Colorectal polyp count discrepancies and their impact on colonoscopy surveillance interval decisions: a retrospective analysis of 1293 specimens.

Abstract

Colorectal cancer surveillance recommendations rely on polyp counts to determine optimal intervals. This study aims to uncover discrepancies in polyp counts between colonoscopy and pathology reports and their clinical implications. A retrospective review of 1293 polyp cases from October 1 to December 31, 2019, was performed, comparing the reported number of polyps removed to the number identified pathologically (gross and microscopic). Cases with discrepant polyp counts prompted additional reviews, including colonoscopy reports and glass slides. The potential impact on surveillance interval decisions was further assessed. Of the 1293 polyp specimens from 600 patients, 1072 (83%) contained a single polyp per container, with no discrepancies. However, in the remaining 221 (17%) specimens that had multiple polyps submitted per container, an exact polyp count was indeterminable in 54 (24%) of these 221 specimens. Among these, polyp count discrepancies in 15 patients potentially influenced surveillance intervals. Overall, the most common discrepancy was a higher number of fragments on gross description and/or glass slides compared to colonoscopy reports and/or a container designator. Discrepancies in polyp counts more often occur when more than 1 polyp is submitted in a single container. These discrepancies may alter the recommended surveillance colonoscopy intervals. Therefore, close collaboration between pathology and colonoscopy providers-through improved endoscopic documentation, specimen handling, reporting strategies, and feedback-is essential to ensure accurate polyp counts and mitigate these effects. Adopting a single polyp per container approach in those cases where polyp count matters would significantly improve report accuracy and ensure the most appropriate surveillance intervals.