Dysplastic Progression to Adenocarcinoma is Equivalent in Ulcerative Colitis and Crohn’s Disease

Abstract Background We sought to determine the rate of progression from dysplasia to adenocarcinoma in ulcerative colitis [UC] vs Crohn’s diseases [CD] and describe the risk factors unique to each. Methods All adult patients [≥18 years] with a known diagnosis of either UC or CD who underwent a surveillance colonoscopy between January 1, 2010 and January 1, 2020 were included. Results A total of 23 751 surveillance colonoscopies were performed among 12 289 patients between January 1, 2010 and January 1, 2020; 6909 [56.2%] had a diagnosis of CD and 5380 [43.8%] had a diagnosis of UC. There were a total of 668 patients [5.4%] with low-grade dysplasia [LGD], 76 patients [0.62%] with high-grade dysplasia [HGD], and 68 patients [0.55%] with adenocarcinoma in the series; the majority of the dysplastic events were located in the right colon. Significantly more UC patients had a dysplastic event, but the rate of LGD and HGD dysplasia progression to adenocarcinoma was not significantly different in CD or UC [p = 0.682 and p = 1.0, respectively]. There was no significant difference in the rate of progression from LGD/HGD to adenocarcinoma based on random biopsies vs targeted biopsies of visible lesions [p = 0.37]. However, the rate of progression from LGD vs HGD to adenocarcinoma was significantly greater for HGD [p < 0.001]. Conclusion While more UC patients were found to have neoplasia on colonoscopy, the rate of progression from LGD and HGD to adenocarcinoma was equivalent in UC and CD, suggesting that endoscopic surveillance strategies can remain consistent for all IBD patients.

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P397 Surveillance in ulcerative colitis: Can we predict the risk for intraepithelial neoplasia?

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.526 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S368-S369

Author(s):

J Estorninho ◽

P Freire ◽

S Lopes ◽

M Ferreira ◽

...

Keyword(s):

Ulcerative Colitis ◽

Disease Duration ◽

Intraepithelial Neoplasia ◽

Screening Colonoscopy ◽

Low Grade ◽

Surveillance Colonoscopy ◽

High Quality ◽

Increased Risk ◽

History Of ◽

Low Grade Dysplasia

Abstract Background Ulcerative colitis (UC) has been associated with an increased risk of colorectal cancer (CRC). Although dye spray chromoendoscopy showed superiority to standard colonoscopy in surveillance studies, with the availability of higher-resolution colonoscopes, the utility of chromoendoscopy (CE) has been questioned. We aimed to evaluate the risk of intraepithelial neoplasia (IN) after a high-quality screening colonoscopy (making use of CE or random biopsies (RB) and removing all detected lesions) in a population with longstanding UC and to identify potential risk factors for dysplasia incidence. Methods In a previous study, 145 patients with clinically and endoscopic longstanding (≥8 yr) distal/extensive UC without primary sclerosing cholangitis and/or history of IN were prospectively randomised to undergo CE or RB. In this study, after a median follow-up of 5 additional years, we evaluated subsequent IN incidence in these patients, submitted to surveillance colonoscopy. Patients without high-quality surveillance colonoscopy (with good bowel preparation and cecum intubation) using high-definition were excluded. Results One hundred and twenty-one patients were included. Nine had removed adenomas with low-grade dysplasia in the index colonoscopy. Now, in surveillance colonoscopy, we detected 9 (7.4%) IN: low-grade dysplasia was found in 8 (6.6%) patients and a colorectal adenocarcinoma in 1 (0.008%) patient. After multivariate analysis, IN was significantly associated with older age (68 vs. 52 years, p < 0.05) and higher disease duration (26 vs. 20 years, p < 0.05). No association was found between IN and previous detection of IN in screening colonoscopy sex, the CE or RB use in index colonoscopy, extent of disease, The presence of pseudopolyps, smoking habits, familial history of CRC or maintenance therapy for UC. Conclusion In this study, older patients and higher disease duration were associated with a higher risk of IN in surveillance colonoscopy.

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P083. Low-grade Dysplasia in Ulcerative Colitis: Risk Factors associated with Progression to High-grade Dysplasia or Colorectal Cancer

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jju027.201 ◽

2015 ◽

Vol 9 (suppl 1) ◽

pp. S119-S120

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Ulcerative Colitis ◽

High Grade Dysplasia ◽

Low Grade ◽

High Grade ◽

Factors Associated ◽

Low Grade Dysplasia

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Ulcerative Colitis and Cytomegalovirus Infection: From A to Z

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa036 ◽

2020 ◽

Vol 14 (8) ◽

pp. 1162-1171 ◽

Cited By ~ 4

Author(s):

Fadi H Mourad ◽

Jana G Hashash ◽

Viraj C Kariyawasam ◽

Rupert W Leong

Keyword(s):

Ulcerative Colitis ◽

Inclusion Bodies ◽

Antiviral Treatment ◽

Low Grade ◽

High Grade ◽

Cmv Infection ◽

Significant Difference ◽

Cmv Colitis ◽

Cmv Disease ◽

Severe Colitis

Abstract Despite multiple studies, the role of cytomegalovirus [CMV] infection in exacerbating the severity of inflammation in ulcerative colitis [UC], and its response to treatment, remain debatable. Additionally, the optimal diagnostic tests for CMV infection in the setting of UC relapse, and timing of antiviral treatment initiation, remain unclear. The challenge faced by gastroenterologists is to differentiate between an acute UC flare and true CMV colitis. It seems that the presence of CMV colitis, as defined by the presence of intranuclear or intracellular inclusion bodies on haematoxylin and eosin [H&E] staining and/or positive immunohistochemistry [IHC] assay on histology, is associated with more severe colitis. Patients with CMV infection and acute severe colitis are more resistant to treatment with corticosteroids than non-infected patients. This refractoriness to steroids is related to colonic tissue CMV viral load and number of inclusion bodies [high-grade CMV infection] which may have a pronounced effect on clinical outcomes and colectomy rates. Whereas many studies showed no effect for antiviral treatment on colectomy rates in CMV-infected UC patients, there was a significant difference in colectomy rates of patients with high-grade infection who received anti-viral therapy compared with those who did not receive treatment. It was therefore proposed that high-grade CMV disease indicates that the virus is acting as a pathogen, whereas in those with low-grade CMV disease, the severity of IBD itself is more likely to influence outcome. The different algorithms that have been put forward for the management of patients with UC and concomitant CMV infection are discussed.

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The value of histological changes and immunohistochemical markers Ki67 and p53 in the assessment of ulcerative colitis related dysplasia

Open Medicine ◽

10.2478/s11536-009-0085-7 ◽

2010 ◽

Vol 5 (4) ◽

pp. 417-425

Author(s):

Ovidiu Fratila ◽

Tiberia Ilias ◽

Dana Puscasiu

Keyword(s):

Ulcerative Colitis ◽

High Grade Dysplasia ◽

Histological Evaluation ◽

Low Grade ◽

High Grade ◽

Immunohistochemical Markers ◽

Colorectal Mucosa ◽

Objective Parameter ◽

Indefinite For Dysplasia ◽

Low Grade Dysplasia

AbstractThe risk of carcinoma increases in patients with a 10-year or longer duration of ulcerative colitis (UC). To search for a more objective parameter to assess epithelial dysplasia. The study comprised 25 cases of longstanding UC: 7 cases with regenerative atypia, 7 with low grade dysplasia, 7 with high grade dysplasia, and 4 cases indefinite for dysplasia. The colonic biopsies obtained during endoscopy were stained with H&E to identify the aforementioned categories. Seventy-five sections from biopsy specimens were stained immunohistochemically to detect differences in the frequency and pattern of nuclei positive for the proliferation marker Ki67 and p53. In high grade dysplasia, the distribution of Ki67 positive cells was diffuse throughout the full length of the crypt, whereas low grade dysplasia and epithelium indefinite for dysplasia, as well as regenerative epithelium, showed an expanded basal zone. None of the regenerative atypia cases showed strong intensity p53 staining compared to dysplasia cases. None of the high grade dysplasia cases showed restricted p53 staining to the lower two thirds of the crypt. All the cases of HGD showed extension of Ki67 and p53 staining above the basal two thirds of the crypt. Ki67 and p53 immunostained cell assessment combined with routine histological evaluation of colorectal mucosa can improve the diagnostic accuracy, as well as the assessment of malignant transformation risk.

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Su1653 Low-Grade Dysplasia in Ulcerative Colitis: Shape and Size of the Lesion, and Previous Episode of Indefinite Dysplasia Are Important Predictors for Progression to High-grade Dysplasia or Cancer

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2015.03.1501 ◽

2015 ◽

Vol 81 (5) ◽

pp. AB366

Author(s):

Chang Ho R. Choi ◽

Ana Wilson ◽

Matt Rutter ◽

Siwan Thomas-Gibson ◽

Janindra Warusavitarne ◽

...

Keyword(s):

Ulcerative Colitis ◽

High Grade Dysplasia ◽

Low Grade ◽

High Grade ◽

Previous Episode ◽

Low Grade Dysplasia ◽

Shape And Size

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Low-Grade Dysplasia in Ulcerative Colitis: Risk Factors for Developing High-Grade Dysplasia or Colorectal Cancer

The American Journal of Gastroenterology ◽

10.1038/ajg.2015.248 ◽

2015 ◽

Vol 110 (10) ◽

pp. 1461-1471 ◽

Cited By ~ 63

Author(s):

Chang-ho Ryan Choi ◽

Ana Ignjatovic-Wilson ◽

Alan Askari ◽

Gui Han Lee ◽

Janindra Warusavitarne ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Ulcerative Colitis ◽

High Grade Dysplasia ◽

Low Grade ◽

High Grade ◽

Low Grade Dysplasia

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Sessile serrated adenomas: prevalence of dysplasia and carcinoma in 2139 patients

Journal of Clinical Pathology ◽

10.1136/jcp.2010.075507 ◽

2010 ◽

Vol 63 (8) ◽

pp. 681-686 ◽

Cited By ~ 189

Author(s):

Richard H Lash ◽

Robert M Genta ◽

Christopher M Schuler

Keyword(s):

Colorectal Polyps ◽

High Grade Dysplasia ◽

Progression Rate ◽

Low Grade ◽

High Grade ◽

Right Colon ◽

The Difference ◽

The Right ◽

Almost All ◽

Serrated Adenomas

Background and aimsSessile serrated adenomas (SSAs) are recognised as precursors to microsatellite unstable adenocarcinomas. This study attempts to estimate the progression rate of SSAs based upon the epidemiology of a large cohort as well as identify relationships to other colorectal polyps.MethodsPathological reports generated at Caris Diagnostics from 290 810 colonoscopic specimens on 179 111 patients were analysed using computerised algorithms.ResultsSSAs with or without dysplasia/carcinoma (SSA+/–) were identified in 2416 specimens from 2139 patients (54% women). The distribution of SSA+/– was: right-sided (81.2%); left-sided (11.2%); both right- and left-sided (3.2%); not specified (4.3%). There were 1816 (85%) patients without dysplasia (SSA–), 257 (12%) with low-grade dysplasia (SSA-LD), 45 (2%) with high-grade dysplasia (SSA-HD) and 21 (1%) with adenocarcinoma (SSA-CA). The difference in median age between almost all groups was significant (SSA–=61 years versus SSA-LD=66 years (p<0.001) vs SSA-HD=72 years (p=0.002) vs SSA-CA=76 years (p=0.07, NS)). Women comprised 53% of the SSA– group (968/1816), 57% of the SSA-LD group (147/257), 69% of the SSA-HD group (31/45) and 76% of the SSA-CA group (16/21), being more likely to have high-grade dysplasia (OR 1.94, 95% CI 1.03 to 3.67) and adenocarcinoma (OR 2.80, 95% CI 1.02 to 7.68).Conclusions1.7% of patients with mucosal polyps had SSAs (with and without dysplasia), more commonly in women and primarily in the right colon. Dysplasia or carcinoma was identified in 15% of patients and significantly disproportionately among women. Based on significant age differences between groups, there appears to be a stepwise progression of dysplasia and carcinoma in SSAs over 10 to 15 years, a period two to three times longer than that for conventional adenomas.

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