Some adenomatous polyps may progress to adenocarcinoma, while others may not. Certain features of a polyp may indicate an increased risk for malignant transformation.
Risk factors:
(1) size
(2) appearance
(3) dysplasia
(4) squamous metaplasia
(5) architecture
(6) number of polyps
Risk Factor
Low Risk
Intermediate Risk
High Risk
size
small (< 1.0 cm)
1.0 – 1.5 cm
large (> 1.5 cm)
appearance
pedunculated
flat or sessile
dysplasia
none or mild
moderate
severe
squamous metaplasia
absent
present
architecture
tubular
tubulovillous
villous
number of polyps
one
two (?or three)
multiple polyps
after table on page 887
Interpretation:
• A polyp with features indicating a high risk of malignant transformation needs to be completely excised if possible, else closely monitored.
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