18F-FDG PET/CT imaging for a gastrointestinal mantle cell lymphoma with multiple lymphomatous polyposis

Multiple lymphomatous polyposis (MLP) is an uncommon type of gastrointestinal lymphoma characterized by the presence of multiple polyps along the gastrointestinal tract. Most of this entity is in fact considered the counterpart of gastrointestinal tract involvement for mantle cell lymphoma (MCL). To our knowledge, there have been no reports on [fluorine-18]-fluorodeoxy-glucose (¹⁸F-FDG)-positron emission tomography (PET)/computed tomography (CT) imaging for gastrointestinal MCL with MLP. We present the results of ¹⁸F-FDG PET/CT imaging in a patient with gastrointestinal tract involvement of MCL showing continuous MLP from the stomach to the rectum and intestinal intussusception. FDG-PET/CT findings were false negative in typical MLP spreading widely over the gastrointestinal tract, but uptake was noted in large lesions with deep infiltration considered atypical as MLP. On FDG-PET/CT imaging, the Ki-67 proliferative index, which is a cell proliferation marker, showed neither correlation with the presence of uptake nor the maximum standardized uptake value.

Obesity and colorectal adenomatous polyps: a cross-sectional study in Korean adults

OBJECTIVE

This study aimed to examine the association between obesity and the risk of colorectal adenomatous polyps.

DESIGN AND METHODS

The design of this study is a cross-sectional study. A total of 1,574 participants (818 males and 756 females), who had undergone colonoscopy for health examinations at the National Cancer Center hospital in South Korea from February to September 2009, were included in the analysis.

RESULTS

The prevalence of colorectal adenomatous polyps was 39.5% in males and 22.6% in females. In multiple logistic regression analysis, obesity (odds ratio [OR] = 1.69, 95% CI = 1.16-2.48) and abdominal obesity (OR = 1.59, 95% CI = 1.13-2.23) were significantly associated with an increased risk of colorectal adenomatous polyps in males, but not in females. In the subgroup analyses by age, obesity (OR = 2.27, 95% CI = 1.32-3.89), and abdominal obesity (OR = 1.76, 95% CI = 1.12-2.76) significantly increased a risk of colorectal adenomatous polyps in males aged <50 years, but not in males aged ≥50 years. However, interaction terms were not significant between obesity and gender (P = 0.397) and between obesity and age (P = 0.531) in the overall analyses.

CONCLUSION

Our findings should be explored in further research.

[Premalignancies of colon]

The most common premalignant lesions of colorectal carcinoma include sporadic adenomas. Tubular and tubulovillous adenomas with mild dysplasia are considered benign lesions, while villous adenomas represent tumors with uncertain bio-logical behavior. In recent years, demonstrable growth of flat lesions in the proximal intestine has been seen. Precision and yield of colonoscopy depends to some extent on good preparation, careful screening of intestine and use of new instruments of better quality. As an indicator of screening colonoscopy quality, the so -called adenoma detection rate is used. The text briefly describes options of endoscopic and surgical resolving of premalignancies. In the Czech Republic, attendance in the screening program is low, which could be changed by prepared addressed invitations of clients. The population with a genetic or familiar risk is examined according to recommended procedures intended for increased- risk persons.

A pedunculated submucosal lesion in the stomach with inverted downgrowth

A 70-year-old man with a gastric lesion was referred to our hospital because of an unusual pedunculated lesion in the gastric body. Endoscopic ultrasound showed scattered cystic lesions within a heterogeneous area confined to the submucosal layer. Endoscopic mucosal resection was performed to obtain a precise diagnosis, as well as for removal. The lesion was histopathologically diagnosed as a heterotopic submucosal gland. We herein describe this rare type of gastric polyp and provide a literature review.

[Proinflammatory markers serum concentrations in patients with adenomatous colon polyps]

BACKGROUND

It has been shown that local chronic inflammation may lead to colorectal carcinogenesis via adenomatous polyps. Tumor necrosing factor-alpha (TNF-alpha), interleukin-6 (IL-6) and C-reactive protein (CRP) are biomarkers of inflammation and indicators of the immune response to tumors. Their elevated levels were observed in patients with colon adenomas, however their clinical significance is unclear.

METHODS

The study included sixty patients with the colorectal adenomatous polyps found on colonoscopy and confirmed pathologically. The control group consisted of 30 individuals with no positive findings on colonoscopy. The aim of our study was to determine the serum levels of TNF-alpha, IL-6 and CRP in colorectal adenomas patients and to assessed the relationships between them and colorectal adenoma location, dysplasia grading, histological type, and size.

RESULTS

One hundred nine adenomas (6-40 mm of size) were found in 60 study patients. The average age of patients with multiple polyps was significantly higher than of those with single pathologies (61.1 vs 56.7 years respectively (p < 0.05)). The prevalence of colon adenomas were observed in distal part of colon (83.3%), compared to the proximal part (16.7%; p < 0.01). The TNF-alpha concentration was similar in both group (24.51 +/- 13.50 pg/ml versus 29.61 +/- 14.94 pg/ml; p > 0.05) and not related to clinical data of patients. In contrast, CRP serum concentrations were higher in patients with adenomas located proximally (8.674 +/- 9.19 microg/ml) compared to control group (4.94 +/- 5.53 microg/ml; p < 0.05). There was also no differences between IL-6 serum level in patients with colon adenomas (19.80 +/- 7.44 pg/ml) and control group (20.46 +/-11.83 pg/ml; p > 0.05). Analyzed cytokines serum levels were not associated with size, number, degree of dysplasia and histological type of colon adenomas.

CONCLUSION

Our results indicate that CRP may be associated with development of tumors of proximal part of colon.

[Endoscopic polypectomy of colorectal adenomas: Monitoring patients in order to review the colonoscopic surveillance interval]

OBJECTIVE

To determine the risk of advanced adenomas at surveillance colonoscopy after polipectomy. To review the colonoscopic surveillance interval and to compare the prevalence of adenomas in patients with low-risk and high-risk adenomas at screening colonoscopies.

METHODS

A cohort retrospective study. It was used a database of colonoscopies performed between 1999 and 2012. Seven hundred and sixty patients who had adenomas at first colonoscopy were included (465 males and 295 females, mean age 62 years old). They were divided into two groups: group A, low-risk adenomas, and group B, high-risk adenomas. In each group, it was compared the presence of adenomas in videocolonoscopies performed at 3 and 5 years.

RESULTS

At the first colonoscopy 409 patients (53.8%) belonged to group A and 351 (46.2%) than group B. In both groups the risk of new advanced adenomas in endoscopic surveillance at 5years was similar to the control at 3 years. Comparing both groups, the risk of new advanced adenomas in endoscopic surveillance at 3 years in group B was 1.96 times greater than in group A (P = 0.012).

CONCLUSIONS

At present, surveillance endoscopy is performed before the suggested interval. In both groups there were no statistically significant differences between surveillance control at 3 or 5 years. However, 62% of patients in group B have developed new advanced adenomas in endoscopic surveillance at 3 years. Therefore, it is recommended the endoscopic control with this interval.

[Endoscopic resection of intestinal mucosa for colorectal neoplasia]

The results of endoscopic resection of intestinal mucosa for colorectal neoplasia were analyzed. There were excised 148 colorectal lesions in 116 patients.The operation was performed, using submucosal injection of adrenaline solution with indigocarmine and the loop resection technique. Endoscopic resection of intestinal mucosa together with pathologic lesion constitute a safe and effective method of treatment of colorectal neoplasia.

Hydrocolonic sonography: a complete colorectal evaluation technique with preliminary results

BACKGROUND

Hydrocolonic ultrasound (HUS) is a low-cost imaging modality as compared with standard colonoscopy. However, HUS is not popular in the clinical setting due to its somewhat complicated technique of examination and inability to visualize the rectum. We developed a technique to overcome these limitations.

METHODS

Ten patients with cancer-suggestive symptoms and 70 asymptomatic patients were included in this study. All patients underwent HUS, with the technique described herein, before colonoscopy on the same day. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated.

RESULTS

There were 30 men and 50 women with a mean age of 60.9 ± 7.3 (SD) years. Thirteen polyps with a size ≥0.6 cm (four lesions size 0.6 to 0.9 cm and nine lesions size ≥1 cm) were detected by colonoscopy. The detection rate of lesions by HUS was 25% for polyps size 0.6-0.9 cm and 89% for lesions size ≥1 cm in size. Three lesions were missed in the sigmoid colon, one in the transverse colon, and one in the rectum.

CONCLUSIONS

HUS is a low-cost and noninvasive procedure for colorectal study. This technique has the potential to be used for the detection of colorectal cancer and polyps.

Optical diagnosis of colorectal polyps using high-definition i-scan: An educational experience

AIM: To examine performances regarding prediction of polyp histology using high-definition (HD) i-scan in a group of endoscopists with varying levels of experience.

METHODS: We used a digital library of HD i-scan still images, comprising twin pictures (surface enhancement and tone enhancement), collected at our university hospital. We defined endoscopic features of adenomatous and non-adenomatous polyps, according to the following parameters: color, surface pattern and vascular pattern. We familiarized the participating endoscopists on optical diagnosis of colorectal polyps using a 20-min didactic training session. All endoscopists were asked to evaluate an image set of 50 colorectal polyps with regard to polyp histology. We classified the diagnoses into high confidence (i.e., cases in which the endoscopist could assign a diagnosis with certainty) and low confidence diagnoses (i.e., cases in which the endoscopist preferred to send the polyp for formal histology). Mean sensitivity, specificity and accuracy per endoscopist/image were computed and differences between groups tested using independent-samples t tests. High vs low confidence diagnoses were compared using the paired-samples t test.

RESULTS: Eleven endoscopists without previous experience on optical diagnosis evaluated a total of 550 images (396 adenomatous, 154 non-adenomatous). Mean sensitivity, specificity and accuracy for diagnosing adenomas were 79.3%, 85.7% and 81.1%, respectively. No significant differences were found between gastroenterologists and trainees regarding performances of optical diagnosis (mean accuracy 78.0% vs 82.9%, P = 0.098). Diminutive lesions were predicted with a lower mean accuracy as compared to non-diminutive lesions (74.2% vs 93.1%, P = 0.008). A total of 446 (81.1%) diagnoses were made with high confidence. High confidence diagnoses corresponded to a significantly higher mean accuracy than low confidence diagnoses (84.0% vs 64.3%, P = 0.008). A total of 319 (58.0%) images were evaluated as having excellent quality. Considering excellent quality images in conjunction with high confidence diagnosis, overall accuracy increased to 92.8%.

CONCLUSION: After a single training session, endoscopists with varying levels of experience can already provide optical diagnosis with an accuracy of 84.0%.

Discrimination of premalignant lesions and cancer tissues from normal gastric tissues using Raman spectroscopy

The feasibility of early detection of gastric cancer using near-infrared (NIR) Raman spectroscopy (RS) by distinguishing premalignant lesions (adenomatous polyp, n=27) and cancer tissues (adenocarcinoma, n=33) from normal gastric tissues (n=45) is evaluated. Significant differences in Raman spectra are observed among the normal, adenomatous polyp, and adenocarcinoma gastric tissues at 936, 1003, 1032, 1174, 1208, 1323, 1335, 1450, and 1655 cm(-1). Diverse statistical methods are employed to develop effective diagnostic algorithms for classifying the Raman spectra of different types of ex vivo gastric tissues, including principal component analysis (PCA), linear discriminant analysis (LDA), and naive Bayesian classifier (NBC) techniques. Compared with PCA-LDA algorithms, PCA-NBC techniques together with leave-one-out, cross-validation method provide better discriminative results of normal, adenomatous polyp, and adenocarcinoma gastric tissues, resulting in superior sensitivities of 96.3%, 96.9%, and 96.9%, and specificities of 93%, 100%, and 95.2%, respectively. Therefore, NIR RS associated with multivariate statistical algorithms has the potential for early diagnosis of gastric premalignant lesions and cancer tissues in molecular level.

[Colorectal cancer screening with colonoscopy]

Colorectal cancer is one of the leading causes of cancer death worldwide and also in Argentina. In the past few years colorectal cancer screening has become more popular and colonoscopy has been postulated as the gold standard. In this review we analyzed the evidence supporting this method in contrast with its complications and disadvantages.

Usefulness of plasma epigenetic changes of five major genes involved in the pathogenesis of colorectal cancer

PURPOSE

The purpose of present study was to investigate the methylation status of the promoter region in five genes (mothers against decapentaplegic homolog 4, fragile histidine triad protein, death-associated protein kinase 1, adenomatous polyposis coli (APC), and E-cadherin), which are known to be involved in the pathogenesis of colorectal cancer (CRC) and its clinicopathological significance.

METHODS

The study subjects were 60 CRC patients, 40 patients with adenomatous colorectal polyp and 60 healthy control individuals. We further enrolled a total of 16 patients (two patients with Crohn's disease, two patients with ulcerative colitis, one patient with serrated adenoma, and 11 patients with colorectal cancer). The methylation states of the five genes were determined in peripheral blood plasma using methylation-specific polymerase chain reaction single-strand conformation polymorphism analysis.

RESULTS

This study showed the most sensitive epigenetic markers, E-cadherin (60 %), followed by APC (57 %), for detecting CRC. E-cadherin and APC had similar specificities and amplified 84 and 86 %, respectively, of CRC patients compared to non-CRC patients. Additionally, APC was the only marker to be significantly increased (OR = 6.67, 95 % CI = 1.19-23.4, P = 0.045) and the most sensitive (57 %) and specific (89 %) marker in stage I CRC. Though we have not examined the paired cancer tissues and plasma, there was relatively high concordant rate (60-80 %) in our limited number of colorectal cancer patients.

CONCLUSIONS

Five genes, promoter methylation, in plasma were statistically significant risk factors in CRC patients. In this study, E-cad and APC genes may be particularly useful epigenetic biomarkers in plasma for the detection of CRC. Additionally, APC may able to identify early potential CRC.

Treatment and surveillance of polypoid lesions of the gallbladder in the United Kingdom

OBJECTIVES

The increase in the routine use of abdominal imaging has led to a parallel surge in the identification of polypoid lesions in the gallbladder. True gallbladder polyps (GBP) have malignant potential and surgery can prevent or treat early gallbladder cancer. In an era of constraint on health care resources, it is important to ensure that surgery is offered only to patients who have appropriate indications. The aim of this study was to assess treatment and surveillance policies for GBP among hepatobiliary and upper gastrointestinal tract surgeons in the UK in the light of published evidence.

METHODS

A questionnaire on the management of GBP was devised and sent to consultant surgeon members of the Association of Upper Gastrointestinal Surgeons (AUGIS) of Great Britain and Ireland with the approval of the AUGIS Committee. It included eight questions on indications for laparoscopic cholecystectomy and surveillance based on GBP (size, number, growth rate) and patient (age, comorbidities, ethnicity) characteristics.

RESULTS

A total of 79 completed questionnaires were returned. The vast majority of surgeons (>75%) stated that they would perform surgery when a single GBP reached 10 mm in size. However, there was a lack of uniformity in the management of multiple polyps and polyp growth rate, with different surveillance protocols for patients treated conservatively.

CONCLUSIONS

Gallbladder polyps are a relatively common finding on abdominal ultrasound scans. The survey showed considerable heterogeneity among surgeons regarding treatment and surveillance protocols. Although no randomized controlled trials exist, national guidelines would facilitate standardization, the formulation of an appropriate algorithm and appropriate use of resources.

Colorectal cancer screening in LHU4 Chiavarese, Italy: ethical, methodological and outcome evaluations at the end of the first round

INTRODUCTION. The screening programmes are very challenging from the ethical perspective, and their impact in terms of morbidity and mortality make secondary colorectal cancer prevention a valuable public health intervention.

METHODS

The target population people aged 50-69 years receive an invitation card with a test-tube for the fecal occult blood test (FOBT) and an immunochemical test is used for fecal occult blood. Subjects positive to FOBT are invited to perform a gastroenterologic examination and a full colonoscopy.

RESULTS

In the firt round of screening, 100% of the target population has been invited with an adhesion rate of 41.3%. A total of 1739 FOBT-positive subjects have been invited to the second level of the screening. 1429 of them have performed the gastroenterologic examination (83.9%). To date 956 full colonoscopies have been completed and the rate of subjects affected by carcinoma, malignant polyp and advanced adenoma has been equal to 23.5%.

DISCUSSION

Thanks to the reminders already sent, an increasing compliance has been registered with an increased rate of subjects with a low schooling that have performed a FOBT test. With the aim to optimize all the operative aspects of the screening programme it is already ongoing a set of meetings between health workers of Local Health Unit 4 and General Practioners.

[Quality indicators for colonoscopy: differences in polyp detection between endoscopists at one hospital]

OBJECTIVE

To compare quality indicators for colonoscopy between different endoscopists at a large community hospital in order to assess the quality of care and the need for structural implementation of quality measurement.

DESIGN

Retrospective, descriptive.

METHOD

Data were analysed from all colonoscopies performed by 5 experienced endoscopists (4 gastroenterologists, 1 internist) during the period November 2008-April 2009. For each endoscopist, the percentage of colonoscopies in which the caecum was intubated was established and the adenoma detection rate (ADR) scored. The ADR is the percentage of colonoscopies in which at least 1 adenomatous polyp is found. A comparison between endoscopists was performed thereafter.

RESULTS

A total of 1006 colonoscopies had been performed of which 700 were included. Mean patient age was 61 years (SD: 16). The caecal intubation rate ranged between 88-97% and was statistically significantly different between the endoscopists (p = 0.045). The ADR for all polyps also differed significantly between endoscopists (p < 0.01). Similar differences were found when only large polyps (> 15 mm) were counted. An age of more than 50 years and caecal intubation were independently associated with a greater chance of polyp detection, with odds ratios of 4.3 (95%-CI: 2.8-6.8) and 2.6 (95%-CI: 1.5-4.6), respectively.

CONCLUSION

Great variation in quality indicators for colonoscopy was found between endoscopists at a large community hospital. The outcome of this study stresses the need for structural implementation of transparent and measurable quality indicators for colonoscopy.

Korean type 2 diabetes patients have multiple adenomatous polyps compared to non-diabetic controls

We tested the correlation between diabetes and aggressiveness of colorectal polyps in diabetic patients and matched non-diabetic controls. We retrospectively studied 3,505 type 2 diabetes (T2DM) patients without gastrointestinal symptoms who underwent colonoscopy for colorectal cancer at Samsung Medical Center, Seoul, Korea from August 1995 to August 2009. We matched 495 non-diabetic subjects with colon polyps to the diabetic patients in whom polyps were detected by year of colonoscopy, age, sex and body mass index (BMI). Among the 3,505 T2DM patients screened, 509 were found to have 1,136 colon polyps. Those with diabetes had a greater proportion of adenomatous polyps (62.8% vs 53.6%) compared to the control. Multivariate logistic regression analysis identified DM, male gender, age and BMI as independent risk factors for multiple polyps (more than three polyps). Polyp multiplicity in diabetic patients was significantly associated with male gender (OR 2.360, P = 0.005), age (OR 1.033, P = 0.005) and BMI (OR 1.077, P = 0.028). Neither aspirin nor metformin use affected either size or number of polyps in diabetic patients. Male patients older than 65 yr with T2DM and BMI greater than 25 have increased risk for multiple adenomatous polyps and should be screened with colonoscopy to prevent colorectal cancer.

Colon cancer associated transcript-1: a novel RNA expressed in malignant and pre-malignant human tissues

Early detection of colorectal cancer (CRC) is currently based on fecal occult blood testing (FOBT) and colonoscopy, both which can significantly reduce CRC-related mortality. However, FOBT has low-sensitivity and specificity, whereas colonoscopy is labor- and cost-intensive. Therefore, the discovery of novel biomarkers that can be used for improved CRC screening, diagnosis, staging and as targets for novel therapies is of utmost importance. To identify novel CRC biomarkers we utilized representational difference analysis (RDA) and characterized a colon cancer associated transcript (CCAT1), demonstrating consistently strong expression in adenocarcinoma of the colon, while being largely undetectable in normal human tissues (p < 000.1). CCAT1 levels in CRC are on average 235-fold higher than those found in normal mucosa. Importantly, CCAT1 is strongly expressed in tissues representing the early phase of tumorigenesis: in adenomatous polyps and in tumor-proximal colonic epithelium, as well as in later stages of the disease (liver metastasis, for example). In CRC-associated lymph nodes, CCAT1 overexpression is detectable in all H&E positive, and 40.0% of H&E and immunohistochemistry negative lymph nodes, suggesting very high sensitivity. CCAT1 is also overexpressed in 40.0% of peripheral blood samples of patients with CRC but not in healthy controls. CCAT1 is therefore a highly specific and readily detectable marker for CRC and tumor-associated tissues.

Effectiveness of the immunofecal occult blood test for colorectal cancer screening in a large population

BACKGROUND

Guaiac tests are the most widely used tests to detect colorectal cancer (CRC). However, their sensitivity is relatively low and results may be affected by various factors. Immunofecal occult blood test (IFOBT) is specific for human hemoglobin and does not require dietary restrictions.

AIMS

The aim of this study was to evaluate the effectiveness of IFOBT for the screening of precancerous lesions and CRC.

METHODS

From July 2006 to June 2007, IFOBT was performed on 5,919 adults who received periodic health examinations in our hospital. The positive cases were examined by colonoscopy and a double-contrast barium enema. Diagnosis was confirmed by histopathological analysis.

RESULTS

Positive IFOBT was detected in 314 of 5,919 cases (5.30%). Further examinations were made in 264 IFOBT-positive cases. Of these, 116 cases with colorectal cancer (16 cases) or precancerous lesions (94 cases with colorectal adenomatous polyps and 6 cases with active ulcerative colitis) were detected. The total detection rate of CRC and precancerous lesions was 43.94% (116/264). TNM classification of 16 CRC cases was as follows: TNM I in eight cases (50.00%), TNM II in seven cases (43.75%) and TNM III in one case (6.25%), indicating IFOBT can detect CRC in the early stages.

CONCLUSION

Regular IFOBT can detect precancerous lesions and CRC in early stages and can thus reduce mortality from CRC.

Clinical and pathologic features of an adenomatous polyp of the colon in a domestic ferret (Mustela putorius furo)

A 6-year-old castrated male domestic ferret (Mustela putorius furo) with a 4-week history of intermittent diarrhea and straining during defecation had an intraluminal mass in the descending colon identified by abdominal ultrasound. The histopathological diagnosis of the resected mass was an adenomatous polyp of the colon. No post-operative complications were identified over a 32-month follow-up period.

Does chromoendoscopy improve the colonoscopic adenoma detection rate?

BACKGROUND/AIMS

It is not clear whether chromoendoscopy with indigo carmine improves the rate of detection of colorectal polyps compared to: detection via standard colonoscopy. The aim of our study was to determine whether chromoendoscopy with indigo carmine significantly improves the detection of adenomas in the distal colon and rectum.

METHODOLOGY

Using back-to-back sigmoidoscopies in each study patient, we prospectively evaluated whether chromoendoscopy with indigo carmine picked up more adenomatous polyps than standard colonoscopy. In all patients, standard high-resolution complete colonoscopy without indigo carmine was performed at the first examination. The second examination was restricted to colonoscopy distal to the splenic flexure of the colon. For the second examination, patients were randomized to chromoendoscopy with indigo carmine or colonoscopy without indigo carmine application. The second examination's detection rate was compared between the two groups.

RESULTS

In the 60 patients in the chromoendoscopy with indigo carmine group, 38 adenomas were found in the first examination and 14 adenomas in the second examination. In the 70 patients in the standard colonoscopy group, 66 adenomas were found in the first examination and 32 adenomas in the second examination. The detection rates in the two groups were 26.9% and 32.7%, re spectively, which were not significantly different (p = 0.47).

CONCLUSION

Chromoendoscopy did not detect more adenomatous polyps in comparison to standard colonoscopy.