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Cancer risk in IBD: How to diagnose and how to manage DALM and ALM

World Journal of Gastroenterology 2011年第27期17卷 3184-3191页

作者： Helmut Neumann Michael Vieth Cord Langner Markus F Neurath Jonas Mudter Department of Medicine 1 Department of SurgeryUniversity of Erlangen-Nuremberg Ulmenweg 1891054 ErlangenGermany Institute of Pathology Klinikum Bayreuth GmbHPreuschwitzer Str. 10195445 BayreuthGermany Institute of Pathology Medical University of GrazAuenbruggerplatz 25A-8036 Graz Austria

The risk of developing neoplasia leading to colorectal cancer is significantly increased in ulcerative colitis (UC) and most likely in Crohn's disease. Several endoscopic surveillance strategies have been implemented to identify these lesions. The main issue is that colitisassociated neoplasms often occurs in flat mucosa, often being detected on taking random biopsies rather than by identification of these lesions via endoscopic imaging. The standard diagnostic procedure in long lasting UC is to take four biopsies every 10 cm. Image enhancement methods, such as chromoendoscopy and virtual histology using endomicroscopy, have greatly im- proved neoplasia detection rates and may contribute toreduced random biopsies by taking targeted "smart" biopsies. Chromoendoscopy may effectively be performed by experienced endoscopists for routine screening of UC patients. By contrast, endomicroscopy is often only available in selected specialized endoscopic centers. Importantly, advanced endoscopic imaging has the poten- tial to increase the detection rate of neoplasia whereas the interplay between endoscopic experience and interpretation of histological biopsy evaluation allows the physician to make a proper diagnosis and to find the appropriate therapeutic approach. Colitis-associated intraepithelial neoplasms may occur in flat mucosa of endoscopically normal appearance or may arise as dysplasia-associated lesion or mass (DALM), which may be indistinguishable from sporadic adenomas in healthy or non-colitis mucosa [adenoma-like mass (ALM)]. The aim of this review was to summarize endoscopic and histological characteristics of DALM and ALM in the context of therapeutic procedures.

关键词： Inflammatory bowel disease Crohn’s dis- ease Endoscopy Colitis Dysplasia-associated lesion or mass Adenoma-like mass endomicroscopy Ulcerative colitis endomicroscopy confocal laser endomicroscopy Probe-based confocal laser endomicroscopy integrated confocal laser endomicroscopy Endoscope-based confocal laser endomicroscopy Narrow band imaging Chromoendoscopy Cancer Dysplasia

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