Ulcerative colitis is a risk factor for colorectal cancer. However, there is no consensus on the optimal management of patients with low-grade dysplasia in flat mucosa.
In this study, physicians from New York determined the frequency that flat low-grade dysplasia progresses to advanced neoplasia in ulcerative colitis patients. They also assessed whether any specific variables could predict this progression.
The team evaluated 46 patients with ulcerative colitis who had flat low-grade dysplasia diagnosed on colonoscopy. They reviewed the medical histories, colonoscopic findings, and surgical and pathology reports of these patients.
The physicians were able to correlated progression to advanced neoplasia with several clinical and colonoscopic variables. These included the number of biopsy samples positive for flat low-grade dysplasia, the duration and anatomic extent of disease, patient age, and medication use.
The team found 7 cases of colorectal cancer. Of these, 5 were stage II or higher.
|Advanced neoplasia occurred in 24% of patients.|
Advanced neoplasia occurred in 24% of patients who underwent colectomy for flat low-grade dysplasia.
The physicians determined that the actuarial rate of neoplastic progression was 53% at 5 years.
The team did not identify any clinical features predicting progression.
They found that cancers developed despite frequent follow-up surveillance examinations.
Dr Thomas Ullman's team concluded, "A finding of flat low-grade dysplasia during ulcerative colitis surveillance is a strong predictor of progression to advanced neoplasia".
"Early colectomy should be recommended for such patients".