Department of Pathology, University of California at San Francisco, San Francisco, CA, USA.
Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Histopathology. 2022 Aug;81(2):183-191. doi: 10.1111/his.14673. Epub 2022 May 10.
It remains controversial as to whether targeted biopsies should completely replace random biopsies for dysplasia surveillance in patients with inflammatory bowel disease (IBD). Several histologic patterns of nonconventional dysplasia have been described in IBD. This study aimed to investigate the rate and clinicopathologic features of dysplastic lesions found in total colectomy or proctocolectomy specimens that were undetected on prior colonoscopy.
The study analyzed 207 consecutive IBD patients who underwent a total colectomy or proctocolectomy and had at least one high-definition colonoscopy prior to colectomy. Dysplasia found in the colectomy specimens was classified as undetected, only when there was no corresponding site of dysplasia detected on previous colonoscopic biopsies. Twenty-seven (13%) patients had 49 undetected dysplastic lesions found only at colectomy, while 22 (11%) had 31 previously detected dysplastic lesions only. The remaining 158 (76%) patients had no dysplasia. A greater proportion of the undetected (19%) or previously detected (23%) dysplasia group had concurrent primary sclerosing cholangitis compared with only 3% in the group without dysplasia (P < 0.001). The undetected dysplastic lesions were more likely to have nonconventional dysplastic features (76%), low-grade dysplasia (94%), and a flat/invisible gross appearance (73%) compared with the previously detected dysplastic lesions (13%, 68%, and 48%, respectively) (P < 0.05). Almost all patients with undetected dysplasia (93%) had a colonoscopy within 1 year of colectomy.
The rate of undetected dysplasia is not insignificant (13%), suggesting that increased random biopsies may improve the rate of dysplasia detection, including nonconventional dysplasia.
对于炎症性肠病（IBD）患者的异型增生监测，靶向活检是否应完全替代随机活检仍存在争议。IBD 中已经描述了几种非典型异型增生的组织学模式。本研究旨在调查在先前结肠镜检查未发现的全结肠切除或结肠直肠切除标本中发现的异型增生病变的发生率和临床病理特征。
本研究分析了 207 例连续的 IBD 患者，这些患者在全结肠切除或结肠直肠切除前行至少一次高清结肠镜检查。在结肠切除标本中发现的异型增生被分类为未检出，只有在先前结肠镜活检中未发现相应的异型增生部位时才如此。27 例（13%）患者的 49 个未检出的异型增生病变仅在结肠切除时发现，而 22 例（11%）患者的 31 个先前检出的异型增生病变仅在结肠切除时发现。其余 158 例（76%）患者无异型增生。未检出（19%）或先前检出（23%）异型增生组中更可能同时存在原发性硬化性胆管炎，而无异型增生组中仅为 3%（P < 0.001）。与先前检出的异型增生病变相比，未检出的异型增生病变更可能具有非典型异型增生特征（76%）、低级别异型增生（94%）和扁平/不可见大体外观（73%）（分别为 13%、68%和 48%）（P < 0.05）。几乎所有未检出异型增生的患者（93%）在结肠切除后 1 年内都进行了结肠镜检查。
未检出异型增生的发生率并不低（13%），这表明增加随机活检可能会提高异型增生的检出率，包括非典型异型增生。
