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Ahadi M, Kazemi Nejad B, Kishani Farahani Z, Mollasharifi T, Jamali E, Mohaghegh Shalmani H, Dehgan A, Saberi Afsharian M, Sadeghi A, Movafagh A, Boran R, Rakhshan A, Moradi A, Heidari MH, Moradi A. Clinicopathologic Features of Colorectal Polyps in Shahid Beheshti University of Medical Sciences (SBMU). Asian Pac J Cancer Prev 2019; 20:1773-1780. [PMID: 31244299 PMCID: PMC7021591 DOI: 10.31557/apjcp.2019.20.6.1773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Indexed: 12/24/2022] Open
Abstract
Aim: This study was designed to report epidemiologic findings of polyps in Iranian patients, and predict histology of polyp regarding to demographic and colonoscopic findings. Background: Classification of colorectal polyps had been revised in the past two decades and there is a need for polyp categorization in the Iranian Health System. Patients and methods: In this retrospective study, the medical records of patients with colonoscopic diagnosis of polyp in pathology departments of SBMU affiliated teaching hospitals were reviewed. Patient’s slides evaluated and demographics findings were assessed. The anatomical location, macroscopic appearance including size and histological assessment of all polyps were recorded. Results: From total number of 1106 polyps (detected in 862 patients), adenomatous polyps (638 [57.7%]) were the most prevalent findings, followed by colon mucosal tag (184[16.6%]), hyperplastic and serrated polyps (122[11%]), inflammatory polyps (110[9.9%]), hamartomatous (21[1.9%]), and malignant lesions (13[1.2%]). Multivariate logistic regression showed age (each one year increasing age; odds ratio [OR] = 1.026, 95%confidence interval [CI] = 1.016–1.036, p < 0.0001), location of polyp (right colon; OR = 1.905, 95%CI = 1.366–2.656, p < 0.0001), and polyp size of 5-10 mm (OR = 1.662, 95%CI = 1.214–2.276, p = 0.002), and polyp size of >10 mm (OR = 2.778, 95%CI = 1.750–4.411, p< 0.0001) were independently associated with neoplastic polyps. Also, polyp size of >10 mm (OR= 2.613, 95%CI= 1.083-6.307, p=0.033), tubulovillous pattern of polyp (OR= 3.508, 95%CI= 1.666-7.387, p=0.001) and villous pattern of polyp (OR= 10.444, 95%CI= 4.211-25.905, p<0.0001) were associated with high grade dysplasia in neoplastic polyps. Conclusion: Increased age, location of polyp (right colon), increased size of polyp and villous component of polyp could classify patients in high risk groups.
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Affiliation(s)
- Mahsa Ahadi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Behrang Kazemi Nejad
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Tahmineh Mollasharifi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Elena Jamali
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hamid Mohaghegh Shalmani
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Dehgan
- Department of Pathology, Hamedan University of Medical Sciences, Hamedan, Iran
| | | | - Amir Sadeghi
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abolfazl Movafagh
- Department of Medical Genetics, Schoolof Medicine, Shahid Behesti University of Medical Sciences, Tehran, Iran
| | - Roxana Boran
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Azadeh Rakhshan
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Arsham Moradi
- University of Toronto, Department of Biology, Toronto, Canada
| | - Mohammad Hassan Heidari
- Department of Anatomy, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Moradi
- Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ,Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sansone S, Ragunath K, Bianco MA, Manguso F, Beg S, Bagewadi A, Din S, Rotondano G. Clinical utility of the SMSA grading tool for the management of colonic neoplastic lesions. Dig Liver Dis 2017; 49:518-522. [PMID: 28096059 DOI: 10.1016/j.dld.2016.12.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/18/2016] [Accepted: 12/19/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Whilst polyp size has been traditionally used as a predictor of the complexity of endoscopic resection, the influence of other factors is increasingly recognised. The SMSA grading system takes into account polyp Site, Morphology, Size and Access, with higher scores correlating with increased technical difficulty. AIMS To evaluate whether the SMSA grading tool correlates with endoscopic and clinical outcomes. METHODS This retrospective study was conducted at two high volume centres in the United Kingdom and Italy. All polyps identified at colonoscopy were included in this study and classified as per the SMSA grading system. RESULTS A total of 1668 lesions were resected in 1016 patients. There was a positive correlation between increasing SMSA level and the inability to resect lesions "en bloc" (p<0.001). Histologically complete clearance was higher in the lower SMSA groups (p<0.0001). Additional endoscopic therapies, were more commonly required with the higher SMSA groups to achieve histological clearance (p<0.0001). Moreover, advanced histology in resection specimens and procedural complications were significantly less common in SMSA level 1 lesions compared to level 3 or 4 lesions (p<0.0001). CONCLUSIONS The SMSA grading tool is a useful predictor of outcome following the resection of colonic neoplastic lesions.
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Affiliation(s)
- Stefano Sansone
- Gastroenterology, Hospital Maresca, ASLNA3sud, Torre del Greco, Italy; NIHR Nottingham Digestive Diseases Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospitals NHS Trust, UK.
| | - Krish Ragunath
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospitals NHS Trust, UK
| | | | | | - Sabina Beg
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospitals NHS Trust, UK
| | - Abhay Bagewadi
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospitals NHS Trust, UK
| | - Said Din
- Derby Teaching Hospitals, NHS Foundation Trust, UK
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Hewett DG, Sakata S. Classifications for optical diagnosis of colorectal lesions: not 2B with JNET. Gastrointest Endosc 2017; 85:822-828. [PMID: 28317692 DOI: 10.1016/j.gie.2017.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/07/2017] [Indexed: 02/06/2023]
Affiliation(s)
- David G Hewett
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Gastroenterology, Mater Health, Brisbane, Queensland, Australia
| | - Shinichiro Sakata
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Sakata S, Kheir AO, Hewett DG. Optical diagnosis of colorectal neoplasia: A Western perspective. Dig Endosc 2016; 28:281-8. [PMID: 26841371 DOI: 10.1111/den.12625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/25/2016] [Accepted: 02/01/2016] [Indexed: 02/08/2023]
Abstract
Optical diagnosis is an emerging paradigm in Western endoscopic practice for the colonoscopic management of diminutive polyps, and includes two complementary clinical strategies: 'resect and discard', in which diminutive high-confidence adenomas are identified, and then removed and discarded without pathological assessment; and 'diagnose and leave', where diminutive high-confidence hyperplastic polyps are identified in the rectosigmoid and then left without resection or biopsy. Like other aspects of colonoscopy performance, adoption of optical diagnosis in Western practice is limited by operator dependency and variation in clinical effectiveness. There is substantial potential for optical diagnosis of colorectal neoplasia during colonoscopy to alleviate the rising costs of health care in the West. However, operator dependence in diagnostic performance together with critical system factors such as informed consent, credentialing, medical legal support and reimbursement incentives must be overcome before optical diagnosis of diminutive lesions is considered for widespread adoption in Western clinical practice.
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Affiliation(s)
- Shinichiro Sakata
- School of Medicine, The University of Queensland, Brisbane, Australia.,Division of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
| | - Ammar O Kheir
- Division of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
| | - David G Hewett
- School of Medicine, The University of Queensland, Brisbane, Australia.,Division of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
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Rex DK, Patel NJ, Vemulapalli KC. A survey of patient acceptance of resect and discard for diminutive polyps. Gastrointest Endosc 2015; 82:376-380.e1. [PMID: 26071067 DOI: 10.1016/j.gie.2015.04.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/15/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Resect and discard is a new paradigm for management of diminutive colon polyps. Little is known regarding whether patients would accept resect and discard. We surveyed colonoscopy patients and their drivers regarding acceptance of resect and discard. METHODS This was a cross-sectional survey of colonoscopy outpatients and their drivers at two outpatient academic endoscopy centers. RESULTS Four hundred fifteen colonoscopy patients and 293 drivers completed the survey (93.5% of all invited participants). Results for the two groups were similar. Overall, 66.3% indicated they would accept resect and discard. Participants who were younger, white, and seen at the ambulatory surgery center (vs the hospital outpatient department) were more likely to accept. Those declining resect and discard were more likely to be willing to pay some amount out-of-pocket to have diminutive polyps checked by pathology (97.1% vs 44.5%). Of those unwilling to accept resect and discard, 49.8% would require a zero chance of cancer in diminutive polyps before accepting resect and discard. CONCLUSIONS Patient acceptance of resect and discard appears promising but is quite variable. Eliciting individual patient acceptance of resect and discard will be important during initial implementation into clinical practice.
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Affiliation(s)
- Douglas K Rex
- Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Nedhi J Patel
- Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Krishna C Vemulapalli
- Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Rex DK. Impediments to implementation of real-time pathology prediction in Barrett's esophagus and colorectal polyps. Endosc Int Open 2015; 3:E186-8. [PMID: 26171428 PMCID: PMC4486029 DOI: 10.1055/s-0034-1391850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 02/20/2015] [Indexed: 11/20/2022] Open
Affiliation(s)
- Douglas K. Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, United States,Corresponding author Douglas K. Rex Indiana University School of Medicine – Gastroenterology550 N. University Blvd., Suite 4100Indianapolis, Indiana 46202United States+1-317-944-5449
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