Clinical-alimentary tractProgression of flat low-grade dysplasia to advanced neoplasia in patients with ulcerative colitis☆
Section snippets
LGD identification
With approval from the Mount Sinai School of Medicine Institutional Review Board, we queried the Mount Sinai Gastrointestinal Pathology database from January 1994 through December 2001 to identify all patients with coexisting diagnoses of LGD and UC. A single gastrointestinal pathologist (N.H.) determined the diagnosis of LGD by using the criteria of the IBD Morphology Study Group.23 Only specimens that were interpreted as definite LGD on the pathology report were included. A biopsy specimen
Cohort identification and patient characteristics
One hundred seventy-one UC patients with LGD were identified. Of these, 37 cases either had been referred for review from extramural sources or had inaccessible medical records, leaving 134 cases for review. Eighty-eight patients were subsequently excluded from the analysis after medical record review showed ≥1 of the following features: LGD outside an area of colitis, polypoid LGD or advanced neoplasia at or before the initial fLGD, lack of endoscopic or surgical follow-up after inclusion,
Discussion
These results show that in our patient population, fLGD found during a surveillance colonoscopy is a powerful predictor of advanced neoplasia. Unexpected advanced neoplasia (2 cancers and 2 HGD) occurred in 4 of the 17 patients who underwent colectomy for fLGD alone. In none of these instances had there been evidence of progression beyond LGD during colonoscopic surveillance. Therefore, when a surveillance examination showed fLGD, the point estimate for progression at colectomy was 24% (4 of
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Supported by grants from the Crohn’s and Colitis Foundation of America (to T.U.), the American Society for Gastrointestinal Endoscopy (to T.U.), and the Burrill B. Crohn Research Foundation.