Clinical Outcome after the Diagnosis of Indefinite for Dysplasia in Patients with Idiopathic Inflammatory Bowel Disease
Keith K Lai, Yinghong Wang, Hao Xie, Bo Shen, John R Goldblum, Brian L Lewis, Xiuli Liu. Cleveland Clinic, Cleveland, OH; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
Background: The management of indefinite for dysplasia (IND) in patients with idiopathic inflammatory bowel disease (IBD) is controversial due to a paucity of published outcome data. The aim of this study was to examine the clinical outcome of patients with IBD after a diagnosis of IND from a single institution.
Design: Our surgical pathology database was searched from 1989 to 2004 for IBD, ulcerative colitis, Crohn's disease, colitis, and indefinite for dysplasia. Pathologic reports, clinical features and outcome data were reviewed. Chi square and Fisher's exact test were used for statistical analyses.
Results: A total of 125 IBD patients with a diagnosis of IND on biopsy were identified. Thirty-two patients were excluded due to a prior diagnosis of neoplasia (N = 12) or being lost to followup (N = 20). Twenty-two of the remaining 93 patients (23.7%) had a surgical resection within 6 months of the IND diagnosis; 6 (27.3%) had dysplasia (1 low-grade dysplasia [LGD] and 5 high-grade dysplasia [HGD]) in their colectomy specimens. The remaining 71 patients were followed with colonoscopy for a mean duration of 98.6 (SD: 65.0; range: 1.7 – 250.5) months; 17 patients (23.9%) developed dysplasia or carcinoma (10 LGD, 5 HGD, and 2 colorectal cancer [CRC]) with a mean interval period of 53.9 (SD: 36.9) months between IND and dysplasia or carcinoma diagnoses. Those who progressed were older than non-progressors (p=0.0063) (Table 1). Also, a diagnosis of IND made by a gastrointestinal (GI) pathologist was more than twice as likely to progress than one made by a non-GI pathologist (34.3% vs. 13.9%; p=0.044).
|IND progressor (n=17)||IND non-progressor (n=54)||p value|
|Worst neoplasia* (LGD/HGD/CRC)||10/5/2||0/0/0||N/A**|
|Age, mean (SD), yrs||54.4 (12.6)||44.1 (13.3)||0.0063|
|Extent of colitis (pan-/left-/rectum/others)||9/5/2/1||24/15/13/2||0.112|
|GI pathologist/non-GI pathologist||12/5||23/31||0.044|