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CLASSIFICATION
Classification
Haggitt classification (malignant-polyp invasion level)
Levels 0–4 of invasion in pedunculated malignant polyps. Sessile malignant polyps are Level 4 by definition. Additional colectomy also depends on SM depth, budding, and lymphovascular invasion (curative-resection page).
Classification overview
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Haggitt
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Level 0 · CIS / intramucosal
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Level 1 · SM limited to the head
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Level 2 · Neck
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Level 3 · Stalk
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Level 4 · Bowel-wall SM
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Assessment
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Assessment · How to use the level
Haggitt
Level 0
CIS / intramucosal
Definition
Carcinoma in situ or intramucosal carcinoma that does not invade through the muscularis mucosae into the submucosa
Level 1
SM limited to the head
Definition
Carcinoma invading through the muscularis mucosae into the submucosa but limited to the head of the polyp
Level 2
Neck
Definition
Carcinoma invading the neck of the polyp (the junction of the head and the stalk)
Level 3
Stalk
Definition
Carcinoma invading any part of the stalk
Level 4
Bowel-wall SM
Definition
Carcinoma invading into the submucosa of the bowel wall below the stalk but above the muscularis propria
Sessile
All sessile malignant polyps with submucosal invasion are Level 4 by definition
Note: Any sessile polyp with submucosal invasion is Level 4.
Assessment
Assessment
How to use the level
Scope
Described for pedunculated adenomas containing carcinoma. Sessile lesions with SM invasion are Level 4
Surgery
Level 4 invasion, lymphovascular invasion, and poor differentiation were adverse factors in Haggitt 1985
Today
Japanese curative-resection rules also use SM depth (µm), budding, and Ly/V. Use the colorectal ESD curability page
Haggitt 1985, Original
Reference
Original article
Haggitt RC, Glotzbach RE, Soffer EE, Wruble LD. Gastroenterology 1985;89:328-336
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ALGORITHM
Curability
→
Colorectal T1 LNM nomogram (Kajiwara / JSCCR)
T1 LNM probability
PREDICTION MODEL
T1 Nomogram
→
Paris classification (superficial morphology)
Paris macroscopic type
CLASSIFICATION
Paris
→
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