Subscribe to RSS
DOI: 10.1055/a-2204-8166
Measuring the concordance between endoscopic and histologic inflammation and its effect on IBD-associated dysplasia
This support was made possible by the Mayo Clinic.Abstract
Background and study aims Chronically inflamed colonic mucosa is primed to develop dysplasia identified at surveillance colonoscopy by targeted or random biopsies. We aimed to explore the effect of mucosal inflammation on detection of visible and “invisible” dysplasia and the concordance between the degree of endoscopic and histologic inflammation.
Patients and methods This was a 6-year cross-sectional analysis of endoscopic and histologic data from IBD. A multinomial model was created to estimate the odds for a specific lesion type as well as the odds of random dysplasia relative to the degree of inflammation. Kappa statistics were used to measure concordance between endoscopic and histologic inflammation.
Results A total of 3437 IBD surveillance colonoscopies between 2016–2021 were reviewed with 970 procedures from 721 patients containing 1603 visible lesions. Kappa agreement between histologic and endoscopic degree of inflammation was low at 0.4. There was a positive association between increased endoscopic inflammation and presence of tubulovillous adenomas (TVAs) (odds ratio [OR] 2.18; 95% confidence interval [CI] 1.03–4.62; P=0.04). Among cases with visible lesions, the yield of concomitant random dysplasia was 2.7% and 1.9% for random indefinite dysplasia. The odds of random dysplasia significantly increased as the degree of endoscopic and histologic inflammation increased (OR 2.18, 95%CI 1.46–3.26; P<0.001 and OR 2.75; 95%CI 1.65–4.57, P<0.001, respectively. The odds of indefinite random dysplasia also significantly increased as endoscopic and histologic inflammation increased (OR 2.90; 95%CI 1.85, 4.55, P<0.001 and OR 1.98; 95%CI 1.08, 3.62, P<0.035, respectively.
Conclusions Endoscopic and histologic inflammation are associated with higher odds of finding TVAs and random low-grade, high-grade, and indefinite dysplasia. Concordance between histologic and endoscopic inflammation severity is low.
Keywords
Inflammatory bowel disease - Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE...)Publication History
Received: 15 May 2023
Accepted after revision: 25 October 2023
Accepted Manuscript online:
06 November 2023
Article published online:
30 January 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Beaugerie L, Itzkowitz SH. Cancers complicating inflammatory bowel disease. N Engl J Med 2015; 372: 1441-1452
- 2 Alkhayyat M, Abureesh M, Gill A. et al. Lower rates of colorectal cancer in patients with inflammatory bowel disease using anti-TNF therapy. Inflamm Bowel Dis 2021; 27: 1052-1060
- 3 Kappelman MD, Farkas DK, Long MD. et al. Risk of cancer in patients with inflammatory bowel diseases: a nationwide population-based cohort study with 30 years of follow-up evaluation. Clin Gastroenterol Hepatol 2014; 12: 265-273.e1
- 4 Laine L, Kaltenbach T, Barkun A. et al. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastroenterology 2015; 148: 639-651.e28
- 5 Lamb CA, Kennedy NA, Raine T. et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut 2019; 68: s1-s106
- 6 Magro F, Gionchetti P, Eliakim R. et al. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders. J Crohns Colitis 2017; 11: 649-670
- 7 Murthy SK, Feuerstein JD, Nguyen GC. et al. AGA Clinical Practice Update on Endoscopic Surveillance and Management of Colorectal Dysplasia in Inflammatory Bowel Diseases: Expert Review. Gastroenterology 2021; 161: 1043-1051.e4
- 8 Rubin DT, Ananthakrishnan AN, Siegel CA. et al. ACG Clinical Guideline: Ulcerative Colitis in Adults. Am J Gastroenterol 2019; 114: 384-413
- 9 Johnson DH, Khanna S, Smyrk TC. et al. Detection rate and outcome of colonic serrated epithelial changes in patients with ulcerative colitis or Crohn's colitis. Aliment Pharmacol Ther 2014; 39: 1408-1417
- 10 Brcic I, Dawson H, Gröchenig HP. et al. Serrated lesions in inflammatory bowel disease: genotype-phenotype correlation. Int J Surg Pathol 2021; 29: 46-53
- 11 Moussata D, Allez M, Cazals-Hatem D. et al. Are random biopsies still useful for the detection of neoplasia in patients with IBD undergoing surveillance colonoscopy with chromoendoscopy?. Gut 2018; 67: 616-624
- 12 Saraiva S, Rosa I, Moleiro J. et al. Dysplasia surveillance in inflammatory bowel disease: a cohort study. GE Port J Gastroenterol 2021; 28: 97-105
- 13 Mooiweer E, van der Meulen-de Jong AE, Ponsioen CY. et al. Chromoendoscopy for surveillance in inflammatory bowel disease does not increase neoplasia detection compared with conventional colonoscopy with random biopsies: results from a large retrospective study. Am J Gastroenterol 2015; 110: 1014-1021
- 14 Azizi S, Al-Rubaye H, Turki MAA. et al. Detecting dysplasia using white light endoscopy or chromoendoscopy in ulcerative colitis patients without primary sclerosing cholangitis: A systematic review and meta-analysis. Int J Surg 2018; 52: 180-188
- 15 Hu AB, Burke KE, Kochar B. et al. Yield of random biopsies during colonoscopies in inflammatory bowel disease patients undergoing dysplasia surveillance. Inflamm Bowel Dis 2021; 27: 779-786
- 16 Navaneethan U, Kochhar G, Venkatesh PG. et al. Random biopsies during surveillance colonoscopy increase dysplasia detection in patients with primary sclerosing cholangitis and ulcerative colitis. J Crohns Colitis 2013; 7: 974-981
- 17 Wan J, Wang X, Zhang Y. et al. Systematic review with meta-analysis: incidence and factors for progression to advanced neoplasia in inflammatory bowel disease patients with indefinite and low-grade dysplasia. Aliment Pharmacol Ther 2022; 55: 632-644
- 18 Watanabe T, Ajioka Y, Mitsuyama K. et al. Comparison of targeted vs random biopsies for surveillance of ulcerative colitis-associated colorectal cancer. Gastroenterology 2016; 151: 1122-1130
- 19 Choi CR, Al I Bakir, Ding NJ. et al. Cumulative burden of inflammation predicts colorectal neoplasia risk in ulcerative colitis: a large single-centre study. Gut 2019; 68: 414-422
- 20 Flores BM, O'Connor A, Moss AC. Impact of mucosal inflammation on risk of colorectal neoplasia in patients with ulcerative colitis: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86: 1006-1011.e8
- 21 Gupta RB, Harpaz N, Itzkowitz S. et al. Histologic inflammation is a risk factor for progression to colorectal neoplasia in ulcerative colitis: a cohort study. Gastroenterology 2007; 133: 1099-1105 quiz 340–341
- 22 Pai RK, Jairath V, Vande Casteele N. et al. The emerging role of histologic disease activity assessment in ulcerative colitis. Gastrointest Endosc 2018; 88: 887-898
- 23 Rutter M, Saunders B, Wilkinson K. et al. Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis. Gastroenterology 2004; 126: 451-459
- 24 Turner D, Ricciuto A, Lewis A. et al. STRIDE-II: An update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) initiative of the International Organization for the Study of IBD (IOIBD): Determining therapeutic goals for treat-to-target strategies in IBD. Gastroenterology 2021; 160: 1570-1583
- 25 Kovach AE, Moulton DE, Plummer WD. et al. Correlation of endoscopic and histologic severity scores in pediatric ulcerative colitis at first presentation. Pediatr Dev Pathol 2019; 22: 106-111
- 26 Lemmens B, Arijs I, Van Assche G. et al. Correlation between the endoscopic and histologic score in assessing the activity of ulcerative colitis. Inflamm Bowel Dis 2013; 19: 1194-1201
- 27 Korelitz BI, Sultan K, Kothari M. et al. Histological healing favors lower risk of colon carcinoma in extensive ulcerative colitis. World J Gastroenterol 2014; 20: 4980-4986
- 28 Eaden JA, Mayberry JF. Guidelines for screening and surveillance of asymptomatic colorectal cancer in patients with inflammatory bowel disease. Gut 2002; 51: V10-V12
- 29 Baars JE, Nuij VJAA, Oldenburg B. et al. Majority of patients with inflammatory bowel disease in clinical remission have mucosal inflammation. inflammatory bowel diseases 2011; 18: 1634-1640
- 30 Rosenberg L, Nanda KS, Zenlea T. et al. Histologic markers of inflammation in patients with ulcerative colitis in clinical remission. Clin Gastroenterol Hepatol 2013; 11: 991-996
- 31 Maeda Y, Kudo SE, Mori Y. et al. Fully automated diagnostic system with artificial intelligence using endocytoscopy to identify the presence of histologic inflammation associated with ulcerative colitis (with video). Gastrointest Endosc 2019; 89: 408-415
- 32 Gui X, Bazarova A, Del Amor R. et al. PICaSSO Histologic Remission Index (PHRI) in ulcerative colitis: development of a novel simplified histological score for monitoring mucosal healing and predicting clinical outcomes and its applicability in an artificial intelligence system. Gut 2022; 71: 889-898
- 33 Mahmoud R, Shah SC, Ten Hove JR. et al. No association between pseudopolyps and colorectal neoplasia in patients with inflammatory bowel diseases. Gastroenterology 2019; 156: 1333-1344.e3
- 34 Parian AM, Lazarev MG. Serrated colorectal lesions in patients with inflammatory bowel disease. Gastroenterol Hepatol (NY) 2018; 14: 19-25