Influence of SCENIC recommendations on terminology used for histopathologic diagnosis of inflammatory bowel disease-associated dysplasia

Table 6 Indications for total colectomies and postoperative findings for ulcerative colitis patients during pre-SCENIC (2012-2014) and post-SCENIC (2016-2018) periods

	No. of cases (%)	Preoperative biopsy/polypectomy (No. of cases)	Postoperative findings (No. of cases)
Pre-SCENIC
Total	54
Refractory UC	34 (63.0)	No dysplasia/adenoma or malignancy (34)	Incidental well-differentiated (low-grade) NET (1); TA (1); no dysplasia/adenoma or malignancy (32)
Complications	6 (11.1)	Perforation (2); fistula (1); stricture (1); volvulus (1); obstruction (1)1	No dysplasia/adenoma or malignancy (6)
Dysplasia/malignancy	14 (25.9)	Invasive adenocarcinoma (4.5 cm mass lesion), a separate focus of LGD	pT4a pN2b adenocarcinoma, a separate focus of HGD
		Invasive adenocarcinoma (6.3 cm mass), a separate focus of LGD	pT3 pN0 adenocarcinoma
		At least HGD (2.6 cm polypoid lesion)	pT1 pN1a adenocarcinoma (2 foci)
		At least HGD (2.0 cm polypoid lesion)	pT1 pN1a adenocarcinoma (2 foci), separate foci of HGD
		Dysplasia (3.6 cm mass)	pT2 pN1b mucinous adenocarcinoma
		HGD (3.0 cm polypoid lesion), also separate foci of LGD	HGD
		Multiple TAs and foci of LGD, one TA with HGD, one SSA/P with low-grade cytologic dysplasia (0.2-1.5 cm sessile polyps)	Multiple TAs and foci of LGD
		LGD (1.0 cm lesion)	pT1 pN0 mucinous adenocarcinoma arising from extensive LGD
		LGD with tubulovillous features (6.5 cm mucosal plaque)	LGD
		LGD (4.6 cm polypoid lesion)	LGD
		Dysplasia (outside diagnosis)	LGD
		LGD (focal on a random biopsy)	No residual dysplasia or carcinoma
		Extensive LGD	Extensive LGD
		Multiple foci of LGD	Focal LGD
Post-SCENIC
Total	40
Refractory UC	26 (65.0)	No dysplasia/adenoma or malignancy (26)	Focal LGD (1); no dysplasia/adenoma or malignancy (25)
Complications	2 (5.0)	Perforation (1); GI bleeding (1)2	Extensive HGD (1)2; no dysplasia/adenoma or malignancy (1)
Dysplasia/malignancy	12 (30.0)	Invasive adenocarcinoma (4.1 cm mass)	pT4a pN1a poorly differentiated NEC
		Invasive adenocarcinoma (1.5 cm mass)	pT3 pN1a adenocarcinoma, separate foci of LGD
		Invasive adenocarcinoma (5.5 polypoid mass), a separate focus of LGD	pT3 pN1a poorly differentiated NEC
		Invasive adenocarcinoma with mucinous features arising in a polypoid lesion with serrated/villiform dysplasia (1.5 cm polyp)	No residual carcinoma or dysplasia
		Invasive adenocarcinoma (2.8 cm mass)	No residual carcinoma or dysplasia (s/p neoadjuvant chemotherapy)
		Atypical cells concerning for adenocarcinoma (13.0 cm mass)	pT4b pN0 mucinous adenocarcinoma
		At least HGD (2.5 cm mass)	pT1 pN0 adenocarcinoma with signet-ring cell features (3 foci)
		Extensive HGD (3.5 cm flat induration)	pT2 pN0 adenocarcinoma (3 foci)
		TVA with focal HGD (6.1 cm mass)	pT2 pN0 adenocarcinoma
		Villous adenoma (2.0 cm sessile polyp)	No residual adenoma or carcinoma
		Multifocal LGD, one TA	Focal LGD and HGD
		LGD with tubulovillous architecture (12 cm polypoid lesion), a separate focus of LGD, multiple TVAs	Villous adenoma

¹Surveillance colonoscopy found a small polypoid area in the sigmoid colon that caused partial obstruction. Biopsy showed features of sessile serrated adenoma/polyp without cytologic dysplasia. No dysplasia or carcinoma was found on resection specimen.

²Surveillance biopsy showed indefinite for dysplasia, resection specimen identified extensive high-grade dysplasia.

SCENIC: Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients; UC: Ulcerative colitis; SSA/P: Sessile serrated adenoma/polyp; NET: Neuroendocrine tumor; TA: Tubular adenoma; TVA: Tubulovillous adenoma; LGD: Low-grade dysplasia; HGD: High-grade dysplasia; IND: Indefinite for dysplasia; NEC: Neuroendocrine carcinoma.