IBD-associated dysplastic lesions show more chromosomal instability than sporadic adenomas

Inflammatory bowel disease (IBD) patients are at increased risk of developing colorectal cancer. However, histologically, it is challenging to distinguish between IBD-associated dysplasia from sporadic adenomas. We have molecularly characterized these precursor lesions and show that IBD-associated dysplasia lesions are genomically much more unstable

Advances in colonoscopic imaging and the approach to dysplasia in IBD

Colorectal cancer (CRC) is one of the most common types of cancer in the western world. CRC develops from dysplastic precursor lesions. Colonoscopy is the gold standard to detect these precursor lesions, so called polyps. Despite colonoscopy is the gold standard; it is not yet 100% protective against CRC. The first part of this thesis focuses on the development of advanced colonoscopic imaging techniques and their ability to detect and differentiate the lesions found during colonoscopy. Patients with longstanding inflammatory bowel disease have a 2-3x increased risk on colorectal cancer. Due to the longstanding inflammation inflammation-related dysplastic lesions can develop, which harbour an increased on CRC. The second part of this thesis addresses the detection, differentiation and management of potentially malignant lesions in patients with IBD

Low interobserver agreement among endoscopists in differentiating dysplastic from non-dysplastic lesions during inflammatory bowel disease colitis surveillance

Item does not contain fulltextOBJECTIVES: During endoscopic surveillance in patients with longstanding colitis, a variety of lesions can be encountered. Differentiation between dysplastic and non-dysplastic lesions can be challenging. The accuracy of visual endoscopic differentiation and interobserver agreement (IOA) has never been objectified. MATERIAL AND METHODS: We assessed the accuracy of expert and nonexpert endoscopists in differentiating (low-grade) dysplastic from non-dysplastic lesions and the IOA among and between them. An online questionnaire was constructed containing 30 cases including a short medical history and an endoscopic image of a lesion found during surveillance employing chromoendoscopy. RESULTS: A total of 17 endoscopists, 8 experts, and 9 nonexperts assessed all 30 cases. The overall sensitivity and specificity for correctly identifying dysplasia were 73.8% (95% confidence interval (CI) 62.1-85.4) and 53.8% (95% CI 42.6-64.7), respectively. Experts showed a sensitivity of 76.0% (95% CI 63.3-88.6) versus 71.8% (95% CI 58.5-85.1, p = 0.434) for nonexperts, the specificity 61.0% (95% CI 49.3-72.7) versus 47.1% (95% CI 34.6-59.5, p = 0.008). The overall IOA in differentiating between dysplastic and non-dysplastic lesions was fair 0.24 (95% CI 0.21-0.27); for experts 0.28 (95% CI 0.21-0.35) and for nonexperts 0.22 (95% CI 0.17-0.28). The overall IOA for differentiating between subtypes was fair 0.21 (95% CI 0.20-0.22); for experts 0.19 (95% CI 0.16-0.22) and nonexpert 0.23 (95% CI 0.20-0.26). CONCLUSION: In this image-based study, both expert and nonexpert endoscopists cannot reliably differentiate between dysplastic and non-dysplastic lesions. This emphasizes that all lesions encountered during colitis surveillance with a slight suspicion of containing dysplasia should be removed and sent for pathological assessment