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Dysplasia complicating chronic ulcerative colitis: is immediate colectomy warranted?
S R Gorfine1, J J Bauer, M T Harris
1The Mount Sinai Medical Center, New York, New York, USA.
Diseases of the Colon and Rectum
|November 23, 2000
Summary
Dysplasia in chronic ulcerative colitis is an unreliable cancer marker, but its presence indicates a high risk of synchronous carcinoma. Colectomy is recommended for any grade of dysplasia due to potential advanced cancer.
Area of Science:
- Gastroenterology
- Oncology
- Colorectal Surgery
Background:
- Inflammatory bowel disease surveillance aims to detect colonic carcinoma risk.
- Colonoscopic detection of mucosal dysplasia is a key surveillance tool.
- The utility of dysplasia as a cancer marker and management post-detection remain debated.
Purpose of the Study:
- To determine the association between dysplasia grade and cancer in chronic ulcerative colitis patients.
- To ascertain the sensitivity, specificity, and positive predictive value of dysplasia as a cancer marker.
- To clarify management strategies upon dysplasia discovery.
Main Methods:
- Review of pathology reports for 590 patients undergoing proctocolectomy for chronic ulcerative colitis.
- Analysis of dysplasia grade, carcinoma presence, and tumor stage.
- Review of colonoscopic findings from 160 patients within one year prior to surgery.
Main Results:
- Dysplasia found in 13.1% of specimens; carcinoma in 6.4%.
- Dysplastic specimens were 36 times more likely to harbor invasive carcinoma (P < 0.001).
- Colonoscopic surveillance had 81% sensitivity and 79% specificity for synchronous cancer; positive predictive value for any dysplasia was 50%.
Conclusions:
- Dysplasia is an unreliable marker for synchronous carcinoma detection.
- Any grade of dysplasia at colonoscopy indicates a high probability of coexistent carcinoma.
- Confirmed dysplasia of any grade warrants colectomy due to the risk of advanced cancer.