title: Endoscopic morphologic features of ulcerative colitis-associated dysplasia classified according to the SCENIC consensus statement.
abstract: OBJECTIVE
  Recent advances in endoscopic equipment and diagnostic techniques have made possible the detection of early dysplasia in the inflamed mucosa of ulcerative colitis (UC). The SCENIC consensus statement recommends the use of unified terminology for the morphology of dysplasia. In this study, we investigated the endoscopic features of high-grade dysplasia (HGD) in a clinical setting.
  
  
  METHODS
  We retrospectively identified 62 patients with UC who were diagnosed with colitis-associated cancer or HGD between 1997 and 2015. A total of 39 lesions of HGD detected by targeted biopsy sampling in 31 patients were reviewed, and the endoscopic morphology was classified according to the SCENIC guidelines.
  
  
  RESULTS
  In total, 0 (0%), 6 (15.4%), 19 (48.7%), 12 (30.8%), and 2 (5.1%) lesions with HGD were classified as pedunculated, sessile, superficial elevated, flat, and depressed, respectively. Nearly 80% of the lesions were located in the rectum or sigmoid colon. All flat and depressed lesions were red in color. Typically, sessile/superficial elevated lesions accompanied a flat area (Is+IIb/IIa+IIb). Ulceration was observed in 2 depressed lesions (5.1%). Although the borders were indistinct in 21 lesions (53.8%) without the use of magnifying colonoscopy, all lesions could be distinguished from the surrounding mucosa using magnifying endoscopy.
  
  
  CONCLUSIONS
  This is the first study to classify the morphologic features of HGD using the SCENIC guidelines in a clinical setting. Based on our findings, endoscopists should recognize that HGD is frequently associated with a flat/superficial elevated area and red discoloration and should inspect particularly carefully in the rectum and sigmoid colon. The findings of chromoendoscopy and magnifying colonoscopy may also be useful in distinguishing lesions from the surrounding mucosa.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Sugimoto
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Naganuma
authors.affiliation: Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iwao
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Matsuoka
authors.affiliation: Department of Pathology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shimoda
authors.affiliation: Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Mikami
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Shinta
authors.initials: S
authors.lastname: Mizuno
authors.affiliation: Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nakazato
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nanki
authors.affiliation: Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Nagamu
authors.initials: N
authors.lastname: Inoue
authors.affiliation: Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Ogata
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Kanai
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult; D003093:Colitis, Ulcerative / Q000150:complications / Q000473:pathology; D012809:Colon, Sigmoid / Q000473:pathology; D003111:Colonic Polyps / Q000209:etiology / Q000473:pathology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000209:etiology / Q000473:pathology; D007417:Intestinal Polyps / Q000209:etiology / Q000473:pathology; D011230:Precancerous Conditions / Q000209:etiology / Q000473:pathology; D011351:Proctoscopy; D012007:Rectum / Q000473:pathology; D012189:Retrospective Studies; D003245:Consensus Statements as Topic