CorrespondenceLetter to the Editor in Response to “Endoscopic Recognition and Management Strategies for Malignant Colorectal Polyps: Recommendations of the US Multi-Society Task Force on Colorectal Cancer”
Section snippets
Methods
Contrary to their described grading methods, MSTF recommends, in statements 2b, 3, and 5, after they classified the strength of such recommendations as “weak.” These imprecisions may cause confusion.
Terminology
MSTF suggests that endoscopists discuss appropriate terminology with their pathologists and pathologists to avoid using the terms carcinoma or cancer in describing tumor in situ. Contrary to the American Cancer Society,5 the World Health Organization descriptions,6 and the Vienna Classification,7 MSTF describes high-grade dysplasia as “dysplastic changes confined to the epithelium, lamina propria, or muscularis mucosa.” Tumor in situ describes cancer invasion into the lamina propria through the
Algorithm
We also wonder if the nonstandard design of the algorithm describing the evaluation of polyps might lead to confusion (MSTF Figure 9). This algorithm suggests the Narrow-band Imaging (NBI) International Colorectal Endoscopic (NICE) Classification is useful in differentiating the granular from the nongranular lesions, but it is not.8,9 Furthermore, the MSTF recommendations begin with a statement regarding image enhancement; we wonder if it gives an incorrect impression that malignant polyp
Pathology
To reconcile the pathology results, MSTF describes the need for pinning the specimen. A recent MSTF publication had stated that orienting and pinning the specimen after endoscopic resection has a “strong recommendation, low quality."19 In contrast, the current recommendation 3 states, “weak recommendation; low quality.” We wonder if the authors can reconcile these 2 recommendations. A precise measurement of the depth of invasion requires the specimen to be uncurled, slightly stretched, and
Uncited Figure
Figure 1
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Committee on Standards for Developing Trustworthy Clinical Practice Guidelines; Board on Health Care Services; Institute of Medicine
Cited by (1)
Conflicts of interest Roy Soetikno is a consultant for Olympus Corp. and Fuji Corp. Hazem Hammad is a consultant for Medtronic, Olympus Corp, and Cook Medical. The remaining authors disclose no conflicts.