Summary
Patients with total long-standing mucosal ulcerative colitis are at an increased risk of developing carcinoma of the colon or rectum. Recently it has been suggested that cytological examination of the colon may play an important role in the examination of these patients. The present study was undertaken in order to determine the malignancy/severe dysplasia rate in our patients and to examine the role of cytology in comparison with mucosal biopsy in the detection of mucosal abnormality. Three patients had severe dysplasia in the absence of active inflammation (7.1%). Fifty-four patients were examined concurrently by histology and cytological brushing and at least seven specimens were obtained from each patient. Cytological examination detected active mucosal inflammation more often than histological examination at all sites in the colon. There was good agreement between the cytologists' evaluation, routine histopathological examination and endoscopic evaluation of the colorectal mucosa, although the latter tended to underestimate the degree of active inflammation. It was concluded that, since there was no real improvement in sampling by brush cytology, there may be little advantage in supplementing routine biopsy with brush cytology in patients with long-standing inflammatory bowel disease.
Similar content being viewed by others
References
Blackstone MO, Riddell RH, Rogers BHG, Levin B (1981) Dysplasia-associated lesion or mass (DALM) detected by colonoscopy in long-standing ulcerative colitis: an indication for colectomy. Gastroenterology 80: 366–374
Collins RH, Feldman M, Fordtran JS (1987) Colon cancer, dysplasia, and surveillance in patients with ulcerative colitis. N Engl J Med 316: 1654–1658
Davis NC, Newland RC (1983) Terminology and classification of colorectal adenocarcinoma: the Australian clinico-pathological staging system. Aust N Z J Surg 53: 211–221
Diagnostic cytology by membrane filter (1984) Applications Bulletin 100R. Gelman Sciences, Ann Arbor, Mich, pp 11–16
Editorial (1989) Brush cytology for colorectal cancer. Lancet I: 477–478
Festa VI, Hjdu SI, Winawer SJ (1985) Colorectal cytology in chronic ulcerative colitis. Acta Cytol 29: 262–268
Graham DY, Spjut HJ (1979) Salvage cytology. Gastrointest Endosc 25: 137–139
Graham DY, Spjut HJ, Estrada RG (1978) Directed cytology of esophagus and stomach. Gastrointest Endosc 24: 277–280
Gupta RK, Naran S, Buchanan A, Fauck R, Simpson J (1988) Fine-needle aspiration cytology of breast: its impact on surgical practice with an emphasis on the diagnosis of breast abnormalities in young women. Diagn Cytopathol 4: 206–209
Hermanek P (1987) Dysplasia in the gastrointestinal tract: definition and clinical significance. Surg Endosc 1: 5–10
Isbister WH (1987) Colonoscopy — a ten year Wellington experience. N Z Med J 100: 74–84
Lashner BA, Hanauer SB, Silverstein MD (1988) Optimal timing of colonoscopy to screen cancer in ulcerative colitis. Ann Intern Med 108: 274–278
Lennard-Jones JE, Morson BC, Ritchie JK, Williams CB (1983) Cancer surveillance in ulcerative colitis: experience over 15 years. Lancet II: 149–152
Melville DM, Richman PI, Shepherd NA, Williams CB, Lennard-Jones JE (1988) Brush cytology of the colon and rectum in ulcerative colitis: an aid to cancer diagnosis. J Clin Pathol 41: 1180–1186
Morson BC, Dawson IMP (1979) Gastrointestinal pathology, 2nd edn. Blackwell, Oxford
Nugent FW, Haggitt RC (1984) Results of a longterm prospective surveillance program for dysplasia in ulcerative colitis. Gastroenterology 86: 1197
Ransohoff DF, Riddell RH, Levin B (1985) Ulcerative colitis and colonic cancer: problems in assessing the diagnostic usefulness of mucosal dysplasia. Dis Colon Rectum 28: 383–388
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Isbister, W.H., Gupta, R.K. Colonoscopy, mucosal biopsy and brush cytology in the assessment of patients with colorectal inflammatory bowel disease. Surg Endosc 3, 159–163 (1989). https://doi.org/10.1007/BF00591363
Issue Date:
DOI: https://doi.org/10.1007/BF00591363