title: Comparison of Targeted vs Random Biopsies for Surveillance of Ulcerative Colitis-Associated Colorectal Cancer.
abstract: A random biopsy is recommended for surveillance of ulcerative colitis (UC)-associated colorectal cancer. However, a targeted biopsy might be more effective. We conducted a randomized controlled trial to compare rates of neoplasia detection by targeted vs random biopsies in patients with UC.
  
  
  
  We performed a study of 246 patients with UC for 7 years or more, seen at 52 institutions in Japan from October 1, 2008 through December 31, 2010. Patients were randomly assigned to the random group (4 random biopsies collected every 10 cm in addition to targeted biopsies, n = 122) or the target group (biopsies collected from locations of suspected neoplasia, n = 124). The primary end point was the number of neoplastic lesions detected in a single surveillance colonoscopy. We estimated the ratio and difference in the mean number of neoplastic lesions between the groups. We also evaluated the non-inferiority between the groups as an exploratory study. A non-inferiority margin of 0.65 (0.13 of 0.20) was considered for the ratio of the mean number of neoplastic lesions between groups.
  
  
  
  The mean number of biopsies found to contain neoplastic tissue per colonoscopy was 0.211 (24 of 114) in the target group and 0.168 (18 of 107) in the random group (ratio of 1.251; 95% confidence interval, 0.679-2.306). The lower limit was above the non-inferiority margin of 0.65. Neoplasias were detected in 11.4% of patients in the target group and 9.3% of patients in the random group (P = .617). Larger numbers of biopsy samples per colonoscopy were collected in the random group (34.8 vs 3.1 in the target group; P < .001), and the total examination time was longer (41.7 vs 26.6 minutes in the target group; P < .001). In the random group, all neoplastic tissues found in random biopsies were collected from areas of the mucosa with a history or presence of inflammation.
  
  
  
  In a randomized controlled trial, we found that targeted and random biopsies detect similar proportions of neoplasias. However, a targeted biopsy appears to be a more cost-effective method. Random biopsies from areas without any signs of present or past inflammation were not found to contain neoplastic tissues. Clinical Trial Registry: UMIN000001608.
authors: Department of Surgical Oncology and Vascular Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan. Electronic address: toshwatanabe@yahoo.co.jp.
authors: Toshiaki
authors: T
authors: Watanabe
authors: Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan.
authors: Yoichi
authors: Y
authors: Ajioka
authors: Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
authors: Keiichi
authors: K
authors: Mitsuyama
authors: Department of Gastroenterology, Graduate School of Medicine, Osaka City University, Abeno-ku, Osaka, Japan.
authors: Kenji
authors: K
authors: Watanabe
authors: Center for Gastroenterology and IBD Research Hamamatsu South Hospital, Minami-ku, Hamamatsu, Japan.
authors: Hiroyuki
authors: H
authors: Hanai
authors: Department of Gastroenterology and Hepatology, Endoscopic Medicine, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan.
authors: Hiroshi
authors: H
authors: Nakase
authors: Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan.
authors: Reiko
authors: R
authors: Kunisaki
authors: Department of Surgery, Teikyo University School of Medicine, Itabashi-Ku, Tokyo, Japan.
authors: Keiji
authors: K
authors: Matsuda
authors: Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan.
authors: Ryuichi
authors: R
authors: Iwakiri
authors: Division of Internal Medicine, Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors: Nobuyuki
authors: N
authors: Hida
authors: Department of Endoscopy, Hiroshima University Hospital, Minami-ku, Hiroshima, Japan.
authors: Shinji
authors: S
authors: Tanaka
authors: Department of Internal Medicine, Showa University School of Medicine, Hatanodai, Shinagawa-ku, Tokyo, Japan.
authors: Yoshiaki
authors: Y
authors: Takeuchi
authors: Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
authors: Kazuo
authors: K
authors: Ohtsuka
authors: Department of Gastroenterology, Oita University, Hasama-cho, Yuhu, Oita, Japan.
authors: Kazunari
authors: K
authors: Murakami
authors: Research and Development Center for New Medical Frontiers, Kitasato University, School of Medicine, Minami, Sagamihara, Kanagawa, Japan.
authors: Kiyonori
authors: K
authors: Kobayashi
authors: Center for Preventive Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
authors: Yasushi
authors: Y
authors: Iwao
authors: Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
authors: Masakazu
authors: M
authors: Nagahori
authors: Department of Gastroenterology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
authors: Bunei
authors: B
authors: Iizuka
authors: Department of Surgical Oncology and Vascular Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors: Keisuke
authors: K
authors: Hata
authors: Cancer Institute Ariake Hospital, Koto-ku, Tokyo, Japan.
authors: Masahiro
authors: M
authors: Igarashi
authors: Department of Gastroenterology, Fujita Health University, Kutsukake-Cho, Toyoake, Aichi, Japan.
authors: Ichiro
authors: I
authors: Hirata
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, Tsuzuki Yokohama, Japan.
authors: Shin-Ei
authors: SE
authors: Kudo
authors: Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan.
authors: Takayuki
authors: T
authors: Matsumoto
authors: Department of Medicine, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan.
authors: Fumiaki
authors: F
authors: Ueno
authors: Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan.
authors: Gen
authors: G
authors: Watanabe
authors: Department of Pathology, The Jikei University, School of Medicine, Minato-ku, Tokyo, Japan.
authors: Masahiro
authors: M
authors: Ikegami
authors: Center for Clinical Research, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
authors: Yoko
authors: Y
authors: Ito
authors: Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; Interfaculty Initiative in Information Studies, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors: Koji
authors: K
authors: Oba
authors: Center for Clinical Research and Development, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.
authors: Eisuke
authors: E
authors: Inoue
authors: Center for Clinical Research, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
authors: Naoki
authors: N
authors: Tomotsugu
authors: Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan.
authors: Toru
authors: T
authors: Takebayashi
authors: Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
authors: Kenichi
authors: K
authors: Sugihara
authors: Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Chiba, Japan.
authors: Yasuo
authors: Y
authors: Suzuki
authors: Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
authors: Mamoru
authors: M
authors: Watanabe
authors: Center for Advanced IBD Research and Treatment, Kitasato Institute Hospital, Kitasato University, Minato-ku, Tokyo, Japan.
authors: Toshifumi
authors: T
authors: Hibi
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods*; D003093:Colitis, Ulcerative / Q000150:complications*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011159:Population Surveillance
keywords: Colonoscopy; Dysplasia; IBD; Random Biopsy