Guideline Interpretation
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2022; 14(8): 1375-1387
Published online Aug 15, 2022. doi: 10.4251/wjgo.v14.i8.1375
Influence of SCENIC recommendations on terminology used for histopathologic diagnosis of inflammatory bowel disease-associated dysplasia
Yuan Li, Hanlin L Wang
Yuan Li, Hanlin L Wang, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, United States
Yuan Li, Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China
Author contributions: Wang HL designed the research, supervised data analysis and manuscript preparation; Li Y collected and analyzed the data, and wrote the manuscript.
Conflict-of-interest statement: There are no conflicts of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hanlin L Wang, MD, PhD, Professor, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, United States. hanlinwang@mednet.ucla.edu
Received: April 27, 2022
Peer-review started: April 27, 2022
First decision: July 6, 2022
Revised: July 18, 2022
Accepted: August 6, 2022
Article in press: August 6, 2022
Published online: August 15, 2022
Processing time: 105 Days and 4.8 Hours
Abstract
BACKGROUND

Published in 2015, the International Consensus Recommendations on Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients (SCENIC) recommended abandoning the use of diagnostic term “dysplasia-associated lesion or mass (DALM)” for polypoid dysplastic lesions detected in patients with inflammatory bowel disease (IBD). The aim of this study was to investigate whether this recommendation had any influence on diagnostic terminologies used by pathologists in their practice.

METHODS

We retrospectively reviewed all pathology reports for surveillance colonoscopic biopsies from ulcerative colitis (UC) patients in our institution during 1/2012-12/2014 (pre-SCENIC) and 1/2016-12/2018 (post-SCENIC). These included 1203 biopsies from 901 UC patients during the pre-SCENIC period and 1273 biopsies from 977 UC patients during the post-SCENIC period. Their corresponding endoscopic findings and histopathologic diagnoses were recorded. Clinical indications for total colectomy for UC patients and corresponding histopathologic findings in colectomy specimens were also recorded and compared.

RESULTS

A total of 347 and 419 polyps/polypoid lesions were identified during the pre-SCENIC and post-SCENIC periods, among which 60 and 104 were dysplastic/ adenomatous, respectively. More polypoid dysplastic lesions were simply diagnosed as “adenoma” during the post-SCENIC period in comparison with the pre-SCENIC period (97.1% vs 65.0%; P < 0.001). The number of cases with a comment in pathology reports regarding the distinction between DALM and sporadic adenoma was also significantly decreased during the post-SCENIC period (5.8% vs 38.3%; P < 0.001). In addition, the term “dysplasia” was more consistently used for random biopsies during the post-SCENIC period. Furthermore, the terms “sessile serrated adenoma/polyp” (SSA/P) and “serrated epithelial change” (SEC) were more consistently used for polypoid lesions and random biopsies, respectively, during the post-SCENIC period, although these were not specifically addressed in the SCENIC recommendations. The indications for colectomy remained unchanged, however, despite the standardization of diagnostic terminologies.

CONCLUSION

The SCENIC recommendations relieve pathologists from the burden of distinguishing DALM from sporadic adenoma in IBD patients, which helps the standardization of diagnostic terminologies used by pathologists. The consistent use of the diagnostic terminologies may help reduce potential confusions to clinicians and patients.

Keywords: Inflammatory bowel disease; Ulcerative colitis; Dysplasia; Terminology; SCENIC

Core Tip: The Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients recommendations help relieve pathologists from the burden of histologically distinguishing dysplasia-associated lesion or mass from sporadic adenoma in inflammatory bowel disease patients, which is an extremely challenging and stressful differential. This has a significant influence on diagnostic terminologies used by pathologists in their practice.