Gastroenterology

Gastroenterology

Volume 160, Issue 6, May 2021, Pages 2216-2220
Gastroenterology

Correspondence
Letter 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”

https://doi.org/10.1053/j.gastro.2020.12.051Get rights and content

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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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  • 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.

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