Abstract Background In Inflammatory Bowel Disease (IBD) colitis, histology may detect areas “indefinite for dysplasia” (IND) in colonic biopsies. This definition is used when a distinction between non-neoplastic changes and neoplasia is not possible (1). The role of this finding in predicting the outcome in IBD colitis is currently undefined. Primary aim of our study was to evaluate the clinical, endoscopic and histological outcome of IBD patients (pts) with an initial histological evidence of areas IND in colonic biopsies at the first endoscopic follow-up. Methods In a retrospective study, all pts with IBD colitis showing areas IND in colonic biopsies at index colonoscopy, followed by a second colonoscopy, were considered. Index colonoscopy was performed from May 2018 to Aug 2022. Endoscopic and histological examinations were performed at our IBD Unit. Data expressed as median range, chi-square test and univariate analysis performed as appropriate. Results Study population included 100 IBD pts (69 Ulcerative Colitis, 18 Crohn’s Colitis) showing: female gender in 38, median age 52 20-82 years, long-standing IBD in 77, family history of colorectal cancer in 16. Colonic segments showing areas IND included: rectum in 38, descending-sigmoid colon in 18, transverse in 7 or right colon in 7 pts. At index colonoscopy, 22 pts. showed areas IND on target biopsies. All biopsies were taken from involved areas including: mild (edema) in 13 and moderate-severe inflammation (erosions, ulcers) in 87 pts. In the same IBD population, the first endoscopic follow-up, performed after a median of 121-49 months, detected: areas with defined dysplasia in 17 pts, areas IND in 17 pts and no dysplasia in 66 pts. In the 17 pts with defined dysplasia, findings included: high grade dysplasia (HGD) with concomitant area of adenocarcinoma in 1, HGD in 4, low grade dysplasia (LGD) in 12 pts. When comparing clinical characteristics of patients developing or not defined dysplasia at follow-up endoscopy, a higher number of areas IND on target biopsies was observed (847.1 vs 1416.9,p=0.006). Pts developing defined dysplasia at second colonoscopy were older than pts not developing it (median age, years: 6642-79 vs 5120-82;p=0.0003). At univariate analysis, both a diagnosis of IND on target biopsies and age50 years at index colonoscopy were identified as risk factors for subsequent detection of defined dysplasia at FU endoscopy (HR 6.341.16-16.23;p=0.03; HR 3.611.15-11.33;p=0.02, respectively). Conclusion Present findings suggest the need of a careful endoscopic surveillance in patients with IBD colitis showing areas IND, particularly when detected in target colonic biopsies and in older age, as defined dysplasia and CRC may occur at subsequent colonoscopy. Reference: 1. Feakins R. et al. Definitions of Histological Abnormalities in Inflammatory Bowel Disease: an ECCO Position Paper. J Crohns Colitis. 2024; 18(2): 175-191. Conflict of interest: Dr. Mancone, Roberto: No conflict of interest Neri, Benedetto: No conflict of interest Fiorillo, Mariasofia: No conflict of interest Elena, Wilhelm: No conflict of interest Laluci, Eleonora: No conflict of interest Muzzi, Eleonora: No conflict of interest Lucarelli, Michele: No conflict of interest Seghetti, Christian: No conflict of interest Lolli, Elisabetta: No conflict of interest Marafini, Irene: Irene Marafini served as advisory board member for Abbvie, Eli Lilly, Galapagos and received speaker honoraria from Abbvie and Eli Lilly Calabrese, Emma: none Savino, Luca: No conflict of interest Biancone, Livia: No conflict of interest
Mancone et al. (Thu,) studied this question.