Decoding Your GI and Pathology Reports

After a colonoscopy or upper endoscopy, you will receive a pathology report that describes the tissue samples (biopsies) taken during the procedure. For someone with FAP, these reports can be dense with medical jargon. Understanding these terms helps you understand the “activity” of your condition and the urgency of your next steps.

Decoding Pathology Terms

When a pathologist looks at your polyps under a microscope, they are looking for specific features that indicate how close a polyp is to becoming cancerous.

• Adenoma: This is the most common term you will see. It simply means a precancerous polyp. In FAP, the goal is to manage these before they progress ^[1][2].
• Dysplasia: This refers to how “abnormal” the cells look.
  • Low-grade dysplasia (LGD): The cells look slightly different from normal but are slow-growing ^[3].
  • High-grade dysplasia (HGD): The cells look very abnormal and are one step away from becoming invasive cancer. HGD is a significant “red flag” on a report ^[4].
• Polyp Architecture (Shape):
  • Tubular: These polyps look like small tubes. They are the most common and generally carry a lower risk ^[5].
  • Villous: These polyps have long, finger-like projections. “Villous” or “Tubulovillous” polyps are considered more advanced and carry a higher risk of developing into cancer ^[4].

The Spigelman Staging System

While the colon is often the first focus, the duodenum (the first part of the small intestine) requires its own specialized scoring system. The Spigelman Stage (0 to IV) is calculated by adding points from four different categories found in your endoscopy and pathology reports ^[6][4].

How the Score is Calculated

Points are assigned (1, 2, or 3) for each of these four areas.

(Note: Modern pathology reports often group “Mild” and “Moderate” into “Low-grade” and label “Severe” as “High-grade”.)

What the Stages Mean

The points are added together to determine your Spigelman Stage ^[4]. If you have even a single small polyp, your minimum score is 4 points.

• Stage 0: 0 points. No polyps found.
• Stage I: 4 points. Very low risk; surveillance every 5 years.
• Stage II: 5–6 points. Mild disease; surveillance every 2–3 years.
• Stage III: 7–8 points. Moderate disease; surveillance every 6–12 months.
• Stage IV: 9–12 points. Severe disease. This stage carries the highest risk for cancer (up to 36% over 10 years) and often triggers a discussion about preventive surgery ^[7][8].

What a “Complete” Report Must Include

Because FAP is a specialized condition, a standard GI report may not be enough. For a report to be considered “complete” for an FAP patient, it should ideally mention:

1. Scope Type: Use of a side-viewing duodenoscope is critical to properly see the ampulla of Vater, a common site for polyps that can be missed by standard scopes ^[9][10].
2. Ampulla Description: The report should specifically describe the appearance of the ampulla and whether it was biopsied ^[11].
3. Polyp Count and Distribution: Instead of “multiple polyps,” the report should estimate the total number (e.g., “>20”) to help with Spigelman staging ^[4].
4. Stomach Check: Descriptions of fundic gland polyps in the stomach, noting if any show “atypical” features ^[12].