Prospective study of the progression of low-grade dysplasia in ulcerative colitis using current cancer surveillance guidelines
Article first published online: 16 APR 2012
Copyright © 2012 Crohn's & Colitis Foundation of America, Inc.
Inflammatory Bowel Diseases
Volume 18, Issue 12, pages 2240–2246, December 2012
How to Cite
Zisman, T. L., Bronner, M. P., Rulyak, S., Kowdley, K. V., Saunders, M., Lee, S. D., Ko, C., Kimmey, M. B., Stevens, A., Maurer, J. and Brentnall, T. A. (2012), Prospective study of the progression of low-grade dysplasia in ulcerative colitis using current cancer surveillance guidelines. Inflamm Bowel Dis, 18: 2240–2246. doi: 10.1002/ibd.22912
- Issue published online: 15 NOV 2012
- Article first published online: 16 APR 2012
- Manuscript Accepted: 20 JAN 2012
- Manuscript Received: 19 JAN 2012
- Supported by National Institutes of Health (NIH). Grant Number: RO1 CA68124
- low-grade dysplasia;
- ulcerative colitis;
- colon cancer
The goal of this study was to assess the natural history of low-grade dysplasia (LGD) and its risk of progression in ulcerative colitis (UC) patients by prospective endoscopic surveillance.
Forty-two UC patients with LGD were followed prospectively using a uniform approach to surveillance colonoscopy with an average of 43 biopsies per exam. The interval between colonoscopies ranged from 3–12 months. Progression was defined as development of high-grade dysplasia (HGD) or cancer at subsequent colonoscopy or at colectomy. Univariate and multivariate analysis were performed to identify risk factors associated with progression.
Patients were followed for an average of 3.9 years (range 1–13). Over that period 19% (8/42) of patients progressed to advanced neoplasia (two cancer, six HGD) while 17% (7/42) had persistent LGD and 64% (27/42) had indefinite dysplasia or no dysplasia at the end of follow-up. Multivariate analysis demonstrated that the number of biopsies with LGD at baseline was associated with an increased risk of progression to advanced neoplasia (relative risk [RR] 5.8, 95% confidence interval [CI]: (1.29–26.04). Among the 15 patients who underwent colectomy, four were found to have higher-grade neoplasia on their colectomy specimen than their preoperative colonoscopy, and these patients were more likely to be nonadherent with recommendations for colectomy.
The majority (81%) of UC patients with LGD did not progress to higher grades of dysplasia during a 4-year follow-up. Patients with three or more biopsies demonstrating LGD at a single colonoscopy were at increased risk for progression to advanced neoplasia. (Inflamm Bowel Dis 2012;)