Discrepancy Between Forceps Biopsy and Resection in Colorectal Polyps: A 1686 Paired Screening-Therapeutic Colonoscopic Finding

• Main Authors: Jiang Y (Author), Wang J (Author), Chen Y (Author), Sun H (Author), Dong Z (Author), Xu S (Author)
• Format: Book
• Published: Dove Medical Press, 2022-05-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1178-203X
• Keywords: colorectal polyps; colorectal adenoma; colonoscopy; pathology;; Therapeutics. Pharmacology; RM1-950
• Source: Therapeutics and Clinical Risk Management, Vol Volume 18, Pp 561-569 (2022)

Yuanxi Jiang, Junwen Wang, Ying Chen, Huihui Sun, Zhiyu Dong, Shuchang Xu Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, People's Republic of ChinaCorrespondence: Shuchang Xu; Zhiyu Dong, Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, No. 389, Xincun Road, Putuo District, Shanghai, People's Republic of China, Tel [phone], Email [e-mail]; [e-mail]: To identify pathology discrepancy between forceps biopsies and polypectomy specimens in colorectal polyps, as well as the reliability of biopsy-based treatment strategy.Methods: All endoscopic polypectomy cases with forceps biopsies performed within 6 months were included in the study. The biopsies were compared with polypectomy specimens in terms of concordance of histological diagnosis. A logistic regression model was used to investigate the independent predictors of upgrade in histological diagnosis compared with concordance in histological diagnosis.Results: A total of 1686 paired screening-therapeutic colonoscopies and 1739 paired biopsy-polypectomy specimens were enrolled in the study. The grade of dysplasia in 84.5% of biopsy specimens were concordant to polypectomy specimens, but this proportion decreased to 75.4% when the specimens were classified using tubular or villousness structure. 10.1% and 5.4% of biopsy specimens were upgraded and downgraded in assessing grade of dysplasia, respectively, while 14.3% and 10.3% of biopsy specimens were upgraded and downgraded in assessing tubular or villousness structure, respectively. In subgroup analysis stratified by size of polyps, 9.0% and 10.6% of biopsies obtained from polyps smaller than 10 mm were upgraded in assessing dysplasia and tubular or villousness structure, respectively. This proportion increased to 10.7% and 21.3%, respectively, in biopsies obtained from polyps larger than 10 mm. Larger size of polyps and pedunculated polyps were associated with a higher incidence of upgrade in histological diagnosis. Nearly 25% of biopsy specimens with high-grade dysplasia were identified as adenocarcinoma in polypectomy specimens.Conclusion: The concordance between biopsy and polypectomy specimens is not adequate. The biopsy-based treatment strategy is not reliable and should not be considered as an indicator for further treatment, particularly in large or pedunculated polyps.Keywords: colorectal polyps, colorectal adenoma, colonoscopy, pathology