Rosenstock E, Farmer R G, Petras R, Sivak M V, Rankin G B, Sullivan B H
Gastroenterology. 1985 Dec;89(6):1342-6. doi: 10.1016/0016-5085(85)90653-5.
To evaluate the efficacy of surveillance colonoscopy with biopsy for the detection of high-grade dysplasia (HGD) or colonic carcinoma in patients with chronic ulcerative colitis, we undertook a retrospective review of 248 patients who underwent 370 examinations (mean duration of disease 12 yr). High-grade dysplasia or carcinoma was found in 24 examinations in 16 patients, with a mean duration of disease of 16 yr. There were 15 patients with HGD. Nine patients had HGD alone, 6 had HGD and carcinoma, and 1 had carcinoma without HGD. The overall incidence of HGD was 6%. Dysplasia-associated lesions or mass were the most consistent indicators of carcinoma, the combination being present in four instances. Of the 7 patients with cancer, 6 were recognized by colonoscopy, and 1 patient with negative visual endoscopic findings was discovered using surveillance biopsies. The conclusions of this study are that dysplasia is a reliable histopathologic marker and correlates with the presence of cancer in chronic ulcerative colitis; the absence of dysplasia correlates with the absence of cancer. The presence of dysplasia-associated lesions or mass with HGD is the strongest indication for operation. This study supports the use of surveillance colonoscopy in managing high-risk ulcerative colitis patients.
为评估监测性结肠镜检查及活检在检测慢性溃疡性结肠炎患者高级别上皮内瘤变（HGD）或结肠癌方面的疗效，我们对248例患者进行了370次检查（疾病平均病程12年）的回顾性研究。16例患者的24次检查中发现了高级别上皮内瘤变或癌，疾病平均病程为16年。有15例患者存在高级别上皮内瘤变。9例患者仅患有高级别上皮内瘤变，6例患者同时患有高级别上皮内瘤变和癌，1例患者患有癌但无高级别上皮内瘤变。高级别上皮内瘤变的总体发生率为6%。发育异常相关病变或肿物是癌最一致的指标，这种情况在4例中出现。7例癌症患者中，6例通过结肠镜检查被识别，1例内镜检查肉眼结果为阴性的患者通过监测活检被发现。本研究的结论是，上皮内瘤变是一种可靠的组织病理学标志物，与慢性溃疡性结肠炎中的癌症存在相关；无上皮内瘤变与无癌症相关。伴有高级别上皮内瘤变的发育异常相关病变或肿物的存在是手术的最强指征。本研究支持在管理高危溃疡性结肠炎患者中使用监测性结肠镜检查。
