Dysplasia in Ulcerative Colitis as a Predictor of Unsuspected Synchronous Colorectal Cancer

Murphy, Jamie; Kalkbrenner, Kristen A; Pembérton, John H.; Landmann, Ron G.; Heppell, Jacques; Young‐Fadok, Tonia M.; Etzioni, David A.

doi:10.1097/dcr.0000000000000172

Cited by 25 publications

(23 citation statements)

References 23 publications

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“…7, 21, 22, 28, 31-37 Overall, findings at time of surgery were: no dysplasia, 37% (95% CI, 29-47; 197/450; I 2 =42%), LGD, 34% (95% CI, 30-39; 153/450; I 2 =0%) or advanced neoplasia, 30% (95% CI, 21-41; 97/450; I 2 =59%).…”

Section: Resultsmentioning

confidence: 99%

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Incidence, Risk Factors, and Outcomes of Colorectal Cancer in Patients With Ulcerative Colitis With Low-Grade Dysplasia: A Systematic Review and Meta-analysis

Fuméry

Dulai

Gupta

et al. 2017

Clinical Gastroenterology and Hepatology

135

111

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Background & Aims Little is known about outcomes of patients with ulcerative colitis with low-grade dysplasia (UC-LGD). We estimated the incidence of and risk factors for progression to colorectal cancer (CRC) in cohorts of patients with UC-LGD who underwent surveillance (surveillance cohort), and the prevalence of dysplasia-related findings among patients who underwent colectomy for UC-LGD (surgical cohort). Methods We performed a systematic literature review through June 1, 2016 to identify cohort studies of adults with UC-LGD. We estimated pooled incidence rates of CRC and risk factors associated with dysplasia progression in surveillance cohorts, and prevalence of synchronous advanced neoplasia (CRC and/or high-grade dysplasia) in surgical cohorts. Results In 14 surveillance cohort studies of 671 patients with UC-LGD (52 developed CRC), the pooled annual incidence of CRC was 0.8% (95% CI, 0.4–1.3); the pooled annual incidence of advanced neoplasia was 1.8% (95% CI, 0.9–2.7). Risk of CRC was higher when LGD was diagnosed by expert gastrointestinal pathologist (1.5%) than by community pathologists (0.2%). Factors significantly associated with dysplasia progression were concomitant primary sclerosing cholangitis (OR, 3.4; 95% CI, 1.5–7.8), invisible dysplasia (vs visible dysplasia; OR, 1.9; 95% CI, 1.0–3.4), distal location (vs proximal location; OR, 2.0; 95% CI, 1.1–3.7) and multifocal dysplasia (vs unifocal dysplasia; OR, 3.5; 95% CI, 1.5– 8.5). In 12 surgical cohort studies of 450 patients who underwent colectomy for UC-LGD, 34 patients had synchronous CRC (pooled prevalence, 17%; 95% CI, 8–33). Conclusion In a systematic review of the literature, we found that among patients with UC-LGD under surveillance, the annual incidence of progression to CRC was 0.8%; differences in rates of LGD diagnosis varied with pathologists' level of expertise. Concomitant primary sclerosing cholangitis, invisible dysplasia, distal location, and multifocal LGD are high-risk features associated with dysplasia progression.

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Section: Resultsmentioning

confidence: 99%

“…21-23,27-31 Among these, 11 patients underwent surgery with curative intent. Overall, two patients died during follow-up, both related to CRC – one patient died due to metastatic CRC, and another following recurrence of CRC after initial curative surgery.…”

Section: Resultsmentioning

confidence: 99%

Incidence, Risk Factors, and Outcomes of Colorectal Cancer in Patients With Ulcerative Colitis With Low-Grade Dysplasia: A Systematic Review and Meta-analysis

Fuméry

Dulai

Gupta

et al. 2017

Clinical Gastroenterology and Hepatology

135

111

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“…Two cohort studies and one case series reported on the rates of prevalent cancer found in the surgical colectomy specimen resected soon after a pre‐operative diagnosis of visible HGD where 94% 28 to 100% 29,30 had not been endoscopically resected pre‐operatively. The prevalent cancer rate varied from 0% (n = 0/26), 28 20% (n = 1/5) 30 to 35.8% (n = 34/95) 29 . The studies with the highest prevalent cancer rates only included cases where the dysplasia was located within the extent of inflamed mucosa, rather than proximal to it 29,30 .…”

Section: Resultsmentioning

confidence: 99%

“…Two cohort studies reported prevalent cancer rates after a pre‐operative diagnosis of invisible HGD as 22.2% (n = 8/36) where the dysplasia was specified to be within inflamed mucosa 29 and 3.0% where it was not specified (n = 1/33) 28 . The pooled estimated cancer prevalence rate from all these studies was 11.4% (95% CI: 4.6%‐20.3%).…”

Section: Resultsmentioning

confidence: 99%

Systematic review with meta‐analysis: IBD‐associated colonic dysplasia prognosis in the videoendoscopic era (1990 to present)

Kabir

Fofaria

Arebi

et al. 2020

Aliment Pharmacol Ther

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Background Introduction The prognosis of dysplasia in patients with IBD is largely determined from observational studies from the pre‐videoendoscopic era (pre‐1990s) that does not reflect recent advances in endoscopic imaging and resection. Aims To better understand the risk of synchronous colorectal cancer and metachronous advanced neoplasia (ie high‐grade dysplasia or cancer) associated with dysplasia diagnosed in the videoendoscopic era, and to stratify risk according to a lesion's morphology, endoscopic resection status or whether it was incidentally detected on biopsy of macroscopically normal colonic mucosa (ie invisible). Methods A systematic search of original articles published between 1990 and February 2020 was performed. Eligible studies reported on incidence of advanced neoplasia at follow‐up colectomy or colonoscopy for IBD‐dysplasia patients. Quantitative and qualitative analyses were performed. Results Thirty‐three studies were eligible for qualitative analysis (five for the meta‐analysis). Pooled estimated proportions of incidental synchronous cancers found at colectomy performed for a pre‐operative diagnosis of visible high‐grade dysplasia, invisible high‐grade dysplasia, visible low‐grade dysplasia and invisible low‐grade dysplasia were 13.7% (95% CI 0.0‐54.1), 11.4% (95% CI 4.6‐20.3), 2.7% (95% CI 0.0‐7.1) and 2.4% (95% CI 0.0‐8.5) respectively. The lowest incidences of metachronous advanced neoplasia, for dysplasia not managed with immediate colectomy but followed up with surveillance, tended to be reported by the studies where high definition imaging and/or chromoendoscopy was used and endoscopic resection of visible dysplasia was histologically confirmed. Conclusions The prognosis of IBD‐dysplasia diagnosed in the videoendoscopic era appears to have been improved but the quality of evidence remains low. Larger, prospective studies are needed to guide management. PROSPERO registration no: CRD42019105736.

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“…As a result, more recent studies report lower progression of LGD and HGD to more advanced dysplasia or neoplasia, likely because of improved endoscopic visualization and resection. 63,64 Improved confidence in dysplasia visualization has resulted in experienced practitioners more frequently opting for endoscopic removal of dysplasia with close follow-up, as opposed to routinely recommending proctocolectomy. While definitive guidelines have not been established, professional societies have released position statements regarding dysplasia management.…”

Section: Dysplasia Managementmentioning

confidence: 99%

Colorectal Cancer in Inflammatory Bowel Disease

Stidham

Higgins

2018

Clinics in Colon and Rectal Surgery

221

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Patients with inflammatory bowel disease (IBD) are at significantly increased risk of colorectal cancer (CRC), principally resulting from the pro-neoplastic effects of chronic intestinal inflammation. Epidemiologic studies continue to highlight the increased risk of CRC in IBD. However, the incidence has declined over the past 30 years, attributed to both successful CRC-surveillance programs and improved control of mucosal inflammation. Risk factors that further increase the risk of IBD-related CRC include disease duration, extent and severity, the presence of inflammatory pseudopolyps, coexistent primary sclerosing cholangitis, and a family history of CRC. All major professional societies agree that IBD-CRC surveillance should occur more frequently than in the general population. Yet, guidelines and consensus statements differ on the surveillance schedule and preferred method of surveillance. Improved sensitivity to previously "invisible" flat dysplastic lesions using high definition and chromoendoscopy methods has resulted in many guidelines abandoning requirements for random untargeted biopsies of the colon. While colonic dysplasia remains a worrisome finding, and several clinical scenarios remain best addressed by total proctocolectomy due to concerns of synchronous undetected lesions and the unpredictable tempo of progression to malignancy, better detection techniques have also increased opportunities for endoscopic resection of dysplastic lesions that can be clearly delineated. Finally, the expanding armamentarium of medical options in IBD, including anti-tumor necrosis factor and anti-adhesion biologic therapies, have substantially improved our ability to control severe inflammation and likely reduce the risk of CRC over time.

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Dysplasia in Ulcerative Colitis as a Predictor of Unsuspected Synchronous Colorectal Cancer

Cited by 25 publications

References 23 publications

Incidence, Risk Factors, and Outcomes of Colorectal Cancer in Patients With Ulcerative Colitis With Low-Grade Dysplasia: A Systematic Review and Meta-analysis

Incidence, Risk Factors, and Outcomes of Colorectal Cancer in Patients With Ulcerative Colitis With Low-Grade Dysplasia: A Systematic Review and Meta-analysis

Systematic review with meta‐analysis: IBD‐associated colonic dysplasia prognosis in the videoendoscopic era (1990 to present)

Colorectal Cancer in Inflammatory Bowel Disease

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