title: Adverse histological features in malignant colorectal polyps: a contemporary series of 239 cases.
abstract: OBJECTIVE
  Screening colonoscopy has led to more colorectal carcinomas presenting at an early stage potentially curable by endoscopic resection. In this study, we examined the clinical and histological features of a contemporary series of malignant colorectal polyps (MCPs) with subsequent surgical resection.
  
  
  METHODS
  We conducted a retrospective study on a consecutive series of MCPs from 239 patients, predominantly males (57.7%) with a median age of 66 years, and assessed histological parameters associated with residual disease on the surgical specimens.
  
  
  RESULTS
  Median MCP size was 18.6 mm, with 23.1% polyps measuring ≤10 mm. From the 140 surgical resection specimens, residual disease was identified in 20 cases, including 12 cases with metastatic lymph nodes and/or 9 cases with residual carcinoma in the large bowel wall. Histological parameters associated with nodal metastases were greater width and greater depth of the invasive component (p=0.001 and 0.006, respectively), poor differentiation (p=0.003) and a cribriform pattern (p=0.01). The risk of nodal metastases was 23.3% if two or three of these features were identified, while it was 0% and 4.5% if none or one was present, respectively. A positive margin was not associated with nodal metastasis and might be adequately treated by local endoscopic resection.
  
  
  CONCLUSIONS
  Surgical resection should be recommended if ≥2 of these adverse histological features are present and may be warranted if one feature is present. A positive margin may require additional local resection but not necessarily surgery if no other adverse factors are present.
authors.affiliation: Envoi Specialist Pathologists, Brisbane, Queensland, Australia Department of Anatomical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Ian S
authors.initials: IS
authors.lastname: Brown
authors.affiliation: Envoi Specialist Pathologists, Brisbane, Queensland, Australia The Conjoint Gastroenterology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Bettington
authors.affiliation: Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bettington
authors.affiliation: Envoi Specialist Pathologists, Brisbane, Queensland, Australia School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Gregory
authors.initials: G
authors.lastname: Miller
authors.affiliation: Envoi Specialist Pathologists, Brisbane, Queensland, Australia School of Medicine, University of Queensland, Brisbane, Queensland, Australia Department of Pathology, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Christophe
authors.initials: C
authors.lastname: Rosty
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000328:Adult; D000368:Aged; D003111:Colonic Polyps / Q000473:pathology*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors
keywords: CANCER; COLON; GASTROINTESTINAL DISEASE; MALIGNANT TUMOURS