Some links on grading and classification of polyps in the colon and rectum
Posted by jpluimers on 2022/06/27
Some links as I have (by publication maybe had) a (pre)cancerous polyp in my rectum; pathology will figure out the exact malignancy:
- [Wayback/Archive] SMSA polyp grading | Digestive Disease Dashboard
Table 1. SMSA scoring system.Benchmarks Points Size <1 cm 1 1–1.9 cm 3 2–2.9 cm 5 3–3.9 cm 7 >4 cm 9 Morphology Pedunculated 1 Sessile 2 Flat 3 Site Left 1 Right 2 Access Easy 1 Difficult 3 Level 1: 4–5 points. Level 2: 6–9 points. Level 3: 10–12 points. Level 4: >12 points. - [Wayback/Archive] Kudo pit pattern | Digestive Disease Dashboard
- I – Round pit (normal pit)
- II – Asteroid pit
- III S – Tubular or round pit that is smaller than the normal pit (Type I)
- III L – Tubular or round pit that is larger than the normal pit (Type I)
- IV N – Dendritic or gyrus-like pit
- V I – Irregular arrangement and sizes of III L, III S, IV type pit pattern
- V N – Loss or decrease of pits with an amorphous structure
Tanaka, et al. Gastrointest Endosc 2006; 64: 604-13
- [Wayback/Archive] Sano classification | Digestive Disease Dashboard
Capillary pattern I II IIIA IIIB Schema Endoscopic findings Capillary characteristics Meshed capillary vessels characterized by: blind ending, branching and curtailed irregularly Meshed capillary vessels (-) - • Meshed capillary vessels (+)
- Capillary vessel surrounds mucosal glands
- Lack of uniformity
- High density of capillary vessels
- Nearly avascular or loose micro capillary vessels
- [Wayback/Archive] EQUIP Training session 2 – ppt video online download (“Introduction to dye and optical staining and classification methods” on KUDO and SANO) with video at
Related tweets (threaded in [Wayback/Archive] Thread by @jpluimers on Thread Reader App – New 25mm rectum polyp: SMSA grade 9, KUDO 5, SANO 3a.):
- [Wayback/Archive] “New 25mm rectum polyp: SMSA grade 9, KUDO 5, SANO 3a. Not happy (despite the midazolam). It will soon be removed via ESD. Hopefully really soon. …”
- [Wayback/Archive] “The SMSA describes difficulty of removal, see for instance …”
- [Wayback/Archive] Keith Siau on Twitter: “… These patients will be at higher risk of polyp recurrence as the colon may have a predisposition to adenomas, but a completely resected polyp shouldn’t grow back in the same spot. I think IRR mainly depends on difficulty as per SMSA (esp access), technique and precautions” / Twitter
- [Wayback/Archive] “and …”
- [Wayback/Archive] Wolfson Endoscopy UK on Twitter: “#stmarksfrontiers2018 @SiwanTG SMSA scoring (size morphology site access) enables you to risk stratify the polyp. M Bourke relates SMSA to failed EMR, recurrence and adverse events. Guides decision making on tertiary endoscopy referral and patient consent. …”
- [Wayback/Archive] Wolfson Endoscopy UK on Twitter: “#stmarksfrontiers2018 @SiwanTG SMSA scoring (size morphology site access) enables you to risk stratify the polyp. M Bourke relates SMSA to failed EMR, recurrence and adverse events. Guides decision making on tertiary endoscopy referral and patient consent. …”
- [Wayback/Archive] “and …”
- [Wayback/Archive] “KUDO is a polyp classification; a score of 5 is cancer. See for instance …”
- [Wayback/Archive] “and …”
- [Wayback/Archive] Sherif Andrawes MD on Twitter: “PIP-Verdict: EMR or ESD for large colon polyp?. assessment is key !, near focus exam Kudo-Class Type Vi irregularly arranged pits:mucosal or superficial submucosal adenocarcinoma. Best approach ESD for complete R0 resection-PATHspot-on.#esd #endoscopy #GITwitter #ThirdSpace …”
- [Wayback/Archive] “Prof Kudo started this classification: …”
- [Wayback/Archive] “SANO is another polyp classification system; there are multiple and it makes sense to use at least two for assessment. See for instance …”
- [Wayback/Archive] Paul T. Kröner on Twitter: “… Polyp Classifications that (hopefully) help predict invasion Paris, Kudo, Sano, NICE, JNET 🤯🤯 We feel your pain…! Are they useful or just cumbersome? Main problem=High interobserver variability→Poor clinical application What’s YOUR “favorite” classification and why? …” / Twitter
- [Wayback/Archive] Paul T. Kröner on Twitter: “… Polyp Classifications that (hopefully) help predict invasion Paris, Kudo, Sano, NICE, JNET 🤯🤯 We feel your pain…! Are they useful or just cumbersome? Main problem=High interobserver variability→Poor clinical application What’s YOUR “favorite” classification and why? …” / Twitter
- [Wayback/Archive] “and …”
- [Wayback/Archive] Enrik Aguila on Twitter: “For best results in polyp detection, use both 💯 1⃣ Wide field view (Paris classification, granularity) 2⃣ Focal interrogation (mesh brown capillary pattern: NICE, JNET, Modified Sano) ✳️ Also important to recognize 👉 base after polyp resection, recurrence or scar #vAPDW2021” / Twitter
- [Wayback/Archive] “and …”
- [Wayback/Archive] Rashid Lui 雷諾信 on Twitter: “@GI_Pearls Yes plz But i respectfully disagree. For Paris, well for one we can’t go around telling one another and patients that we removed 2 wrecking balls, clipped one of them, and also a pizza polyp… Kudo and Sano are quite good. But I think the simpler NICE is more useful IRL”
- [Wayback/Archive] “Sano was introduced by yet another Japanese professor: … Please note that no classification system is complete and the field is still evolving to become better. It is already a lot better than a decade ago. Also note I am scared. But less than 2 years ago.”
- [Wayback/Archive] “Slide deck on KUDO and SANO: …”
Via [Wayback/Archive] kudo classification – Google Search
–jeroen
The Wiert Corner - irregular stream of stuff 
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