Poor Agreement between Preoperative Biopsies and Pathological Resection Findings in IBD-Associated Dysplasia

Background: The decision to perform a proctocolectomy in patients with inflammatory bowel disease (IBD)-associateddysplasia is based on the degree of dysplasia on endoscopic biopsies. Unexpected pathological findings at the time of surgery can be troubling to patients. Therefore, we aimed to determine the extent of pathological agreement between endoscopic biopsies and surgical resection specimens in patients undergoing surgery at a tertiary referral center and to identify risk factors for poor agreement. Methods: Aretrospective review of patients who underwent surgery for IBDassociated dysplasia was performed. Data including demographics, disease history, endoscopic surveillance, and procedure type were collected. Risk factors for poor agreement were assessed using regression analysis. Results: 81 patients were identified; 60 (74%) male with a mean age of 54 years. Ulcerative colitis was seen in 70 (86%) while 11 (14%) had Crohn’s disease. In the colectomy specimens, newly diagnosed adenocarcinoma was identified in 16 (20%) and no dysplasia was seen in 16 (20%). Agreement between preoperative endoscopic biopsies and whole specimen pathology occurred in 33 (41%) patients (r=0.17, p=0.14). Highest agreement was flat low grade dysplasia, while lowest agreement was indefinite dysplasia and polypoid low grade dysplasia. The diagnosis of cancer was more common with a preoperative diagnosis of high grade dysplasia. A repeat endoscopic evaluation at our institution was associated with lower likelihood of the findings of no dysplasia on the final surgical specimen. Conclusions: Agreement between preoperative biopsies and final pathology remains low, however, newer endoscopic techniques may provide better pathological correlation. This study highlights the necessity of preoperative counseling and joint decision making prior to surgery for dysplasia in IBD.