Histopathological assessment of radicality after polypectomy

The radicality of resection of colorectal polyps should be based on the diagnosis, and it focuses the attention on neoplastic polyps, in particular, those ones containing a malignancy or those with dysplastic changes (adenomatous polyps).

In these circumstances, it is mandatory to assess:

1) For malignant polyps:
- Resection margins (deep and circumferential)
- Clinically adverse features: Grading, Extension (depth of invasion, lymphovascular invasion) Tumor “budding”
2) For dysplastic polyps:
- Growth pattern
- Grading

We should remember that a significant adenoma is at risk to contain carcinoma
- If it is on the left side and pedunculated, it is also at risk to include pseudoinvasion
- Pseudoinvasion is clinically meaningless
- Invasive carcinoma is crucial if it extends to the margins, is poorly differentiated, and perhaps has other features like a vascular invasion.