Misclassification of dysplasia in patients with inflammatory bowel disease: Consequences for progression rates to advanced neoplasia

Background: The natural behavior of flat low‐grade (LGD) and indefinite dysplasia (IND) in patients with inflammatory bowel disease (IBD) remains uncertain and seems to be dependent on the interpretation of the pathologist. We studied the progression rate of flat LGD and IND to advanced neoplasia (h...

Full description

Saved in:
Bibliographic Details
Published in:Inflammatory bowel diseases 2011-05, Vol.17 (5), p.1108-1116
Main Authors: van Schaik, Fiona D.M., ten Kate, Fiebo J.W., Offerhaus, G. Johan A., Schipper, Marguerite E.I., Vleggaar, Frank P., van der Woude, C. Janneke, Stokkers, Pieter C.F., de Jong, Dirk J., Hommes, Daan W., van Bodegraven, Ad A., Siersema, Peter D., Oldenburg, Bas
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Child
Colitis, Ulcerative - classification
Colitis, Ulcerative - epidemiology
Colitis, Ulcerative - pathology
Colorectal cancer
Colorectal Neoplasms - epidemiology
Colorectal Neoplasms - pathology
Crohn Disease - classification
Crohn Disease - epidemiology
Crohn Disease - pathology
Databases, Factual
Disease Progression
Dysplasia
Female
Humans
Inflammatory bowel diseases
Intestine
Kaplan-Meier Estimate
Key Words: inflammatory bowel disease, dysplasia, colorectal cancer
Male
Middle Aged
Neoplasia
Precancerous Conditions - classification
Precancerous Conditions - epidemiology
Precancerous Conditions - pathology
Risk Factors
Young Adult
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background: The natural behavior of flat low‐grade (LGD) and indefinite dysplasia (IND) in patients with inflammatory bowel disease (IBD) remains uncertain and seems to be dependent on the interpretation of the pathologist. We studied the progression rate of flat LGD and IND to advanced neoplasia (high‐grade dysplasia [HGD] or colorectal cancer [CRC]) before and after histopathological review by a panel of gastrointestinal expert pathologists. Methods: A nationwide pathology database was used to identify IBD patients with dysplasia in six Dutch university medical centers between 1990 and 2006. Medical charts of patients with recorded flat LGD or IND were reviewed. Histological slides from three university medical centers were reviewed by a panel of three expert gastrointestinal pathologists. Results: We identified 113 flat LGD patients and 26 flat IND patients. Advanced neoplasia was found in 18 flat LGD patients (16%) after a median follow‐up of 48 months, resulting in a 5‐year progression rate of 12%. Five IND patients (19%) developed advanced neoplasia after a median follow‐up of 24 months, resulting in a 5‐year progression rate of 21%. Review of 1547 histological slides from 87 patients resulted in an increase of the 5‐year progression rate of flat LGD to advanced neoplasia to 37%, whereas the progression rate of IND decreased to 5%. Conclusions: A diagnosis of flat LGD that is confirmed by a panel of expert gastrointestinal pathologists is associated with a substantial risk of progression to advanced neoplasia, while confirmed IND is associated with a low risk of progression. (Inflamm Bowel Dis 2010;)
ISSN:1078-0998
1536-4844
1536-4844
DOI:10.1002/ibd.21467