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Gastrointestinal pathologist consensus of revised high-grade dysplasia in inflammatory bowel disease impacts the advanced neoplasia rate: a multicenter study: A multicenter study

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Title: Gastrointestinal pathologist consensus of revised high-grade dysplasia in inflammatory bowel disease impacts the advanced neoplasia rate: a multicenter study: A multicenter study
Authors: Groen, M. te, Derks, M.E.W., Nagtegaal, I.D., Peters, C.P., Vries, A.C.H. de, Dijkstra, G., Romkens, T.E., Horjus, C.S., Boer, N.K. de, Jong, Michiel E. de, Ruijven, B. van, Hoentjen, F., Vos, S., Derikx, L.A.A.P.
Source: European Journal of Gastroenterology & Hepatology, 37, 3, pp. 287-294
Publisher Information: Ovid Technologies (Wolters Kluwer Health), 2025.
Publication Year: 2025
Subject Terms: Male, Adult, recurrence, Consensus, Databases, Factual, Netherlands/epidemiology, Crohn, Neoplasms, Multiple Primary, Crohn Disease/pathology, SDG 3 - Good Health and Well-being, Crohn Disease, Risk Factors, Predictive Value of Tests, Neoplasms, Precancerous Conditions/pathology, Humans, Retrospective Studies, Netherlands, Aged, Colorectal Neoplasms/pathology, treatment, Incidence, Pathology - Radboud University Medical Center, Neoplasms, Second Primary, Middle Aged, Colitis, Inflammatory Bowel Diseases, Pathologists, Second Primary/pathology, Multiple Primary/pathology, Ulcerative/pathology, Inflammatory Bowel Diseases/pathology, Female, Colitis, Ulcerative, Gastroenterology - Radboud University Medical Center, Neoplasm Grading, Colorectal Neoplasms
Description: Objective The diagnosis of inflammatory bowel disease (IBD) associated with high-grade dysplasia (HGD) has a significant impact on clinical management, including colectomy. However, the prognosis of HGD remains unclear due to diagnostic uncertainty and low-quality data on subsequent synchronous and metachronous neoplasia. We aimed to evaluate a diagnostic strategy with dedicated gastrointestinal (GI) pathologist consensus of revised HGD and the impact on synchronous and metachronous neoplasia rates. Methods In this retrospective multicenter cohort study, we used the Dutch Nationwide Pathology Databank to identify IBD patients with HGD in seven hospitals. Histopathological specimens of the initial HGD were independently revised by two dedicated GI pathologists. Definitive diagnosis was established in a consensus meeting. Synchronous and metachronous neoplasia incidences were assessed with a competing risk analysis. Results We included 54 IBD patients with HGD, of whom 33 (61.1%) with ulcerative colitis and 42 (77.8%) with extensive disease. After consensus, 18 (33.3%) lesions were downgraded to indefinite/low-grade dysplasia, and 6 (11.1%) were revised to colorectal cancer (CRC). Seven patients (13.0%) had synchronous CRC. Patients with downgraded lesions showed a lower cumulative advanced neoplasia (HGD/CRC) incidence compared with confirmed HGD [(Gray’s test P Conclusions We demonstrated frequent downgrading of HGD, associated with lower metachronous neoplasia rates. This underlines the potential impact of dedicated GI pathologist consensus meetings. The high and synchronous and metachronous neoplasia rates after HGD underline the need for close surveillance.
Document Type: Article
Language: English
ISSN: 1473-5687
DOI: 10.1097/meg.0000000000002897
Access URL: https://pubmed.ncbi.nlm.nih.gov/39919003
https://hdl.handle.net/https://repository.ubn.ru.nl/handle/2066/316374
https://doi.org/10.1097/MEG.0000000000002897
https://pure.eur.nl/en/publications/84897dfb-dd71-4946-9c8f-699b05769dd9
https://doi.org/10.1097/MEG.0000000000002897
https://hdl.handle.net/11370/9e45bf28-cab3-440f-89d6-a181732dc2ab
https://research.rug.nl/en/publications/9e45bf28-cab3-440f-89d6-a181732dc2ab
https://doi.org/10.1097/MEG.0000000000002897
https://pure.amsterdamumc.nl/en/publications/8e71952e-fa59-4c36-9e2c-51f0ff7ed863
https://doi.org/10.1097/MEG.0000000000002897
https://repository.ubn.ru.nl//bitstream/handle/2066/316374/316374.pdf
https://hdl.handle.net/2066/316374
Rights: taverne
Accession Number: edsair.doi.dedup.....15316dbaa30e236e8d821aa502506cfc
Database: OpenAIRE
Description
Abstract:Objective The diagnosis of inflammatory bowel disease (IBD) associated with high-grade dysplasia (HGD) has a significant impact on clinical management, including colectomy. However, the prognosis of HGD remains unclear due to diagnostic uncertainty and low-quality data on subsequent synchronous and metachronous neoplasia. We aimed to evaluate a diagnostic strategy with dedicated gastrointestinal (GI) pathologist consensus of revised HGD and the impact on synchronous and metachronous neoplasia rates. Methods In this retrospective multicenter cohort study, we used the Dutch Nationwide Pathology Databank to identify IBD patients with HGD in seven hospitals. Histopathological specimens of the initial HGD were independently revised by two dedicated GI pathologists. Definitive diagnosis was established in a consensus meeting. Synchronous and metachronous neoplasia incidences were assessed with a competing risk analysis. Results We included 54 IBD patients with HGD, of whom 33 (61.1%) with ulcerative colitis and 42 (77.8%) with extensive disease. After consensus, 18 (33.3%) lesions were downgraded to indefinite/low-grade dysplasia, and 6 (11.1%) were revised to colorectal cancer (CRC). Seven patients (13.0%) had synchronous CRC. Patients with downgraded lesions showed a lower cumulative advanced neoplasia (HGD/CRC) incidence compared with confirmed HGD [(Gray’s test P Conclusions We demonstrated frequent downgrading of HGD, associated with lower metachronous neoplasia rates. This underlines the potential impact of dedicated GI pathologist consensus meetings. The high and synchronous and metachronous neoplasia rates after HGD underline the need for close surveillance.
ISSN:14735687
DOI:10.1097/meg.0000000000002897