Are Upfront Levels for Colon “Polyps” Necessary? A Pragmatic Review

Armen Khararjian, Abul Ala Syed Rifat Mannan, Kathleen Byrnes, Norman Barker, Lysandra Voltaggio

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction. Colon biopsies are among the most frequently examined specimens by pathologists. Many pathology practices, ours included, review upfront levels on all gastrointestinal biopsies. In our experience, when a lesion is present on specimens labeled “colon polyp,” it is readily identified on the first level. To test our hypothesis, we re-reviewed 500 cases in which a lesion was identified histologically and determined if the diagnosis could be made on the first level. Furthermore, we examined 50 additional cases of high-grade dysplasia/carcinoma to determine if the higher-grade component was also present on the first level. Materials and Methods. Cases were retrieved for lesions that could account for a colon polyp clinically, and the first level was examined to determine if lesional tissue was present on the first level. Fifty additional cases of higher-grade lesions were included to ensure higher-grade lesions were present on the first level. Results. Overall, 497/500 (99.4%) of the non–high-grade lesions were present on the first level, whereas 3/500 (0.6%) required the additional level for diagnosis. All 50 high-grade lesions were present on the first level examined. Discussion. Many pathology practices routinely order upfront levels on all gastrointestinal biopsies, often generating 2 or 3 slides. Additional slides increase costs, increase the likelihood of laboratory-generated errors, and can waste limited tissue on small biopsies for which ancillary studies may be necessary. Our study showed that a single level is sufficient in the overwhelming majority of cases in which a lesion is identified histologically.

Original languageEnglish (US)
Pages (from-to)15-18
Number of pages4
JournalInternational journal of surgical pathology
Volume27
Issue number1
DOIs
StatePublished - Feb 1 2019

Keywords

  • GI pathology
  • cost saving
  • initial levels
  • polyps
  • value

ASJC Scopus subject areas

  • Surgery
  • Anatomy
  • Pathology and Forensic Medicine

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