Outcome after surveillance of low-grade and indefinite dysplasia in patients with ulcerative colitis.
BACKGROUND
The management of low-grade (LGD) and indefinite dysplasia (IND) in patients with ulcerative colitis (UC) remains controversial, as outcomes after a diagnosis of LGD or IND in previous studies vary widely.


METHODS
All patients evaluated were from a single institution referral center who had a history of UC and a diagnosis of either LGD or IND between 1994 and 2008 as confirmed by 2 expert gastrointestinal (GI) pathologists. Data were collected by chart review of electronic and paper medical records. All patients who did not undergo a colectomy within 90 days of their dysplasia diagnosis were included in the final analysis. Hazard ratios for risk factors as well as incidence rates and Kaplan-Meier estimates were used to calculate the progression to high-grade dysplasia (HGD) or colorectal cancer (CRC).


RESULTS
Thirty-five patients were included in the analysis, of whom 2 patients with IND and 2 patients with LGD developed HGD or CRC over a mean duration of 49.8 months. In total, the incident rate for advanced neoplasia for all patients was 2.7 cases of HGD or CRC per 100 person-years at risk. For flat and polypoid LGD the incident rate of advanced neoplasia was 4.3 and 1.5 cases per 100 person-years at risk, respectively. Patients with primary sclerosing cholangitis (PSC) had an incident rate of 10.5 cases per 100 years of patient follow-up.


CONCLUSIONS
We report a low rate of progression to HGD or CRC in patients who underwent surveillance for LGD or IND; polypoid dysplasia showed less risk of progression than flat dysplasia.
Pekow
Joel R
JR
University of Chicago, Section of Gastroenterology, Hepatology, and Nutrition, Chicago, Illinois, USA.
Hetzel
Jeremy T
JT
Rothe
Jami A
JA
Hanauer
Stephen B
SB
Turner
Jerrold R
JR
Hart
John
J
Noffsinger
Amy
A
Huo
Dezheng
D
Rubin
David T
DT
D000230:Adenocarcinoma / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D018450:Disease Progression; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018571:Sentinel Surveillance; D055815:Young Adult