Back to Program | 2010 Program and Abstracts Overview | 2010 Posters

Preoperative biopsy findings of neoplasia in inflammatory bowel disease (IBD) do not always correlate with postoperative pathology. The aim of this study was to determine the pathologic correlation rate between preoperative biopsies and postoperative pathology. From 2002 - 2009, patients presenting for colectomy for IBD associated neoplasia underwent review of preoperative biopsies and colectomy specimens by pathologist specializing in gastrointestinal disease at our institution. All specimens underwent standardized examination at 5 micron intervals in areas of interest. 35 patients with IBD-associated neoplasia were identified. 6 patients had a biopsy proven mass consistent with invasive cancer and were excluded. Of the remaining 29 patients, 22 (76%) were male, mean age was 50 yrs, mean time with IBD was 16 yrs, 23 underwent restorative proctocolectomy (RP). The average histology sections examined per patient following RP was 36.4 (range 22 - 66). 3 patients had invasive cancer on routine surveillance biopsy. High grade dysplasia (HGD) was identified in 8 patients and low grade dysplasis (LGD) with or without a dysplastic associated lesion or mass (DALM) was identified in 17 patients. 1 patient was indefinite for dysplasia. Overall, the rate of cancer in the final pathology specimen was 14%, the rate of no neoplasia was 24%, and correlation with preoperative biopsy was 41%. In patients with an intial biopsy demonstrating cancer, one patient had no identifiable cancer in the colectomy specimen. Among patients with HGD, unknown cancers were found in 12.5% of patients and preoperative biopsies correlated with the final postoperative pathology in 50% of patients. Among patients with LGD, unknown cancers were identified in 5.9% of patients and preoperative biopsies correlated with the final postoperative pathology in 35.3% of patients. With no associated lesion (DALM) and LGD, the correlation rate was 57% (see table). Correlation between preoperative biopsies and final pathology among patients with IBD-associated neoplasia, especially if a DALM is present, remains low even among pathologist specializing in inflammatory bowel disease. The cancer risk remains elevated, which suggests that surgery remains indicated for both HGD and LGD.

Preoperative Pathology	Final Path No Dysplasia	Final Path Indefinite	Final Path LGD	Final Path HGD	Final Cancer
Indefinite	1	0	0	0	0
LGD-DALM	4	1	2	2	1
LGD-No DALM	1	1	4	1	0
HGD	1	0	2	4	1
Cancer	1	0	0	0	2