Prognostic significance of high-grade dysplasia in colorectal adenomas
Version of Record online: 8 MAR 2011
© 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland
Volume 13, Issue 4, pages 370–373, April 2011
How to Cite
Toll, A. D., Fabius, D., Hyslop, T., Pequignot, E., DiMarino, A. J., Infantolino, A. and Palazzo, J. P. (2011), Prognostic significance of high-grade dysplasia in colorectal adenomas. Colorectal Disease, 13: 370–373. doi: 10.1111/j.1463-1318.2010.02385.x
- Issue online: 8 MAR 2011
- Version of Record online: 8 MAR 2011
- Accepted manuscript online: 16 AUG 2010 02:46PM EST
- Received 26 April 2010; accepted 3 June 2010; Accepted Article online 16 August 2010
- High-grade dysplasia;
- colon cancer
Aim Colonoscopy to detect and remove polyps has contributed to a reduction in colorectal carcinoma. Three-year follow up is recommended for patients considered to be at high risk (at least three adenomas, adenoma ≥ 1 cm, villous or high-grade features). Our study focused on patients diagnosed with high-grade dysplasia with regard to initial management and follow up.
Method A search of patients who had had endoscopic removal of a high-grade adenoma was carried out. Patients with the following were excluded: follow up of < 1 year, polyposis syndromes, prior colon cancer and a diagnosis of adenocarcinoma within 6 months following initial diagnosis.
Results Eighty-three patients treated between 1999 and 2007 for high-grade dysplasia (HGD) in a colorectal adenoma were identified. Over a median follow-up period of 4 years, 53 (64%) developed further adenomatous polyps. Among these, 7% had an adenoma with HGD or an adenocarcinoma. In all these patients, the initial high-grade adenoma was > 1 cm in diameter. Initial follow-up colonoscopy was performed on average 7 months following the initial diagnosis. Ten per cent of patients underwent prophylactic segmental resection, and 6% received argon laser therapy.
Conclusion The study demonstrates that patients who have a colorectal adenoma > 1 cm with HGD may be at high risk of developing further adenomas with HGD or carcinoma. Close follow up is warranted.