{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 30, Ep 3 of 5: The Malignant Polyp and Surveillance","html":"","width":"100%","height":180,"duration":604,"description":"Episode three resolves the malignant polyp on one anatomic fact: lymphatics in the colon begin at the muscularis mucosae, so disease confined above it cannot metastasize while submucosal invasion opens the door to nodal spread. Intramucosal adenocarcinoma behaves as high-grade dysplasia and is cured by complete resection, which is why the word on the path report pulls toward unnecessary surgery. The Kikuchi and Haggitt systems describe depth, but the modern algorithm aggregates depth with tumor budding, differentiation, lymphovascular invasion, and margin status rather than acting on depth alone. Surveillance then calibrates the next exam to the worst lesion found, with the shortest interval winning when findings conflict and a separate six-month site check for piecemeal EMR of lesions twenty millimeters or larger.\n \nTopics covered\n\nMuscularis mucosae and metastatic potential\nIntramucosal adenocarcinoma versus true cancer\nKikuchi and Haggitt depth systems\nAggregating high-risk histologic features\nTumor budding by ITBCC criteria\nUSMSTF twenty twenty surveillance intervals\nSerrated surveillance intervals\nPiecemeal EMR site surveillance\n \n \nKey decisions\n\nIntramucosal adenocarcinoma is confined above the muscularis mucosae and behaves as high-grade dysplasia, so complete endoscopic resection is curative and surgery is unnecessary morbidity.\nDeep submucosal invasion alone, meaning Kikuchi sm three, Haggitt level four, or over one thousand microns, without other adverse features carries only about two and a half percent nodal risk, which can spare surgery in poor operative candidates.\nFour high-risk features drive surgical referral regardless of invasion depth: poor differentiation, lymphovascular invasion, high-grade tumor budding, and a positive margin under one millimeter.\nHigh-grade tumor budding by ITBCC is ten or more buds in a zero point seven eight five square millimeter hotspot, defined as single cells or clusters of up to four cells at the invasive front,...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}