Colon polyps classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

Colon polyps may be classified into two groups of neoplastic and non-neoplastic. Non-neoplastic polyps consist of inflammatory and hamartomatous polyps. Neoplastic polyps consist of serrated and adenomatous polyps. Adenomatous polyps may be classified into several subtypes based on endoscopic and histologic features, and degree of dysplasia. Adenomas may be classified according to endoscopic features into four groups including sessile, pedunculated, flat, or depressed. Adenomas may be classified according to histologic features into three groups including tubular, tubulovillous, and villous.

Classification

Colon polyps may be classified into several subtypes based on:^[1]^[2]^[3]^[4]^[5]
- Malignancy potentials
- Endoscopic features
- Histologic features
- Degree of dysplasia

Colon polyps may be classified according to the NBI International Colorectal Endoscopic (NICE) classification into two types:^[6]^[7]

NICE criterion	Type 1	Type 2
Color	Same or lighter background	Darker background
Vessels	None, or isolated lacy vessels coursing across the lesion	Brown vessels surrounding the white center
Surface	Circular pattern with dark or white small spots surrounded by lighter mucosa	Oval, tubular, or branched white structures
Probable pathology	Hyperplastic	Adenoma

Colon polyps may be classified according to malignancy potentials into two large groups:

Non-neoplastic
- Inflammatory polyps
  - Inflammatory pseudopolyps
  - Prolapse type inflammatory polyps
  - Myoglandular polyps
- Hamartomatous polyps
  - Juvenile polyps
  - Peutz-Jeghers syndrome
  - Cronkhite-Canada syndrome
  - Phosphatase and tensin homolog (PTEN) hamartoma tumor syndrome
Neoplastic
- Serrated polyps
  - Hyperplastic polyps
  - Traditional serrated adenomas
  - Sessile serrated polyps
  - Serrated polyposis syndrome
- Adenomatous polyps

Adenomas may be classified according to endoscopic features into four groups:

Sessile
Pedunculated
Flat
Depressed

Adenomas may be classified according to histologic features into three groups:

Tubular
Villous
Tubulovillous

Adenomas may be classified according to degree of dysplasia into two groups:

Low-grade dysplasia
High-grade dysplasia

References

↑ Shussman, N.; Wexner, S. D. (2014). “Colorectal polyps and polyposis syndromes”. Gastroenterology Report. 2 (1): 1–15. doi:10.1093/gastro/got041. ISSN 2052-0034.
↑ Li SC, Burgart L (2007). “Histopathology of serrated adenoma, its variants, and differentiation from conventional adenomatous and hyperplastic polyps”. Arch. Pathol. Lab. Med. 131 (3): 440–5. doi:10.1043/1543-2165(2007)131[440:HOSAIV]2.0.CO;2. PMID 17516746.
↑ Bonnington, Stewart N (2016). “Surveillance of colonic polyps: Are we getting it right?”. World Journal of Gastroenterology. 22 (6): 1925. doi:10.3748/wjg.v22.i6.1925. ISSN 1007-9327.
↑ Ponugoti, Prasanna; Lin, Jingmei; Odze, Robert; Snover, Dale; Kahi, Charles; Rex, Douglas K. (2017). “Prevalence of sessile serrated adenoma/polyp in hyperplastic-appearing diminutive rectosigmoid polyps”. Gastrointestinal Endoscopy. 85 (3): 622–627. doi:10.1016/j.gie.2016.10.022. ISSN 0016-5107.
↑ O’Brien, Michael J. (2007). “Hyperplastic and Serrated Polyps of the Colorectum”. Gastroenterology Clinics of North America. 36 (4): 947–968. doi:10.1016/j.gtc.2007.08.007. ISSN 0889-8553.
↑ Hewett, David G.; Kaltenbach, Tonya; Sano, Yasushi; Tanaka, Shinji; Saunders, Brian P.; Ponchon, Thierry; Soetikno, Roy; Rex, Douglas K. (2012). “Validation of a Simple Classification System for Endoscopic Diagnosis of Small Colorectal Polyps Using Narrow-Band Imaging”. Gastroenterology. 143 (3): 599–607.e1. doi:10.1053/j.gastro.2012.05.006. ISSN 0016-5085.
↑ Rameshshanker, R.; Wilson, Ana (2016). “Electronic Imaging in Colonoscopy: Clinical Applications and Future Prospects”. Current Treatment Options in Gastroenterology. 14 (1): 140–151. doi:10.1007/s11938-016-0075-1. ISSN 1092-8472.

[ShussmanWexner2014-1] Shussman, N.; Wexner, S. D. (2014). “Colorectal polyps and polyposis syndromes”. Gastroenterology Report. 2 (1): 1–15. doi:10.1093/gastro/got041. ISSN 2052-0034.

[pmid17516746-2] Li SC, Burgart L (2007). “Histopathology of serrated adenoma, its variants, and differentiation from conventional adenomatous and hyperplastic polyps”. Arch. Pathol. Lab. Med. 131 (3): 440–5. doi:10.1043/1543-2165(2007)131[440:HOSAIV]2.0.CO;2. PMID 17516746.

[Bonnington2016-3] Bonnington, Stewart N (2016). “Surveillance of colonic polyps: Are we getting it right?”. World Journal of Gastroenterology. 22 (6): 1925. doi:10.3748/wjg.v22.i6.1925. ISSN 1007-9327.

[PonugotiLin2017-4] Ponugoti, Prasanna; Lin, Jingmei; Odze, Robert; Snover, Dale; Kahi, Charles; Rex, Douglas K. (2017). “Prevalence of sessile serrated adenoma/polyp in hyperplastic-appearing diminutive rectosigmoid polyps”. Gastrointestinal Endoscopy. 85 (3): 622–627. doi:10.1016/j.gie.2016.10.022. ISSN 0016-5107.

[O'Brien2007-5] O’Brien, Michael J. (2007). “Hyperplastic and Serrated Polyps of the Colorectum”. Gastroenterology Clinics of North America. 36 (4): 947–968. doi:10.1016/j.gtc.2007.08.007. ISSN 0889-8553.

[HewettKaltenbach2012-6] Hewett, David G.; Kaltenbach, Tonya; Sano, Yasushi; Tanaka, Shinji; Saunders, Brian P.; Ponchon, Thierry; Soetikno, Roy; Rex, Douglas K. (2012). “Validation of a Simple Classification System for Endoscopic Diagnosis of Small Colorectal Polyps Using Narrow-Band Imaging”. Gastroenterology. 143 (3): 599–607.e1. doi:10.1053/j.gastro.2012.05.006. ISSN 0016-5085.

[RameshshankerWilson2016-7] Rameshshanker, R.; Wilson, Ana (2016). “Electronic Imaging in Colonoscopy: Clinical Applications and Future Prospects”. Current Treatment Options in Gastroenterology. 14 (1): 140–151. doi:10.1007/s11938-016-0075-1. ISSN 1092-8472.

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