Assessment of peri-polyp biopsy specimens of flat mucosa in patients with inflammatory bowel disease

Noa Krugliak Cleveland, Dezheng Huo, Farah Sadiq, Mark (Anthony) Sofia, Julia Marks, Russell D. Cohen, Stephen B. Hanauer, Jerrold Turner, John Hart, David T. Rubin

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background and Aims: When colon polyps are removed in the setting of inflammatory bowel disease (IBD) involving the large intestine, biopsy sampling of the flat mucosa surrounding such polyps have been recommended, but there are no data to support this practice. Methods: We reviewed endoscopic and pathologic findings in IBD patients who had dysplastic polyps removed and biopsy sampling of the adjacent flat mucosa. We assessed risk for subsequent neoplasia based on the presence or absence of dysplasia in the peri-polyp flat mucosa and based on number and grade of index polypoid lesions. Kaplan-Meier survival analysis was performed. Results: Fifty-six IBD patients (68% ulcerative colitis [UC]) underwent 102 colonoscopies, in which 129 dysplastic polyps were resected. Five hundred three biopsy procedures of the surrounding flat mucosa were performed (mean, 3.9 biopsy samples per polyp), of which 16 (3.2%) were dysplastic. Thirty-four patients (21 UC) had follow-up in a median of 1.7 years (range,.02-15) and 147 colonoscopies. The presence of dysplasia in peri-polyp biopsy specimens during index colonoscopy was not associated with risk of developing high-grade dysplasia (HGD) or cancer (Pearson χ2 test =.19). The size and number of dysplastic polyps were not predictive of neoplastic outcomes, but the probability of developing subsequent advanced neoplasia for polypoid low-grade dysplasia was 18%, 29%, and 40% by 1, 3, and 5 years, respectively, and for polypoid HGD was 50%, 60%, and 70% by 1, 3, and 5 years, respectively (hazard ratio, 7.0; standard error, 4.8). Conclusions: In patients with IBD-associated colitis, biopsy sampling of the mucosa adjacent to discrete dysplastic polypoid lesions are low yield and do not predict findings in follow-up examinations. However, the grade of dysplasia of the polyp itself is predictive of subsequent advanced neoplasia.

Original languageEnglish (US)
Pages (from-to)1304-1309
Number of pages6
JournalGastrointestinal endoscopy
Volume87
Issue number5
DOIs
StatePublished - May 1 2018
Externally publishedYes

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Polyps
Inflammatory Bowel Diseases
Mucous Membrane
Biopsy
Colonoscopy
Ulcerative Colitis
Neoplasms
Large Intestine
Kaplan-Meier Estimate
Colitis
Survival Analysis
Colon

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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Assessment of peri-polyp biopsy specimens of flat mucosa in patients with inflammatory bowel disease. / Krugliak Cleveland, Noa; Huo, Dezheng; Sadiq, Farah; Sofia, Mark (Anthony); Marks, Julia; Cohen, Russell D.; Hanauer, Stephen B.; Turner, Jerrold; Hart, John; Rubin, David T.

In: Gastrointestinal endoscopy, Vol. 87, No. 5, 01.05.2018, p. 1304-1309.

Research output: Contribution to journalArticle

Krugliak Cleveland, N, Huo, D, Sadiq, F, Sofia, MA, Marks, J, Cohen, RD, Hanauer, SB, Turner, J, Hart, J & Rubin, DT 2018, 'Assessment of peri-polyp biopsy specimens of flat mucosa in patients with inflammatory bowel disease', Gastrointestinal endoscopy, vol. 87, no. 5, pp. 1304-1309. https://doi.org/10.1016/j.gie.2017.12.016
Krugliak Cleveland, Noa ; Huo, Dezheng ; Sadiq, Farah ; Sofia, Mark (Anthony) ; Marks, Julia ; Cohen, Russell D. ; Hanauer, Stephen B. ; Turner, Jerrold ; Hart, John ; Rubin, David T. / Assessment of peri-polyp biopsy specimens of flat mucosa in patients with inflammatory bowel disease. In: Gastrointestinal endoscopy. 2018 ; Vol. 87, No. 5. pp. 1304-1309.
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abstract = "Background and Aims: When colon polyps are removed in the setting of inflammatory bowel disease (IBD) involving the large intestine, biopsy sampling of the flat mucosa surrounding such polyps have been recommended, but there are no data to support this practice. Methods: We reviewed endoscopic and pathologic findings in IBD patients who had dysplastic polyps removed and biopsy sampling of the adjacent flat mucosa. We assessed risk for subsequent neoplasia based on the presence or absence of dysplasia in the peri-polyp flat mucosa and based on number and grade of index polypoid lesions. Kaplan-Meier survival analysis was performed. Results: Fifty-six IBD patients (68{\%} ulcerative colitis [UC]) underwent 102 colonoscopies, in which 129 dysplastic polyps were resected. Five hundred three biopsy procedures of the surrounding flat mucosa were performed (mean, 3.9 biopsy samples per polyp), of which 16 (3.2{\%}) were dysplastic. Thirty-four patients (21 UC) had follow-up in a median of 1.7 years (range,.02-15) and 147 colonoscopies. The presence of dysplasia in peri-polyp biopsy specimens during index colonoscopy was not associated with risk of developing high-grade dysplasia (HGD) or cancer (Pearson χ2 test =.19). The size and number of dysplastic polyps were not predictive of neoplastic outcomes, but the probability of developing subsequent advanced neoplasia for polypoid low-grade dysplasia was 18{\%}, 29{\%}, and 40{\%} by 1, 3, and 5 years, respectively, and for polypoid HGD was 50{\%}, 60{\%}, and 70{\%} by 1, 3, and 5 years, respectively (hazard ratio, 7.0; standard error, 4.8). Conclusions: In patients with IBD-associated colitis, biopsy sampling of the mucosa adjacent to discrete dysplastic polypoid lesions are low yield and do not predict findings in follow-up examinations. However, the grade of dysplasia of the polyp itself is predictive of subsequent advanced neoplasia.",
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AU - Krugliak Cleveland, Noa

AU - Huo, Dezheng

AU - Sadiq, Farah

AU - Sofia, Mark (Anthony)

AU - Marks, Julia

AU - Cohen, Russell D.

AU - Hanauer, Stephen B.

AU - Turner, Jerrold

AU - Hart, John

AU - Rubin, David T.

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N2 - Background and Aims: When colon polyps are removed in the setting of inflammatory bowel disease (IBD) involving the large intestine, biopsy sampling of the flat mucosa surrounding such polyps have been recommended, but there are no data to support this practice. Methods: We reviewed endoscopic and pathologic findings in IBD patients who had dysplastic polyps removed and biopsy sampling of the adjacent flat mucosa. We assessed risk for subsequent neoplasia based on the presence or absence of dysplasia in the peri-polyp flat mucosa and based on number and grade of index polypoid lesions. Kaplan-Meier survival analysis was performed. Results: Fifty-six IBD patients (68% ulcerative colitis [UC]) underwent 102 colonoscopies, in which 129 dysplastic polyps were resected. Five hundred three biopsy procedures of the surrounding flat mucosa were performed (mean, 3.9 biopsy samples per polyp), of which 16 (3.2%) were dysplastic. Thirty-four patients (21 UC) had follow-up in a median of 1.7 years (range,.02-15) and 147 colonoscopies. The presence of dysplasia in peri-polyp biopsy specimens during index colonoscopy was not associated with risk of developing high-grade dysplasia (HGD) or cancer (Pearson χ2 test =.19). The size and number of dysplastic polyps were not predictive of neoplastic outcomes, but the probability of developing subsequent advanced neoplasia for polypoid low-grade dysplasia was 18%, 29%, and 40% by 1, 3, and 5 years, respectively, and for polypoid HGD was 50%, 60%, and 70% by 1, 3, and 5 years, respectively (hazard ratio, 7.0; standard error, 4.8). Conclusions: In patients with IBD-associated colitis, biopsy sampling of the mucosa adjacent to discrete dysplastic polypoid lesions are low yield and do not predict findings in follow-up examinations. However, the grade of dysplasia of the polyp itself is predictive of subsequent advanced neoplasia.

AB - Background and Aims: When colon polyps are removed in the setting of inflammatory bowel disease (IBD) involving the large intestine, biopsy sampling of the flat mucosa surrounding such polyps have been recommended, but there are no data to support this practice. Methods: We reviewed endoscopic and pathologic findings in IBD patients who had dysplastic polyps removed and biopsy sampling of the adjacent flat mucosa. We assessed risk for subsequent neoplasia based on the presence or absence of dysplasia in the peri-polyp flat mucosa and based on number and grade of index polypoid lesions. Kaplan-Meier survival analysis was performed. Results: Fifty-six IBD patients (68% ulcerative colitis [UC]) underwent 102 colonoscopies, in which 129 dysplastic polyps were resected. Five hundred three biopsy procedures of the surrounding flat mucosa were performed (mean, 3.9 biopsy samples per polyp), of which 16 (3.2%) were dysplastic. Thirty-four patients (21 UC) had follow-up in a median of 1.7 years (range,.02-15) and 147 colonoscopies. The presence of dysplasia in peri-polyp biopsy specimens during index colonoscopy was not associated with risk of developing high-grade dysplasia (HGD) or cancer (Pearson χ2 test =.19). The size and number of dysplastic polyps were not predictive of neoplastic outcomes, but the probability of developing subsequent advanced neoplasia for polypoid low-grade dysplasia was 18%, 29%, and 40% by 1, 3, and 5 years, respectively, and for polypoid HGD was 50%, 60%, and 70% by 1, 3, and 5 years, respectively (hazard ratio, 7.0; standard error, 4.8). Conclusions: In patients with IBD-associated colitis, biopsy sampling of the mucosa adjacent to discrete dysplastic polypoid lesions are low yield and do not predict findings in follow-up examinations. However, the grade of dysplasia of the polyp itself is predictive of subsequent advanced neoplasia.

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