Objective: Due to its effect on polypectomy surveillance, dysplasia grading is essential in colorectal adenomas. We aimed to investigate the terminologies used for high-grade dysplasia in routine practice if any, and to assess the practice patterns of dysplasia grading among Turkish pathologists with reference to current guidelines.

Material and Methods: A survey including seven images of colorectal adenomas with low-grade and high-grade dysplasia was sent to pathologists in Türkiye. The images were selected from the Canadian National Polyp Guidelines. The pathologists were asked to grade the dysplasia as in their routine practice.

Results: A total of 324 pathologists (including 48 senior residents and 176 gastrointestinal pathologists) participated in the survey. Among staff pathologists, the rate of agreement of dysplasia according to the guidelines was as follows; for colorectal adenomas with low-grade dysplasia, Image 1 (with low-grade cytology)-97.1%, Image 2 (with focal cribriformity)-6.2%, Image 5 (with high-grade cytology)-26.8%, and Image 6 (with slightly high-grade cytology)-48.9%. For colorectal adenomas with high-grade dysplasia, the agreement ratio was >91% (range 91.6-99.6%). However, intramucosal adenocarcinoma was the preferred terminology by 43.8%, 68.5%, and 50% of the participants, respectively. The results were similar for residents.

Conclusion: Among pathologists in Türkiye, in contrast to current guidelines for colorectal adenomas, 1. Intramucosal adenocarcinoma is still a commonly used terminology, 2. High-grade cytological features are over-relied upon, 3. Small foci of architectural abnormality are overcalled. Therefore, strategies to increase the usage of established practice guidelines should be developed. A national polyp guideline seems to be necessary for an attempt to standardize the reporting of colorectal adenomas.