Three colonic polyps to choose between !
WHICH IS THE MOST SUSPICIOUS?
I agree! Looks like cancer!
Looks too pretty to be evil !
On size criteria, the risk is probably about 1:7
B has a lovely brain-like crypt pattern of a rather pretty TVA. Of course, C is difficult to assess as the surface crypt pattern may not reflect was is lurking deep inside. Data from the NHS Bowel Cancer Screening Programme (see table below) puts the risk of cancer in a >45 mm at 15%. For this reason, the polyp should be removed in as few fragments as possible.
However, A is the polyp which I think looks most suspicious. It has a suspicious central nodule and on the NBI image (top-right), I don't see an organised crypt pattern in parts of the polyp. This is a superficially invasive cancer which was just invading into the muscular mucosa (sm1 invasion)! it lifted well enough for a resection. Again single fragment resection would be paramount when removing this polyp.
Below is a table which I received from Matt Rutter a few years ago. It links size with histology for polyps resected on the NHS Bowel Cancer Screening Programme