifty cases also underwent high-resolution digital scanning and tissue morphometry. After exclusions, 352 polyps from 210 patients were identi-
fied, including 235 adenomas, 107 hyperplastic polyps and 10 other lesions. Only 89% of adenomas had a documented endoscopic measurement and 22% a histopathological measurement. The median endoscopic measurement was significantly greater, resulting in 13% of patients being misclassified as high or low risk. Conclusions: There are significant differences between endoscopic and histopathological measurement, and currently histopathologists frequently fail to accurately measure adenomas. Histopathological measurement should still be considered as the gold standard; however, there must be a hierarchy of measurements to take account of the practical limitations of sample fragmentation.
Keywords: colorectal polyps, endoscopic measurement, histopathological measurement
Introduction The UK National Health Service Bowel Cancer Screening Programme (NHS BCSP) was piloted in 2006 and became fully implemented across the United Kingdom in 2010.1 The current programme relies on a kit-based faecal occult blood (FOB) test sent to Address for correspondence: N P West, Pathology and Tumour Biology, Level 4, Wellcome Trust Brenner Building, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK. e-mail: [email protected] © 2014 John Wiley & Sons Ltd.
individuals aged between 60 and 74 years. If positive, the individual is invited for investigation. The first 1 million tests have demonstrated a positive test rate of 1.5% for females and 2.5% for males. At subsequent colonoscopy, adenomatous polyps were detected in 29% of females and 43% of males, with invasive cancers in 8% and 12%, respectively. Onethird of cancers were early, being Dukes’ stage A.2 Polyps removed during colonoscopy must be examined carefully by histopathologists to rule out cancer and to identify individuals with a higher risk of developing further neoplastic lesions, so that the clinical
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team can optimize patient follow-up.3–5 The degree of subsequent risk is determined currently by reporting the presence of adenomatous epithelium, the size of each adenoma, and the number of adenomas present.5,6 Polyps are usually measured in situ by the endoscopist, resected, recovered and placed in formalin fixative for subsequent histopathological analysis. The polyp should be measured macroscopically by histopathologists and then processed for microscopic examination. Patients with low-risk adenomas (one or two,
The correlation between endoscopic and histopathological measurements in colorectal polyps Yasmin Levene, John M Hutchinson,1 Emma Tinkler-Hundal, Philip Quirke & Nicholas P West Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, and 1Molecular Gastroenterology, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK Date of submission 11 March 2014 Accepted for publication 2 June 2014 Published online Article Accepted 4 June 2014
Levene Y, Hutchinson J M, Tinkler-Hundal E, Quirke P, West N P (2015) Histopathology 66, 485–490. DOI: 10.1111/his.12472
The correlation between endoscopic and histopathological measurements in colorectal polyps Aims: Colorectal adenomas measuring 10 mm or more are at increased neoplastic risk and therefore undergo more rigorous follow-up. Currently there is no standardized method of assessing polyp size. We aimed to examine the correlation between endoscopic and histopathological measurements to determine the most appropriate method for clinical use. Methods and results: Colorectal polyps removed between November 2008 and January 2009 were identified. Routine endoscopic and histopathological measurements were determined retrospectively from the reports. Glass slide measurements using a ruler and magnified graticule were performed prospectively on all cases. Fifty cases also underwent high-resolution digital scanning and tissue morphometry. After exclusions, 352 polyps from 210 patients were identi-
fied, including 235 adenomas, 107 hyperplastic polyps and 10 other lesions. Only 89% of adenomas had a documented endoscopic measurement and 22% a histopathological measurement. The median endoscopic measurement was significantly greater, resulting in 13% of patients being misclassified as high or low risk. Conclusions: There are significant differences between endoscopic and histopathological measurement, and currently histopathologists frequently fail to accurately measure adenomas. Histopathological measurement should still be considered as the gold standard; however, there must be a hierarchy of measurements to take account of the practical limitations of sample fragmentation.
Keywords: colorectal polyps, endoscopic measurement, histopathological measurement
Introduction The UK National Health Service Bowel Cancer Screening Programme (NHS BCSP) was piloted in 2006 and became fully implemented across the United Kingdom in 2010.1 The current programme relies on a kit-based faecal occult blood (FOB) test sent to Address for correspondence: N P West, Pathology and Tumour Biology, Level 4, Wellcome Trust Brenner Building, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK. e-mail: [email protected] © 2014 John Wiley & Sons Ltd.
individuals aged between 60 and 74 years. If positive, the individual is invited for investigation. The first 1 million tests have demonstrated a positive test rate of 1.5% for females and 2.5% for males. At subsequent colonoscopy, adenomatous polyps were detected in 29% of females and 43% of males, with invasive cancers in 8% and 12%, respectively. Onethird of cancers were early, being Dukes’ stage A.2 Polyps removed during colonoscopy must be examined carefully by histopathologists to rule out cancer and to identify individuals with a higher risk of developing further neoplastic lesions, so that the clinical
486
Y Levene et al.
team can optimize patient follow-up.3–5 The degree of subsequent risk is determined currently by reporting the presence of adenomatous epithelium, the size of each adenoma, and the number of adenomas present.5,6 Polyps are usually measured in situ by the endoscopist, resected, recovered and placed in formalin fixative for subsequent histopathological analysis. The polyp should be measured macroscopically by histopathologists and then processed for microscopic examination. Patients with low-risk adenomas (one or two,
