Accurate Diagnosing of Lesions in IBD Patients Requires Coordination of Care

A poster presentation at the 2015 Advances in Inflammatory Bowel Disease show in Orlando, FL, suggested that collaboration between gastroenterologists and pathologists is essential in arriving at an accurate diagnosis for precursor lesions in inflammatory bowel disease (IBD) patients.

The presentation, from researchers at Washington, D.C.’s George Washington University, included a retrospective review of surveillance colonoscopy and pathology reports of IBD patients over a 1-year period at the GWU Medical Center. The researchers recorded the medical histories, patient demographics, IBD severity, and colonoscopy and pathology findings for diagnoses of dysplasia.

Of the 136 surveillance colonoscopies studied, dysplastic lesions were detected in 16; of those, 10 patients had sporadic adenoma per both the gastroenterologist and pathologist. Of the 6 patients diagnosed with dysplasia-associated lesions or masses (DALMs) by the pathologist, the gastroenterologist agreed in 4 patients; in the case of 2 patients, endoscopists’ diagnosis was sporadic adenoma. After further review from a collaborative clinical team, two lesions initially classified as DALMs by the pathologist were re-classified as adenomas. Pathologists and endoscopists agreed in 14 of 16 cases of dysplastic lesions.

The research is of note because IBD patients are more likely to develop colorectal cancer than people in the general population, although many of these cases are diagnosed sooner than it is for patients in the general population. The distinction between DALM and sporadic adenoma is both difficult and important; it carries important management consequences for IBD patients.

“The resection of a sporadic adenoma constitutes complete management, but resection of a DALM leaves behind a significant risk for the development of colorectal cancer,” the researchers noted. “Labeing the lesion as adenoma would provide inappropriate reassurance to the patient. Conversely, a sporadic adenoma mislabeled as DALM may lead to unnecessary colectomy.”

The researchers hope the study will further emphasize the importance of pursuing and achieving diagnostic agreement between gastoenterologists and pathologists.