title: A simple tissue-handling technique performed in the endoscopy suite improves histologic section quality and diagnostic accuracy for serrated polyps.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Shannon John
authors.initials: SJ
authors.lastname: Morales
authors.forename: Carol A
authors.initials: CA
authors.lastname: Bodian
authors.forename: Susan
authors.initials: S
authors.lastname: Kornacki
authors.forename: Robert V
authors.initials: RV
authors.lastname: Rouse
authors.forename: Robert
authors.initials: R
authors.lastname: Petras
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Rouse
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Cohen
authors.forename: Neville D
authors.initials: ND
authors.lastname: Bamji
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Miller
authors.forename: Roy M
authors.initials: RM
authors.lastname: Soetikno
authors.forename: Tonya
authors.initials: T
authors.lastname: Kaltenbach
authors.forename: James
authors.initials: J
authors.lastname: Aisenberg
mesh_terms: D018256:Adenomatous Polyps / Q000473:pathology*; D000368:Aged; D001706:Biopsy; D003111:Colonic Polyps / Q000473:pathology*; D003113:Colonoscopy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D016037:Single-Blind Method; D013048:Specimen Handling / Q000295:instrumentation / Q000379:methods*