Prognostic significance of high-grade dysplasia in colorectal adenomas.
OBJECTIVE
Colonoscopy to detect and remove polyps has contributed to a reduction in colorectal carcinoma. Three-year follow up is recommended for patients considered to be at high risk (at least three adenomas, adenoma ≥ 1 cm, villous or high-grade features). Our study focused on patients diagnosed with high-grade dysplasia with regard to initial management and follow up.


METHODS
A search of patients who had had endoscopic removal of a high-grade adenoma was carried out. Patients with the following were excluded: follow up of < 1 year, polyposis syndromes, prior colon cancer and a diagnosis of adenocarcinoma within 6 months following initial diagnosis.


RESULTS
Eighty-three patients treated between 1999 and 2007 for high-grade dysplasia (HGD) in a colorectal adenoma were identified. Over a median follow-up period of 4 years, 53 (64%) developed further adenomatous polyps. Among these, 7% had an adenoma with HGD or an adenocarcinoma. In all these patients, the initial high-grade adenoma was > 1 cm in diameter. Initial follow-up colonoscopy was performed on average 7 months following the initial diagnosis. Ten per cent of patients underwent prophylactic segmental resection, and 6% received argon laser therapy.


CONCLUSIONS
The study demonstrates that patients who have a colorectal adenoma > 1 cm with HGD may be at high risk of developing further adenomas with HGD or carcinoma. Close follow up is warranted.
Toll
A D
AD
Pathology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
Fabius
D
D
Hyslop
T
T
Pequignot
E
E
DiMarino
A J
AJ
Infantolino
A
A
Palazzo
J P
JP
D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology; D000236:Adenoma / Q000453:epidemiology / Q000473:pathology*; D018253:Adenoma, Villous / Q000453:epidemiology / Q000473:pathology; D018256:Adenomatous Polyps / Q000453:epidemiology / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors