Performance improvements of imaging-based screening tests

Is there a difference in adenoma detection rates between gastroenterologists and surgeons?

AIM

To compare the adenoma detection rate (ADR) between gastroenterologists and colorectal surgeons at Box Hill Hospital, Melbourne, Australia.

METHODS

A total of 300 colonoscopies performed by gastroenterologists and colorectal surgeons at Box Hill Hospital were retrospectively reviewed from May 2016 to June 2017. Exclusion criteria were: Patients ≤ 50 years old, colonoscopies with failure of caecal intubation, patients who previously had colon cancer and/or a colonic resection, history of polyposis syndromes or inflammatory bowel disease, or a colonoscopy within the last 10 years. Patient demographics, indications, symptoms and procedural-related outcomes were measured.

RESULTS

The ADR was not significantly different between gastroenterologists and colorectal surgeons (34% vs 34.67%; P = 0.90). The adjusted odds ratio correcting for gender, age, 1^st degree relative with colorectal cancer, previous colonoscopy, trainee involvement and caecal or terminal ileum intubation rate was 1.19 (0.69-2.05).

CONCLUSION

Both specialties at our institution exceed benchmark standards suggested by published Australian and American guidelines. An association between endoscopist specialty and ADR was not observed.

Precancerous lesions in inflammatory bowel disease

Reduction of mortality from colorectal cancer is a prime goal in the clinical management of patients with extensive, longstanding ulcerative colitis and colonic Crohn's disease. The cornerstone of current cancer prevention efforts is endoscopic surveillance for colorectal dysplasia, or intraepithelial neoplasia, the direct histological precursor of cancer. A diagnosis of dysplasia provides a reliable indicator of heightened cancer risk and an end-point for colonoscopic surveillance allowing most patients to undergo prophylactic colectomy before the development of incurable cancer. This article reviews the classification, pathological criteria and clinical implications of colorectal dysplasia, current recommendations for the performance of surveillance colonoscopy, recent technical advances in colonoscopic imaging to enhance the detection of dysplasia, and a summary of the molecular genetic events implicated in its development.

Advances in oncologic imaging: update on 5 common cancers

Imaging has become a pivotal component throughout a patient's encounter with cancer, from initial disease detection and characterization through treatment response assessment and posttreatment follow-up. Recent progress in imaging technology has presented new opportunities for improving clinical care. This article provides updates on the latest approaches to imaging of 5 common cancers: breast, lung, prostate, and colorectal cancers, and lymphoma.