Abstract
Background: Early detection of ulcerative colitis-associated neoplasia (UCAN) is often difficult. The aim of this study was to clarify the morphology of initial UCAN. Methods: White-light colonoscopy images obtained within the 2 years before UCAN diagnosis were retrospectively reviewed. The primary endpoint was the frequency of visible or invisible neoplasia on the endoscopic images before UCAN diagnosis. The secondary endpoints were comparisons of (1) visible or invisible neoplasia on initial endoscopic images of early-stage and advanced cancers, (2) the clinical backgrounds of patients in whom neoplasia was visible or invisible on initial endoscopic images, and (3) the clinical backgrounds of patients with distinct and indistinct UCAN borders. Results: Of the 27 UCAN lesions (11 early-stage; 16 advanced-stage), 25.9% (n = 7) were initially visible and 74.1% (n = 20) were invisible. The mean interval between the last surveillance colonoscopy and UCAN diagnosis was 14.5 ± 6.7 months. Of early-stage cancers, 18.2% (n = 2) were visible and 81.8% (n = 9) were invisible. Of advanced-stage cancers, 31.3% (n = 5) were visible and 68.8% (n = 11) were invisible. Invisible lesions were significantly more common in the rectum (p = 0.011) and tended to be more common in patients with inflammation and left-sided colitis (p = 0.084, p = 0.068, respectively). Patients with indistinct UCAN borders were significantly more likely to present with inflammation than those with distinct UCAN borders (p = 0.021). Conclusion: More careful surveillance is needed because rectum lesions and inflammation are difficult to identify as neoplasia even within the 2 years before a UCAN diagnosis.
Highlights
Licensee MDPI, Basel, Switzerland.The frequency of colorectal cancer is significantly higher in patients with ulcerative colitis (UC) than in the general population [1] because of chronic inflammation of the intestinal tract in the former group
We retrospectively reviewed the white-light colonoscopy images obtained from patients before a diagnosis of ulcerative colitis-associated neoplasia (UCAN) and examined the initial UCAN lesions to clarify the clinicopathological features
The following inclusion criteria were applied during the patient selection process: (1) a neoplastic lesion identified by colonoscopy, subsequent surgical resection, and histopathological diagnosis of UCAN at Fukuoka
Summary
The frequency of colorectal cancer is significantly higher in patients with ulcerative colitis (UC) than in the general population [1] because of chronic inflammation of the intestinal tract in the former group. UC and the prolongation of disease durations have emphasized the need for surveillance of UC-associated neoplasia (UCAN). Researchers have proposed the dysplasia–carcinoma sequence theory as the mechanism underlying the development of inflammatory bowel. Disease (IBD)-related cancers and have reported the frequent involvement of TP53 mutations [2,3]. These cancers less frequently involve APC and KRAS mutations [4,5]. Research has gradually revealed the pathology of UCAN, including the potential risk factors
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call