Keep a "sharp eye" in
search of architectural dysplasia and/or high-grade adenomatous
change. The key deal on biopsies of colonic polyps
or tumors is to separate unequivocal banal small classical
hyperplastic polyps (HPP) from all other epithelial lesions
(outline). [table of classification] It apparently
makes no practical difference in the non-academic setting,
as of 11/2005, whether we pinpoint lesions with serratedness
prior to definitive removal of the polyp. It is probably
best to discuss polyp variants in the "micro" section
of the path report and let the diagnosis stay as close as
possible to addressing "adenoma vs. hyperplastic polyp".
Hence, the practical decision flow of this decision chart,
To effectively help our practitioners biopsying colonic lesions
to do the right thing, you must have/get an idea of lesion
size and location when interpreting slides of colonic growths!
The few small endoscopic biopsies taken may not reflect the true
lesion (especially those epithelial lesions with potentially
mixed components)...we have seen many instances of polyp biopsies
failing to show the adenomatous area or the malignant area.