[High-grade dysplasia as a risk factor of metachronous advanced colorectal neoplasms in patients with advanced adenomas].
BACKGROUND
Patients with advanced adenomas (AA) have a high risk of developing advanced colorectal neoplasms. Therefore, shorter monitoring intervals have been recommended in this patient subgroup. High grade dysplasia (HGD) is the main marker of cancer transformation. However, its predictive value for developing advanced neoplams in patients with advanced adenoma is unknown.


OBJECTIVE
To investigate if HGD increases the risk for developing advanced neoplasms in patients with AA.


METHODS
Between January 1996 and December 1997 every patient with an AA endoscopically resected were considered for inclusion. Patients with a history of colorectal cancer (CRC), inflammatory bowel disease, familial adenomatous polyposis or patients who met the Amsterdam criteria, and those without colonoscopic monitoring were excluded. We assessed the development of advanced neoplasms during the study period.


RESULTS
71 patients were included and classified into 2 groups, depending on the presence (n = 49) or lack (n = 22) of HGD in the initial colonoscopy. The probability of developing advanced neoplasms (log rank, p = 0.47; Breslow, p = 0.58) or AA with HGD (log rank, p = 0.47; Breslow, p = 0.53) in the study period was similar between both groups. The number of metachronic polyps (p = 0.67), adenomas (p = 0.73), AA (p = 0.93) and AA with HGD (p = 0.88) was also similar.


CONCLUSIONS
The risk of developing advanced neoplasms is not different between AA with HGD and those with other characteristics of AA (villous pattern and larger than 1 cm). Therefore, changes in monitoring intervals are not warranted.
Gimeno-García
Antonio Z
AZ
Servicio de Gastroenterología, Institut de Malalties Digestives, Hospital Clínic, Universitat de Barcelona, Barcelona, España.
Ramírez
Francisco
F
Gonzalo
Victòria
V
Balaguer
Francesc
F
Petit
Anna
A
Pellisé
Maria
M
Llach
Josep
J
Bordas
Josep M
JM
Piqué
Josep M
JM
Castells
Antoni
A
D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology*; D000236:Adenoma / Q000453:epidemiology / Q000473:pathology*; D000368:Aged; D003111:Colonic Polyps / Q000453:epidemiology / Q000473:pathology*; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology*; D011230:Precancerous Conditions / Q000473:pathology*; D012307:Risk Factors; D013997:Time Factors