The Effect of Electrothermal Cautery-Assisted Resection of Diminutive Colonic Polyps on Histopathologic Diagnosis

Abstract

We examined diminutive colonic polyps to identify relationships between thermal electrocoagulation or resection trauma cytologic artifacts, type of thermal electrocoagulation, polyp size, and the interobserver variation among 3 pathologists. The 3 pathologists independently evaluated 119 colonic polyps 5 mm or less in maximum dimension for diagnosis and degree of thermal electrocoagulation or resection trauma cytologic artifacts. The maximum dimension of the polyps and type of thermal electrocoagulation were recorded. The average percentage of polyps in which a definitive diagnosis could not be made because of cytologic artifacts was 16.5% (range, 11.8%-19.3%). Decreasing polyp size was associated linearly with the inability to make a definitive diagnosis owing to cytologic artifacts. Polyps smaller than 2 mm significantly more often could not be definitively diagnosed by at least 1 pathologist owing to cytologic artifacts, including some polyps that were excised without thermal electrocautery. Interobserver variation increased with decreasing polyp dimension. Two millimeters seems to represent a cut point, below which the likelihood that a definitive diagnosis can be made can be increased if thermal electrocoagulation is used. This small size seems to make them especially susceptible to cytologically injurious forces.

Cold snare polypectomy versus hot snare polypectomy in endoscopic treatment of small polyps

“…In the treatment of small polyps with hot forceps polypectomy, it can be difficult to assess the histologically definitive diagnosis of polyps due to cautery artifacts (9,10). In the study by Goldstein et al (9), it was reported that the average percentage of polyps in which a definitive diagnosis could not be made because of cytologic artifacts was 16.5% (range, 11.8%-19.3%).…”

“…In the study by Goldstein et al (9), it was reported that the average percentage of polyps in which a definitive diagnosis could not be made because of cytologic artifacts was 16.5% (range, 11.8%-19.3%). The same study reported that polyps smaller than 2 mm were significantly less likely to be definitively diagnosed because of cautery artifacts.…”

Nuclear artifacts in gastric endoscopic submucosal dissection specimens: A clinicopathological study

“…To the best of our knowledge, the present study is the first to describe ESD-related nuclear artifacts in detail. Nuclear artifacts were found close to marking-related erosive and/or depressed coagulation, corresponding to thermal artifacts, also called electrothermal, diathermic, or cautery-related changes (1,3,4,(9)(10)(11). Therefore, nuclear artifacts themselves would have contributed to the thermal artifacts.…”

“…The precise histological assessment of ER specimens, such as pathological diagnosis, the depth of cancerous invasion, lymphovascular permeation and the status of the surgical margin, is crucial for the subsequent management of the patients (1,3,4,(6)(7)(8)(9). Therapeutic procedures using electrothermal devices may induce varying artifacts disturbing the histological evaluation in gastrointestinal and other specimens (1,3,4,(9)(10)(11)(12)(13)(14). However, histological artifacts in newly developed ESD specimens remain poorly understood.…”

The Histological Quality and Adequacy of Diminutive Colorectal Polyps Resected Using Jumbo Versus Hot Biopsy Forceps

“…Although HBF has the advantages of fulgurating any adenomatous remnants, and coagulating blood vessels, it has several drawbacks related to electrocautery, such as perforation and delayed bleeding [4,5]. In addition, some prospective studies have demonstrated that the cytological features of DCPs can be distorted by thermal electrocoagulation-induced cytological artifacts, so that a definitive diagnosis cannot be made [6].…”