A 70-year-old woman with UC for 27 years undergoes a surveillance colonoscopy; one of the biopsy specimens from the right colon is shown (see figure below). What is your recommendation?
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1- immediate colectomy
2-Rt hemi
3-repeat colonscopy in 3/12 with extensive Bx from Rt colon
4-repeat colonscopy in 1 year
5-confirm finding with 2nd pathologist then recommend total colectomy
The biopsy depicted in the figure shows high-grade dysplasia. After confirmation by a second expert pathologist, a total proctocolectomy should be advised for this patient. Because significant interobserver variability exists among pathologists for the diagnosis of dysplasia and the recommendation for colectomy is not one to be taken lightly, a second opinion must always be obtained. Because there exists a significant risk of a synchronous cancer on colectomy in those patients with high-grade dysplasia (42% in a review study), it would be insufficient to recommend resection of only the part of the colon from which the high-grade dysplasia was found. Further, because of the significant risk of concomitant and future colorectal cancer, it would be incorrect to recommend following this patient with colonoscopy in three months or a year.
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