What should be the protocol to manage high grade dysplasia in IBD?
If high grade dysplasia (HGD) is diagnosed in flat mucosa and confirmed by a separate pathologist, surgery is usually required. According to a review of 10 dysplasia studies, a finding of high grade dysplasia was accompanied by actual cancer in 42%, and in the rest who underwent surgery, definite dysplasia was usually detected in colectomy specimens. Experience from the 30 year St Mark’s Hospital surveillance programme found that 19/600 (3.2%) developed HGD. Of these, 11 underwent immediate colectomy and five (45%) had cancer in the operative specimen. Eight patients refused immediate surgery, of whom two subsequently developed CRC. In total, 37% of all patients with HGD eventually developed CRC.
Evidence summary and recommendations
|The predictive value of HGD for imminent or established cancer is high.||II||, |
|High grade dysplasia in flat mucosa is a strong risk factor for established or imminent carcinoma, and colectomy is usually recommended.||B|
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