Ten year follow up of ulcerative colitis patients with and without low grade dysplasia

Ulcerative colitis and cancer

“…Furthermore, reactive epithelial changes in response to inflammation mimic LGD; thus, causing inter-pathologist variation and diagnosis of LGD which is not always reproducible. Although one pathologist diagnosed LGD in 80% of original dysplasia cases, a majority of pathologists agreed on the diagnosis in only 38% of cases [66].…”

“…Despite surveillance for dysplasia, CC is not an uncommon occurrence because of poor patient compliance, inadequate referral, development of cancer before initiation of surveillance, sampling errors, incorrect pathological assessment, inter-observer variability in the diagnosis of dysplasia, and lack of consensus regarding the value of dysplasia, and true absence of dysplasia [24,48,63,65]. Agreement among pathologists for IDD or LGD is low, 50-65% [41,63,66]. About 25% of CC occurs without detectable dysplasia distant to the tumor [14,41,47,48,50,64].…”

“…DALM is also a maker of increased cancer risk since cancer is found in 58-63% of patients with DALM [31,32]. The presence of HGD in flat or raised mucosa and any dysplasia with DALM is an indication for PC because of the high rate of synchronous CRC and progression to cancer [31,39,43,59,66]. The management of patients with fLGD varies from repeat colonoscopy to PC or watch and see.…”

“…Some studies have found lower progression rate of LGD [36,44,59,66]. Lynch et al [36] identified only 2.5% of patients with LGD who went on to develop cancer.…”

“…Befrits et al [59] in a study of patients with extensive longstanding colitis who were found to have fLGD on index colonoscopy, found LGD on subsequent colonoscopy in 73% of cases but none progressed to HGD except in two patients with DALM during a 10-year follow-up period. Lim et al [66] in a retrospective cohort study of patients still alive with an intact colon who had LGD, HGD, or cancer developed 10% versus 4% in patients with no LGD after 10-year follow-up. The authors noted that the diagnosis of LGD could not be relied on because of poor agreement between pathologists.…”