Intest Res.  2016 Jul;14(3):264-269. 10.5217/ir.2016.14.3.264.

Role of random biopsies in surveillance of dysplasia in ulcerative colitis patients with high risk of colorectal cancer

  • 1Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
  • 2Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
  • 3Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.


Recent data suggest that the incidence of ulcerative colitis (UC) related colorectal cancer (CRC) in India is similar to that of West. The optimum method for surveillance is still a debate. Surveillance with random biopsies has been the standard of care, but is a tedious process. We therefore undertook this study to assess the yield of random biopsy in dysplasia surveillance.
Between March 2014 and July 2015, patients of UC attending the Inflammatory Bowel Disease clinic at the All India Institute of Medical Sciences with high risk factors for CRC like duration of disease >15 years and pancolitis, family history of CRC, primary sclerosing cholangitis underwent surveillance colonoscopy for dysplasia. Four quadrant random biopsies at 10 cm intervals were taken (33 biopsies). Two pathologists examined specimens for dysplasia, and the yield of dysplasia was calculated.
Twenty-eight patients were included. Twenty-six of these had pancolitis with a duration of disease greater than 15 years, and two patients had associated primary sclerosing cholangis. No patient had a family history of CRC. The mean age at onset of disease was 28.89±8.73 years and the duration of disease was 19.00±8.78 years. Eighteen patients (64.28%) were males. A total of 924 biopsies were taken. None of the biopsies revealed any evidence of dysplasia, and 7/924 (0.7%) were indefinite for dysplasia.
Random biopsy for surveillance in longstanding extensive colitis has a low yield for dysplasia and does not suffice for screening. Newer techniques such as chromoendoscopy-guided biopsies need greater adoption.


Colitis, ulcerative; Random biopsy; Surveillance; Dysplasia

MeSH Terms

Age of Onset
Cholangitis, Sclerosing
Colitis, Ulcerative*
Colorectal Neoplasms*
Inflammatory Bowel Diseases
Mass Screening
Risk Factors
Standard of Care


  • Fig. 1 Flow chart showing study design. CRC, colorectal cancer.

  • Fig. 2 Colonic biopsy specimens showing "Indefinite for dysplasia". Low-power photomicrograph shows colonic biopsy in ulcerative colitis with altered crypt architecture and dense mixed inflammation in lamina propria (A, H&E ×40). Focally, the crypt epithelial cells show nuclear stratification and hyperchromasia without prominent nucleoli, (B–D, H&E ×400) in areas adjacent to neutrophilic infiltration (C, arrow), qualifying as indefinite for dysplasia changes.

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