American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the primary indication for endoscopic polypectomy in invasive adenocarcinoma?

1. Lesion removal only if it invades the muscle layer

2. The lesion is no more than 2 cm in size

3. The lesion must be completely removed and have clear margins

4. To treat non-invasive adenomas only

The correct answer is: The lesion must be completely removed and have clear margins

The primary indication for endoscopic polypectomy in cases of invasive adenocarcinoma is that the lesion must be completely removed and have clear margins. This is essential because complete resection with negative margins significantly reduces the likelihood of residual disease and the potential for local recurrence. By ensuring that the tumor is resected entirely, clinicians can provide a definitive treatment approach for early-stage invasive adenocarcinomas. In cases of adenocarcinoma, the histological evaluation of the margins is crucial, as positive margins typically indicate that some cancerous tissue may remain, which can compromise the patient’s prognosis. While factors such as size and depth of invasion are important considerations in clinical practice, the presence of clear margins indicates an adequate surgical response and optimizes long-term outcomes for patients. Additionally, endoscopic polypectomy is not primarily indicated for treating non-invasive adenomas, which is a separate category from invasive adenocarcinoma, making that option less relevant in this context.