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Microscopic pathology assessment of colorectal polyp size is less accurate than intracolonoscopic assessment
  1. Maurice B Loughrey1,2
  1. 1Cellular Pathology, Belfast Health and Social Care Trust, Belfast, UK
  2. 2Centre for Public Health and Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
  1. Correspondence to Professor Maurice B Loughrey, Cellular Pathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast BT12 6BA, UK; maurice.loughrey{at}

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The recent study by Djinbachian et al comparing accuracy of intracolonoscopic to pathology-based assessment of colorectal polyp size is of considerable interest.1 The authors reported that pathology sizing is often not possible because of piecemeal polyp resection or fragmentation during retrieval and, for intact polypectomy specimens, pathology accuracy is limited by formalin-related shrinkage. 78% of pathology-based polyp measurements were smaller than the reference postcolonoscopy size assessed by digital vernier calipre, and mean shrinkage effect was estimated at 25.7%. However, there is another aspect of the pathology assessment which has not been considered and is perhaps a more likely explanation of size reduction based on pathology measurement.

While formalin-related specimen shrinkage is well established, this mainly relates to specimens with significant contractility, such as cutaneous specimens.2 Studies examining the impact of formalin on polyp sizing have yielded conflicting results, though most have suggested …

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  • Contributors MBL devised and wrote the report and composed the associated composite figure.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.