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Endoscopic and pathological aspects of colitis-associated dysplasia

Abstract

The risk of developing colorectal cancer in patients with colitis-associated dysplasia is considerable. Surveillance programs in patients with ulcerative colitis and Crohn's disease aim to detect dysplastic lesions early and rely heavily on taking random biopsy samples along the length of the colon. Diagnosing dysplasia can be difficult because of the heterogenous endoscopic appearance of dysplasia and the poor interobserver agreement among pathologists when grading dysplasia. Colitis-associated dysplasia may present as a dysplasia-associated lesion or mass (DALM), which may be indistinguishable from a sporadic adenoma in non-colitic tissue, or may arise in flat mucosa of endoscopically normal appearance. Information about the endoscopic appearance, the colonic distribution and the histopathological grade of colitis-associated dysplasia is required to define the optimal treatment. This Review summarizes the endoscopic and histopathological features of colitis-associated dysplasia and the requirements for optimal interaction between endoscopists and pathologists, with the aim of reducing the uncertainties in the diagnosis of dysplastic lesions and improving the management of colitis-associated dysplasia.

Key Points

  • Identification and classification of colitis-associated dysplasia is still a challenge

  • It is important to distinguish sporadic adenomas that are not associated with inflammation from colitis-associated dysplasia, because the behavior of these lesions and the associated cancer risk differ greatly

  • To improve the accuracy of the histopathological diagnosis of colitis-associated dysplasia, pathologists may benefit from additional clinical and endoscopic information

  • Regular, scheduled meetings between pathologists and endoscopists to discuss difficult cases may be useful to help reach an unequivocal diagnosis of colitis-associated dysplasia

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Figure 1: Endoscopy image showing a nonadenoma-like dysplasia-associated lesion or mass.
Figure 2: Histopathology of high-grade dysplasia.
Figure 3: Algorithm for the management of colitis-associated dysplasia.
Figure 4: Histopathology of indefinite or low-grade dysplasia.

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van Schaik, F., Offerhaus, G., Schipper, M. et al. Endoscopic and pathological aspects of colitis-associated dysplasia. Nat Rev Gastroenterol Hepatol 6, 671–678 (2009). https://doi.org/10.1038/nrgastro.2009.162

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