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Re-examining the 1-mm margin and submucosal depth of invasion: a review of 216 malignant colorectal polyps

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Abstract

Malignant colorectal polyps have a risk of lymph node metastases between 9 and 24%, but patients who are negative for certain histologic poor prognostic factors have the potential to be treated with polypectomy alone. Retrospective cohort of 216 malignant polyps from 213 patients identified through the British Columbia Colon Screening Program. Complete pathologic reporting (reporting of tumor grade, lymphovascular invasion, margin status, and tumor budding) was present in only 43% of patients. Sixty-one patients had no poor prognostic factors on polypectomy, and 23 (37%) of those underwent surgery. A positive margin cutoff of tumor at cautery showed significantly increased rates of lymph node metastases (p = 0.04) compared to a margin of greater than 0 mm, and polyps with a margin of greater than 0 mm had no risk of residual carcinoma. A submucosal depth of ≥ 2000 μm had an increased rate of lymph node metastases compared to < 2000 μm (p = 0.01). Malignant polyps with either tumor at cautery or a submucosal depth of ≥ 2000 μm, compared to polyps without these risk factors, had a relative risk for lymph node metastases of 16.3. Adoption of submucosal depth and refinement of the cutoffs for positive margin and submucosal depth have the potential to identify high-risk patients and reduce the number of surgeries required in patients with malignant polyps, a group that continues to grow significantly in part due to the introduction of colon screening programs.

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada

    Kyra B. Berg & David F. Schaeffer

  2. Department of Medicine, Division of Gastroenterology, The University of British Columbia, Vancouver, BC, Canada

    Jennifer J. Telford

  3. Colon Cancer Screening Program, British Columbia Cancer Agency, Vancouver, BC, Canada

    Jennifer J. Telford, Laura Gentile & David F. Schaeffer

  4. Division of Anatomical Pathology, Vancouver General Hospital, Vancouver, BC, Canada

    David F. Schaeffer

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  1. Kyra B. Berg
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  4. David F. Schaeffer
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Contributions

*K. Berg contributed to the conception and design of the study, data acquisition, data analysis, data interpretation, manuscript drafting and revision, and agrees to be accountable for the work.

*J. Telford contributed to the conception and design of the study, data interpretation, critical revision of the manuscript, approval of the final version, and agrees to be accountable for the work.

*L. Gentile contributed to the design of the study, data acquisition, critical revision of the manuscript, approval of the final version, and agrees to be accountable for the work.

*D. Schaeffer contributed to the conception and design of the study, data acquisition and interpretation, critical revision of the manuscript, approval of the final version, and agrees to be accountable for the work.

Corresponding author

Correspondence to David F. Schaeffer.

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Conflict of interest

DFS reports consultant fees from Provincial Health Services Authority (BC Colon Cancer Screening Program).

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This was a retrospective review study approved by the Research Ethics Board for the University of British Columbia and did not require informed consent.

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This article is part of the Topical Collection on Quality in Pathology

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Berg, K.B., Telford, J.J., Gentile, L. et al. Re-examining the 1-mm margin and submucosal depth of invasion: a review of 216 malignant colorectal polyps. Virchows Arch 476, 863–870 (2020). https://doi.org/10.1007/s00428-019-02711-9

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  • DOI: https://doi.org/10.1007/s00428-019-02711-9

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