Multi-Society Task Force Issues Malignant Polyp Management Recommendations
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Multi-Society Task Force Issues Malignant Polyp Management Recommendations

Douglas K. Rex, MD, MASGE, reviewing Shaukat A, et al. Gastrointest Endosc 2020 Nov 1.

The U.S. Multi-Society Task Force on Colorectal Cancer, which consists of experts from the 3 luminal GI societies, has issued recommendations on the management of malignant polyps. Some of the key recommendations are as follows:

  • Nonpedunculated lesions with NICE 3- or Kudo V-classified features should undergo biopsy and referral for surgery.
  • Pedunculated lesions with NICE 3- or Kudo V-classified features can still be resected endoscopically.
  • Nongranular lesions with Paris 1s classification or pseudodepressed shape and granular laterally spreading tumors with a dominant nodule should be considered for en bloc resection, or at least en bloc resection of the nodule. All pedunculated polyps should be resected en bloc. 
  • Specimens from en bloc resections should be handled to optimize orientation in pathologic assessment.
  • Malignant pedunculated polyps should be considered high risk if there is poor tumor differentiation, lymphovascular invasion, or tumor within 1 mm of the resection margin.
  • For malignant nonpedunculated lesions, high risk is indicated by invasion depth >1000 µ, poor differentiation, lymphovascular invasion, margin involvement, excess tumor budding, and piecemeal resection.
  • Malignant polyps should be reported by pathologists using synoptic reports.

Douglas K. Rex, MD, FASGE

COMMENT

Some of the new recommendations include guidance on which lesions to remove en bloc when feasible, how to handle pathology specimens that are resected en bloc, and use of invasion depth as a predictor of high risk in nonpedunculated malignant lesions.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Shaukat A, Kaltenbach T, Dominitz JA, et al. Endoscopic recognition and management strategies for malignant colorectal polyps: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2020;92:997-1015.e1. (https://doi.org/10.1016/j.gie.2020.09.039)

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