Detection of Anorectal Cancer among Patients with Crohn's Disease Undergoing Surveillance with Various Biopsy Methods

Background/Aims: Crohn's disease (CD) is an inflammatory bowel disease. The risk of colorectal cancer (CRC) is increased in patients with CD. In Japan, anorectal cancer accounted for >60% of CRCs associated with CD. These anorectal cancers are typically diagnosed in advanced stages, because a surveillance protocol remains to be established. This study aimed to assess various biopsy methods for detecting CRC. Methods: This study included 72 patients (113 examinations) with CD who underwent cancer surveillance between August 2008 and October 2015. Surveillances were performed with a core needle biopsy in perianal regions (54 cases), endoscopic biopsy (90 cases), and excisional biopsy (34 cases). When it was difficult to perform colonoscopy in an outpatient setting, due to perianal pain or stricture, we employed examinations under anesthesia for surveillance. Results: The total CRC detection rate was 6.19% (7 examinations). CRC detection rates were 1.85% (1 case) with core needle biopsy, 5.56% (5 cases) with endoscopic biopsy, and 5.88% (2 cases) with excisional biopsy. Conclusions: We showed that it was important to employ various biopsy methods in cancer surveillance to detect CRC among patients with CD.

[1]  A. Amiot,et al.  Detection of Dysplasia or Cancer in 3.5% of Patients With Inflammatory Bowel Disease and Colonic Strictures. , 2015, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[2]  P. Siersema,et al.  Incidence of Interval Colorectal Cancer Among Inflammatory Bowel Disease Patients Undergoing Regular Colonoscopic Surveillance. , 2015, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[3]  Hanan Khalil,et al.  Crohn’s disease: a clinical update , 2015, Therapeutic advances in gastroenterology.

[4]  M. Lazarev,et al.  Who and how to screen for cancer in at-risk inflammatory bowel disease patients , 2015, Expert review of gastroenterology & hepatology.

[5]  I. Papaconstantinou,et al.  Anal adenocarcinoma complicating chronic Crohn’s disease , 2015, International journal of surgery case reports.

[6]  A. Deshpande,et al.  Perianal Crohn’s disease: A review , 2015, Postgraduate medicine.

[7]  I. Kohane,et al.  Colonoscopy is associated with a reduced risk for colon cancer and mortality in patients with inflammatory bowel diseases. , 2015, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[8]  P. Rutgeerts,et al.  A rule for determining risk of colorectal cancer in patients with inflammatory bowel disease. , 2015, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[9]  M. V. van Oijen,et al.  A risk-profiling approach for surveillance of inflammatory bowel disease-colorectal carcinoma is more cost-effective: a comparative cost-effectiveness analysis between international guidelines. , 2014, Gastrointestinal endoscopy.

[10]  P. d'Halluin,et al.  Anorectal stricture in 102 patients with Crohn's disease: natural history in the era of biologics , 2014, Alimentary pharmacology & therapeutics.

[11]  J. Andrews,et al.  Colon cancer surveillance in inflammatory bowel disease: unclear gain but no psychological pain? , 2014, Internal medicine journal.

[12]  M. Toruner,et al.  Colorectal cancer in inflammatory bowel disease: results of the 3rd ECCO pathogenesis scientific workshop (I). , 2014, Journal of Crohn's & colitis.

[13]  U. Navaneethan,et al.  Random biopsies during surveillance colonoscopy increase dysplasia detection in patients with primary sclerosing cholangitis and ulcerative colitis. , 2013, Journal of Crohn's & colitis.

[14]  A. Amiot,et al.  European evidence based consensus for endoscopy in inflammatory bowel disease. , 2013, Journal of Crohn's & colitis.

[15]  T. Jess,et al.  Has the risk of colorectal cancer in inflammatory bowel disease decreased? , 2013, World journal of gastroenterology.

[16]  Y. Doki,et al.  Metachronous, colitis-associated rectal cancer that developed after sporadic adenocarcinoma in an adenoma in a patient with longstanding Crohn’s disease: a case report , 2013, World Journal of Surgical Oncology.

[17]  P. Lakatos,et al.  Risk of colorectal cancer in Crohn's disease patients with colonic involvement and stenosing disease in a population-based cohort from Hungary. , 2013, Journal of gastrointestinal and liver diseases : JGLD.

[18]  T. Matsui,et al.  Cancer risk in Japanese Crohn's disease patients: Investigation of the standardized incidence ratio , 2013, Journal of gastroenterology and hepatology.

[19]  M. V. van Oijen,et al.  Declining Risk of Colorectal Cancer in Inflammatory Bowel Disease: An Updated Meta-analysis of Population-based Cohort Studies , 2013, Inflammatory bowel diseases.

[20]  H. Sasaki,et al.  Clinical role of a modified seton technique for the treatment of trans-sphincteric and supra-sphincteric anal fistulas , 2013, Surgery Today.

[21]  J. Imura,et al.  Immunohistochemical analysis of the DNA methyltransferase 3b expression is associated with significant improvements in the discrimination of ulcerative colitis-associated neoplastic lesions , 2013, Surgery Today.

[22]  T. Levin,et al.  Incidence and mortality of colorectal adenocarcinoma in persons with inflammatory bowel disease from 1998 to 2010. , 2012, Gastroenterology.

[23]  R. Steele,et al.  Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002) , 2010, Gut.

[24]  Y. Ohno,et al.  Malignancy in Crohn’s Disease: Incidence and Clinical Characteristics in Japan , 2010, Digestion.

[25]  R. McLeod,et al.  Position Statement on the Diagnosis and Management of olorectal Neoplasia in Inflammatory Bowel Disease , 2022 .

[26]  B. Cagir,et al.  Malignant Transformation in Perianal Fistulas of Crohn’s Disease: a Systematic Review of Literature , 2009, Journal of Gastrointestinal Surgery.

[27]  H. Freeman.  Colorectal cancer risk in Crohn's disease. , 2008, World journal of gastroenterology.

[28]  M. Shinozaki.  Crohn's Disease and Intestinal Cancer in Japan , 2008 .

[29]  K. Futami,et al.  Study of colorectal cancer with Crohn's disease. , 2007, Anticancer research.

[30]  K R Abrams,et al.  Meta‐analysis: colorectal and small bowel cancer risk in patients with Crohn's disease , 2006, Alimentary pharmacology & therapeutics.

[31]  T. Sørensen,et al.  Increased Risk of Intestinal Cancer in Crohn's Disease: A Meta-Analysis of Population-Based Cohort Studies , 2005, The American Journal of Gastroenterology.

[32]  A. Zinsmeister,et al.  A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn's perianal fistulas. , 2001, Gastroenterology.