title: Risk for colorectal neoplasia in patients with inflammatory bowel disease and mucosa indefinite for dysplasia.
abstract: BACKGROUND
  The management of colonic epithelial changes indefinite for dysplasia (IND) in patients with inflammatory bowel disease (IBD) remains controversial because of a paucity of published outcome data.
  
  
  METHODS
  We analyzed data from 93 patients with IBD who were IND and 52 IBD patients without dysplasia (controls) from the Department of Anatomic Pathology database at the Cleveland Clinic from 1989 to 2004. Pathology reports, histologic slides, clinical features, and outcomes were reviewed.
  
  
  RESULTS
  Twenty-two patients (23.7%) had surgical resections within 6 months of the IND assignment; of these, 6 had dysplasia (27.3%; 1 low-grade dysplasia and 5 high-grade dysplasia [HGD]). The remaining 71 patients received regular colonoscopy examinations for a mean period of 98.6 months; 18 patients developed dysplasia or carcinoma (25.2%; 10 low-grade dysplasia, 5 HGD, and 3 colorectal cancer). There was a mean interval of 53.9 months between an IND assignment and identification of dysplasia or carcinoma. Histology review of 59 cases revealed 3.2 cases per 100 person-years for neoplasia (low-grade dysplasia, HGD, or colorectal cancer) and 1.5 cases per 100 person-years for advanced neoplasia (HGD or colorectal cancer); these values were higher than those for controls (1.9 cases per 100 person-years for neoplasia and 0.7 cases per 100 person-years for advance neoplasia; P = 0.1 and P = 0.2, respectively, for IND versus controls). Patients aged more than 44 years when they were found to be IND were more likely than younger patients to develop neoplasia (hazard ratio, 6.7; P = 0.01).
  
  
  CONCLUSIONS
  Patients with IBD and IND are at significant risk for colorectal dysplasia and cancer. These patients should be closely followed.
authors.affiliation: *Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio; †Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; and Departments of ‡Colorectal Surgery, and §Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Keith K
authors.initials: KK
authors.lastname: Lai
authors.forename: Bela
authors.initials: B
authors.lastname: Horvath
authors.forename: Hao
authors.initials: H
authors.lastname: Xie
authors.forename: Xianrui
authors.initials: X
authors.lastname: Wu
authors.forename: Brian L
authors.initials: BL
authors.lastname: Lewis
authors.forename: Rish K
authors.initials: RK
authors.lastname: Pai
authors.forename: Thomas
authors.initials: T
authors.lastname: Plesec
authors.forename: Deepa T
authors.initials: DT
authors.lastname: Patil
authors.forename: Ilyssa O
authors.initials: IO
authors.lastname: Gordon
authors.forename: Yinghong
authors.initials: Y
authors.lastname: Wang
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.forename: John R
authors.initials: JR
authors.lastname: Goldblum
authors.forename: Xiuli
authors.initials: X
authors.lastname: Liu
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D055815:Young Adult