Are dysplasia and colorectal cancer endoscopically visible in patients with ulcerative colitis?
BACKGROUND
Dysplasia and colorectal cancer (CRC) in ulcerative colitis (UC) develop via pathways distinct from sporadic CRC and may occur in flat mucosa indistinct from surrounding tissue. Surveillance guidelines, therefore, have emphasized the ;roach of periodic endoscopic examinations and systematic random biopsies of involved mucosa. Given the imperfect nature of this random approach, recent work has focused on improved surveillance techniques and suggests that neoplasia is endoscopically visible in many patients.


OBJECTIVE
To assess the endoscopic visibility of dysplasia and CRC in UC.


METHODS
This was a retrospective review that used the University of Chicago Inflammatory Bowel Disease Registry and the clinical administrative database. All cases of dysplasia or CRC in UC between November 1994 and October 2004 were identified. The approach to surveillance in these patients included both random biopsies at approximately 10-cm intervals throughout the involved colon and directed biopsies of polypoid lesions, masses, strictures, or irregular mucosa distinct from surrounding inflamed tissue. Findings on endoscopy were compared with pathologic findings from biopsy or surgical specimens. Visible dysplasia was defined as a lesion reported by the endoscopist that led to directed biopsy and that was confirmed by pathology. Invisible dysplasia was defined as dysplasia diagnosed on pathology but not described on endoscopy. Per-lesion and per-patient sensitivities were determined.


METHODS
Tertiary referral center.


METHODS
Database of patients with inflammatory bowel disease seen at the University of Chicago.


METHODS
Endoscopically visible neoplasia.


RESULTS
In this database, there were 1339 surveillance examinations in 622 patients with UC. Forty-six patients were found to have dysplasia or CRC at a median age of 48 years and with median duration of disease of 20 years. Of these patients, 77% had pancolitis, 21% had left-sided colitis, and 2% had proctitis. These patients had 128 surveillance examinations (median 3 per patient; range, 1-9 per patient), and, in 51 examinations, 75 separate dysplastic or cancerous lesions were identified (mean, 1.6 lesions per patient; standard deviation, 1.3). Thirty-eight of 65 dysplastic lesions (58.5%) and 8 of 10 cancers (80.0%) were visible to the endoscopist as 23 polyps and masses, 1 stricture, and 22 irregular mucosa. The per-patient sensitivities for dysplasia and for cancer were 71.8% and 100%, respectively. The overall per-lesion and per-patient sensitivities were 61.3% and 76.1%, respectively.


CONCLUSIONS
Retrospective review of clinical databases and medical records.


CONCLUSIONS
Dysplasia and cancer in UC are endoscopically visible in most patients and may be reliably identified during scheduled examinations. Future surveillance guidelines should incorporate this information.
Rubin
David T
DT
The Reva and David Logan Gastrointestinal Clinical Research Center at the University of Chicago, Chicago, Illinois 60637, USA.
Rothe
Jami A
JA
Hetzel
Jeremy T
JT
Cohen
Russell D
RD
Hanauer
Stephen B
SB
D000328:Adult; D000368:Aged; D001706:Biopsy; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D003093:Colitis, Ulcerative / Q000473:pathology*; D003111:Colonic Polyps / Q000453:epidemiology / Q000473:pathology*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology*; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D015994:Incidence; D007413:Intestinal Mucosa / Q000473:pathology*; D008875:Middle Aged; D011159:Population Surveillance; D011230:Precancerous Conditions / Q000453:epidemiology / Q000473:pathology*; D015995:Prevalence; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors