Morphological subtypes of colorectal low-grade intraepithelial neoplasia: Diagnostic reproducibility, frequency and clinical impact

Lang-Schwarz C, Büttner-Herold M, Burian S, Erber R, Hartmann A, Jesinghaus M, Kamarádová K, Rubio CA, Seitz G, Sterlacci W, Vieth M, Bertz S (2023)

Publication Language: English

Publication Type: Journal article, Original article

Publication year: 2023

Journal

Article Number: jcp-2023-209206

DOI: 10.1136/jcp-2023-209206

Abstract

Aims: Special histomorphological subtypes of colorectal low-grade intraepithelial neoplasia (LGIN) with variable prognostic impact were recently described in patients with inflammatory bowel disease (IBD) referred to as non-conventional dysplasia. However, they can also be found in patients without IBD. We aimed to analyse the reproducibility, frequency and prognostic impact of non-conventional colorectal LGIN in patients with and without IBD. Methods: Six pathologists evaluated 500 specimens of five different LGIN-cohorts from patients with and without IBD. Non-conventional LGIN included hypermucinous, goblet cell-deficient, Paneth cell-rich and crypt cell dysplasia. A goblet cell-rich type and non-conventional LGIN, not otherwise specified were added. Results were compared with the original expert-consented diagnosis from archived pathology records. Results: Four or more pathologists agreed in 86.0% of all cases. Non-conventional LGIN was seen in 44.4%, more frequently in patients with IBD (52%; non-IBD: 39.3%, p=0.005). In patients with IBD non-conventional LGIN associated with more frequent and earlier LGIN relapse (p=0.006, p=0.025), high-grade intraepithelial neoplasia (p=0.003), larger lesion size (p=0.001), non-polypoid lesions (p=0.019) and additional risk factors (p=0.034). Results were highly comparable with expert-consented diagnoses. In patients without IBD, non-conventional LGIN may indicate a higher risk for concurrent or subsequent colorectal carcinoma (CRC, p=0.056 and p=0.061, respectively). Frequencies and association with high-grade intraepithelial neoplasia or CRC varied between the different LGIN subtypes. Conclusions: Non-conventional histomorphology in colorectal LGIN is frequent and highly reproducible. Our results indicate an increased risk for CRC in patients with non-conventional LGIN, probably independent of IBD. We recommend reporting non-conventional LGIN in routine pathology reports.

Authors with CRIS profile

Involved external institutions

Sozialstiftung Bamberg Germany (DE) Technische Universität München (TUM) Germany (DE) University Hospital Hradec Králové / Fakultní Nemocnice Hradec Králové Czech Republic (CZ) Karolinska Institute Sweden (SE)

How to cite

APA:

Lang-Schwarz, C., Büttner-Herold, M., Burian, S., Erber, R., Hartmann, A., Jesinghaus, M.,... Bertz, S. (2023). Morphological subtypes of colorectal low-grade intraepithelial neoplasia: Diagnostic reproducibility, frequency and clinical impact. Journal of Clinical Pathology. https://doi.org/10.1136/jcp-2023-209206

MLA:

Lang-Schwarz, Corinna, et al. "Morphological subtypes of colorectal low-grade intraepithelial neoplasia: Diagnostic reproducibility, frequency and clinical impact." Journal of Clinical Pathology (2023).

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