%0 Journal Article
%T Are Upfront Levels for Colon ¡°Polyps¡± Necessary? A Pragmatic Review
%A Armen Khararjian
%A Kathleen Byrnes
%A Lysandra Voltaggio
%A Norman Barker
%A Rifat Mannan
%J International Journal of Surgical Pathology
%@ 1940-2465
%D 2019
%R 10.1177/1066896918783264
%X Introduction. Colon biopsies are among the most frequently examined specimens by pathologists. Many pathology practices, ours included, review upfront levels on all gastrointestinal biopsies. In our experience, when a lesion is present on specimens labeled ¡°colon polyp,¡± it is readily identified on the first level. To test our hypothesis, we re-reviewed 500 cases in which a lesion was identified histologically and determined if the diagnosis could be made on the first level. Furthermore, we examined 50 additional cases of high-grade dysplasia/carcinoma to determine if the higher-grade component was also present on the first level. Materials and Methods. Cases were retrieved for lesions that could account for a colon polyp clinically, and the first level was examined to determine if lesional tissue was present on the first level. Fifty additional cases of higher-grade lesions were included to ensure higher-grade lesions were present on the first level. Results. Overall, 497/500 (99.4%) of the non¨Chigh-grade lesions were present on the first level, whereas 3/500 (0.6%) required the additional level for diagnosis. All 50 high-grade lesions were present on the first level examined. Discussion. Many pathology practices routinely order upfront levels on all gastrointestinal biopsies, often generating 2 or 3 slides. Additional slides increase costs, increase the likelihood of laboratory-generated errors, and can waste limited tissue on small biopsies for which ancillary studies may be necessary. Our study showed that a single level is sufficient in the overwhelming majority of cases in which a lesion is identified histologically
%K value
%K cost saving
%K initial levels
%K GI pathology
%K polyps
%U https://journals.sagepub.com/doi/full/10.1177/1066896918783264