Endoscopic Recognition and Management Strategies for Malignant Colorectal Polyps

Publication Date: November 4, 2020
Last Updated: March 14, 2022

Recommendations

We recommend that both pedunculated and nonpedunculated polyps with the following features be considered to have deep submucosal invasion: NICE classification type 3 or Kudo classification of type V (VN and VI). (High, Strong)
612
Nonpedunculated lesions with these features should be biopsied (in the area of surface feature disruption), tattooed (unless in or near the cecum), and referred to surgery. Pedunculated polyps with features of deep submucosal invasion should undergo endoscopic polypectomy. (Low, Conditional (weak))
612
LST-NG morphology with sessile shape or depression, and LST-G with a dominant nodule predict a higher risk of submucosally invasive cancer. (Moderate, Conditional (weak))
612
We recommend that such lesions be considered for en bloc endoscopic resection, instead of piecemeal resection, when feasible and based on local expertise. In the case of LST-G with a dominant nodule, at least the nodular area should be considered for en bloc resection. All pedunculated polyps, even if large, should be resected en bloc. (Low, Conditional (weak))
612
We recommend that specimens with features associated with submucosally invasive cancer that are removed en bloc be handled in ways to optimize specimen orientation and pathologic assessment. (Low, Conditional (weak))
612
We recommend that nonpedunculated malignant polyps be considered high risk for residual or recurrent cancer if they have any of the following features: poor tumor differentiation, lymphovascular invasion, submucosal invasion depth >1 mm, tumor involvement of the cautery margin, or tumor budding. (Moderate, Strong)
612
We recommend that pedunculated malignant polyps be considered at high risk of residual or recurrent cancer if they have any of the following features: poor tumor differentiation, lymphovascular invasion, tumor within 1 mm of the resection margin. (Moderate, Strong)
612
We recommend that the pathology report adhere to the recommendation of the College of American Pathologists structured template and that the report contain the histologic type, grade of differentiation, tumor extension/invasion, stalk and mucosal margin status, as well as the presence or absence of lymphovascular invasion. We suggest other aspects, such as specimen integrity, polyp size, polyp morphology, and tumor budding be included. (Low, Conditional (weak))
612
We suggest establishing methods of communication among the gastroenterologist, pathologist, oncologist, surgeon, and the patient for the management of patients with malignant polyps. (Low, Conditional (weak))
612

Recommendation Grading

Overview

Title

Endoscopic Recognition and Management Strategies for Malignant Colorectal Polyps

Authoring Organizations

Publication Month/Year

November 4, 2020

Last Updated Month/Year

February 7, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital

Intended Users

Social worker, physician, nurse, nurse practitioner, physician assistant

Scope

Assessment and screening, Management

Diseases/Conditions (MeSH)

D011127 - Polyps

Keywords

colorectal cancer, colonoscopy, Polypectomy, endoscopic mucosal resection, Malignant Polyp, Submucosal Invasion, Histology

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
82
Literature Search Start Date
January 1, 1980
Literature Search End Date
December 31, 2018