Keep a "sharp eye" in search of architectural dysplasia and/or high-grade adenomatous change. The key deal on biopsies of colonic polyps or tumors is to separate unequivocal banal small classical hyperplastic polyps (HPP) from all other epithelial lesions (outline). It apparently makes no practical difference in the non-academic setting, as of 11/2005, whether we pinpoint lesions with serratedness prior to definitive removal of the polyp. It is probably best to discuss polyp variants in the "micro" section of the path report and let the diagnosis stay as close as possible to addressing "adenoma vs. hyperplastic polyp". Hence, the practical decision flow of this decision chart, below.

To effectively help our practitioners biopsying colonic lesions to do the right thing, you must have/get an idea of lesion size and location when interpreting slides of colonic growths! The few small endoscopic biopsies taken may not reflect the true lesion (especially those epithelial lesions with potentially mixed components)...we have seen many instances of polyp biopsies failing to show the adenomatous area or the malignant area.