DNA aneuploidy in colonic biopsies predicts future development of dysplasia in ulcerative colitis

Ulcerative colitis and cancer

“…Furthermore, percentage of patients with aneuploidy increases after duration of more than 10 years compared to patients with dysplasia findings that are found more often with disease duration of over 20 years [35]. Other studies confirmed that DNA aneuploidy is stable, widely spread (hence sampling error is minimal), may precede dysplasia (hence represents an early marker), and is evident 10 years after onset of colitis in young patients [23,25,55,63,68,75,76]. In addition to duration, aneuploidy correlates with extent of disease and is associated with total colitis [23,74].…”

“…Serial non-targetted biopsies are obtained at 10 cm interval to check for dysplasia since CC is often associated with either contiguous dysplasia or dysplasia separate from the primary lesion where the dysplasia is widespread ''field effect'' [3,11,12,33]. A minimum of 33 samples and a total 40-50 or more biopsies is required to achieve a 90-95% confidence of detecting neoplasia [24,62,63]. Surveillance is considered a success when colectomy yields high-risk pre-invasive lesions or curable stage I or II cancer [36].…”

“…In more than 50% of cases CC is discovered because of increased colitis and in 18% cancer develops with <8-year history of IBD [14]. Despite surveillance for dysplasia, CC is not an uncommon occurrence because of poor patient compliance, inadequate referral, development of cancer before initiation of surveillance, sampling errors, incorrect pathological assessment, inter-observer variability in the diagnosis of dysplasia, and lack of consensus regarding the value of dysplasia, and true absence of dysplasia [24,48,63,65]. Agreement among pathologists for IDD or LGD is low, 50-65% [41,63,66].…”

“…Despite surveillance for dysplasia, CC is not an uncommon occurrence because of poor patient compliance, inadequate referral, development of cancer before initiation of surveillance, sampling errors, incorrect pathological assessment, inter-observer variability in the diagnosis of dysplasia, and lack of consensus regarding the value of dysplasia, and true absence of dysplasia [24,48,63,65]. Agreement among pathologists for IDD or LGD is low, 50-65% [41,63,66]. About 25% of CC occurs without detectable dysplasia distant to the tumor [14,41,47,48,50,64].…”

“…A pre-operative diagnosis of dysplasia of any grade is associated with a 50% probability of associated invasive carcinoma [49]. Dysplasia may be not visible or may be sessile, flat, or minimally elevated and require careful examination to be detected and numerous biopsies are required to confirm its presence [63,68]. Magnifying or high-resolution endoscopy after spraying of dye (indigo carmine, methylene blue, crystal violet) to high light architectural irregularities improves sensitivity of examination of surface mucosa especially when dysplastic changes are subtle, facilitates discovery of dysplasia/CC, and allows targeted biopsies [68][69][70][71].…”