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Taylor SA. CT Colonography Reporting and Data System Version 2023: Updated, Robust, and Relevant. Radiology 2024; 310:e233169. [PMID: 38289211 DOI: 10.1148/radiol.233169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Stuart A Taylor
- From the UCL Centre for Medical Imaging, Division of Medicine, 2nd Floor Charles Bell House, 43-45 Foley St, London W1W 7TY, England
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2
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Shen MH, Liu CY, Chang KW, Lai CL, Chang SC, Huang CJ. Propolis Has an Anticancer Effect on Early Stage Colorectal Cancer by Affecting Epithelial Differentiation and Gut Immunity in the Tumor Microenvironment. Nutrients 2023; 15:4494. [PMID: 37960147 PMCID: PMC10648826 DOI: 10.3390/nu15214494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common cancers and is the second leading cause of cancer-related death in the world. Due to the westernization of diets, young patients with CRC are often diagnosed at advanced stages with an associated poor prognosis. Improved lifestyle choices are one way to minimize CRC risk. Among diet choices is the inclusion of bee propolis, long recognized as a health supplement with anticancer activities. Understanding the effect of propolis on the gut environment is worth exploring, and especially its associated intratumoral immune changes and its anticancer effect on the occurrence and development of CRC. In this study, early stage CRC was induced with 1,2-dimethylhydrazine (DMH) and dextran sulfate sodium (DSS) for one month in an animal model, without and with propolis administration. The phenotypes of early stage CRC were evaluated by X-ray microcomputed tomography and histologic examination. The gut immunity of the tumor microenvironment was assessed by immunohistochemical staining for tumor-infiltrating lymphocytes (TILs) and further comparative quantification. We found that the characteristics of the CRC mice, including the body weight, tumor loading, and tumor dimensions, were significantly changed due to propolis administration. With further propolis administration, the CRC tissues of DMH/DSS-treated mice showed decreased cytokeratin 20 levels, a marker for intestinal epithelium differentiation. Additionally, the signal intensity and density of CD3+ and CD4+ TILs were significantly increased and fewer forkhead box protein P3 (FOXP3) lymphocytes were observed in the lamina propria. In conclusion, we found that propolis, a natural supplement, potentially prevented CRC progression by increasing CD3+ and CD4+ TILs and reducing FOXP3 lymphocytes in the tumor microenvironment of early stage CRC. Our study could suggest a promising role for propolis in complementary medicine as a food supplement to decrease or prevent CRC progression.
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Affiliation(s)
- Ming-Hung Shen
- Department of Surgery, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City 243089, Taiwan;
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan;
| | - Chih-Yi Liu
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan;
- Department of Pathology, Sijhih Cathay General Hospital, New Taipei City 221037, Taiwan
| | - Kang-Wei Chang
- Taipei Neuroscience Institute, Taipei Medical University, Taipei City 110301, Taiwan;
- Laboratory Animal Center, Taipei Medical University, Taipei City 110301, Taiwan
| | - Ching-Long Lai
- Division of Basic Medical Sciences, Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City 333324, Taiwan;
- Research Center for Chinese Herbal Medicine, Chang Gung University of Science and Technology, Taoyuan City 333324, Taiwan
| | - Shih-Chang Chang
- Division of Colorectal Surgery, Department of Surgery, Cathay General Hospital, Taipei City 106438, Taiwan;
| | - Chi-Jung Huang
- Department of Biochemistry, National Defense Medical Center, Taipei City 114201, Taiwan
- Department of Medical Research, Cathay General Hospital, Taipei City 106438, Taiwan
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3
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Chervenkov L, Sirakov N, Georgiev A, Miteva D, Gulinac M, Peshevska-Sekulovska M, Sekulovski M, Velikova T. High Concordance of CT Colonography and Colonoscopy Allows for the Distinguishing and Diagnosing of Intestinal Diseases. Life (Basel) 2023; 13:1906. [PMID: 37763309 PMCID: PMC10532908 DOI: 10.3390/life13091906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/26/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Although new imaging methods for examining the GIT with high diagnostic capabilities were introduced, the improvement and implementation of safe, efficient, and cost-effective approaches continue, and GIT diseases are still challenging to diagnose; (2) Methods: We aim to show the possibilities of computed tomography (CT) colonography for early diagnosis of colon diseases using a multidetector 32-channel CT scanner after appropriate preparation; (3) Results: After a colonoscopy was performed earlier, 140 patients were examined with CT colonography. Complete colonoscopy was performed in 80 patients (57.1%) out of 140 who underwent CT colonography. Incomplete colonoscopy was observed in 52 patients (37.2%); in 5 patients (3.6%), it was contraindicated, and in 3 patients (2.1%), it was not performed because of patients' refusal. We determined that in cases of complete FCS in 95% of patients, CT colonography established the same clinical diagnosis as FCS. In cases of incomplete, refused, or contraindicated FCS in 32.7% (17 patients), FCS failed to diagnose correctly. The main reasons for incomplete colonoscopy were: intraluminal obturation of tumor nature-17 patients (33%), extraluminal obturation (compression) from a tumor formation-4 patients (8%), stenotic changes of non-tumor nature-11 patients (21%), congenital diseases with changes in the length of the lumen of the intestinal loops-7 patients (13%), and subjective factors (pain, poor preparation, contraindications) in 13 patients (25%); (4) Conclusions: Our results confirmed that CT colonography is a method of choice in cases of negative FCS results accompanied by clinical data for the neoplastic process and in cases of incomplete and contraindicated FCS. Also, the insufflation system we developed optimizes the method by improving the quality of the obtained images and ensuring good patient tolerance.
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Affiliation(s)
- Lyubomir Chervenkov
- Department of Diagnostic Imaging, Medical University Plovdiv, 4000 Plovdiv, Bulgaria; (L.C.); (A.G.)
- Research Complex for Translational Neuroscience, Medical University of Plovdiv, Bul. Vasil Aprilov 15A, 4002 Plovdiv, Bulgaria;
| | - Nikolay Sirakov
- Research Complex for Translational Neuroscience, Medical University of Plovdiv, Bul. Vasil Aprilov 15A, 4002 Plovdiv, Bulgaria;
- Department of Diagnostic Imaging, Dental Allergology and Physiotherapy, Faculty of Dental Medicine, Medical University Plovdiv, 4000 Plovdiv, Bulgaria
| | - Aleksander Georgiev
- Department of Diagnostic Imaging, Medical University Plovdiv, 4000 Plovdiv, Bulgaria; (L.C.); (A.G.)
| | - Dimitrina Miteva
- Department of Genetics, Faculty of Biology, Sofia University “St. Kliment Ohridski”, 8 Dragan Tzankov Str., 1164 Sofia, Bulgaria;
- Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria; (M.G.); (M.P.-S.); (M.S.)
| | - Milena Gulinac
- Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria; (M.G.); (M.P.-S.); (M.S.)
- Department of General and Clinical Pathology, Medical University of Plovdiv, Bul. Vasil Aprilov 15A, 4000 Plovdiv, Bulgaria
| | - Monika Peshevska-Sekulovska
- Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria; (M.G.); (M.P.-S.); (M.S.)
- Department of Gastroenterology, University Hospital Lozenetz, 1407 Sofia, Bulgaria
| | - Metodija Sekulovski
- Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria; (M.G.); (M.P.-S.); (M.S.)
- Department of Anesthesiology and Intensive Care, University Hospital Lozenetz, 1 Kozyak Str., 1407 Sofia, Bulgaria
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria; (M.G.); (M.P.-S.); (M.S.)
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4
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Hsu WF, Su CW, Hsu CY, Yen AMF, Chen SLS, Chiu SYH, Lee YC, Hsu TH, Lin LJ, Chia SL, Wu MS, Chen HH, Chiu HM. Double-contrast barium enema is no longer justified as a backup examination for colonoscopy in the population screening program: Population study in an organized fecal immunochemical test-based screening program. J Gastroenterol Hepatol 2023; 38:1299-1306. [PMID: 37078599 DOI: 10.1111/jgh.16191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/12/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND AND AIM Currently, some countries still acknowledge double-contrast barium enema (DCBE) as a backup confirmatory examination when colonoscopy is not feasible or incomplete in colorectal cancer (CRC) screening programs. This study aims to compare the performance of colonoscopy and DCBE in terms of the risk of incident CRC after negative results in the fecal immunochemical test (FIT)-based Taiwan Colorectal Cancer Screening Program. METHODS Subjects who had positive FITs and received confirmatory exams, either colonoscopy or DCBE, without the findings of neoplastic lesions from 2004 to 2013 in the screening program comprised the study cohort. Both the colonoscopy and DCBE subcohorts were followed until the end of 2018 and linked to the Taiwan Cancer Registry to identify incident CRC cases. Multivariate analysis was conducted to compare the risk of incident CRC in both subcohorts after controlling for potential confounders. RESULTS A total of 102 761 colonoscopies and 5885 DCBEs were performed after positive FITs without neoplastic findings during the study period. By the end of 2018, 2113 CRCs (2.7 per 1000 person-years) and 368 CRCs (7.6 per 1000 person-years) occurred in the colonoscopy and DCBE subcohorts, respectively. After adjusting for major confounders, DCBE had a significantly higher risk of incident CRC than colonoscopy, with an adjusted HR of 2.81 (95% CI = 2.51-3.14). CONCLUSIONS In the FIT screening program, using DCBE as a backup examination was associated with a nearly threefold risk of incident CRC compared with colonoscopy, demonstrating that it is no longer justified as a backup examination for incomplete colonoscopy.
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Affiliation(s)
- Wen-Feng Hsu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chiu-Wen Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Yang Hsu
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan
| | - Yi-Chia Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsui-Hsia Hsu
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Li-Ju Lin
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Shu-Li Chia
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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5
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Mang T, Lampichler K, Scharitzer M. [CT colonography : Technique and indications]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:418-428. [PMID: 37249607 PMCID: PMC10234944 DOI: 10.1007/s00117-023-01153-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Dedicated radiological expertise and a high-quality examination, performed according to current technical standards and for accepted indications, are prerequisite to achieve excellent results with CT colonography (CTC). OBJECTIVES The aim of this article is to review current standards of the examination technique as well as indications and contraindications for CTC based on recent recommendations and guidelines. MATERIALS AND METHODS Based on extensive literature research, current knowledge about the examination technique and the indications and contraindications is summarized. RESULTS CTC is the radiological examination of choice for the detection of colorectal neoplasia. Beside incomplete or refused colonoscopy and contraindications to colonoscopy, CTC is also a noninvasive option for opportunistic colorectal cancer screening. The examination technique is based on a CTC-specific patient preparation scheme that includes fecal tagging, colonic distension, low-dose CT scans in two patient positions and a combined 2D and 3D data evaluation. CONCLUSIONS Performing CTC according to current technical standards is prerequisite for high-quality examinations and is, thus, also a key factor to obtain a correct diagnosis. CTC is a noninvasive examination, capable of providing clinically relevant diagnoses for a wide range of indications.
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Affiliation(s)
- Thomas Mang
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Katharina Lampichler
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Martina Scharitzer
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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Kadari M, Subhan M, Saji Parel N, Krishna PV, Gupta A, Uthayaseelan K, Uthayaseelan K, Sunkara NABS. CT Colonography and Colorectal Carcinoma: Current Trends and Emerging Developments. Cureus 2022; 14:e24916. [PMID: 35719832 PMCID: PMC9191267 DOI: 10.7759/cureus.24916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 12/24/2022] Open
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Yoshino T, Argilés G, Oki E, Martinelli E, Taniguchi H, Arnold D, Mishima S, Li Y, Smruti BK, Ahn JB, Faud I, Chee CE, Yeh KH, Lin PC, Chua C, Hasbullah HH, Lee MA, Sharma A, Sun Y, Curigliano G, Bando H, Lordick F, Yamanaka T, Tabernero J, Baba E, Cervantes A, Ohtsu A, Peters S, Ishioka C, Pentheroudakis G. Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis treatment and follow-up of patients with localised colon cancer. Ann Oncol 2021; 32:1496-1510. [PMID: 34411693 DOI: 10.1016/j.annonc.2021.08.1752] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 12/24/2022] Open
Abstract
The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of localised colon cancer was published in 2020. It was decided by both the ESMO and the Japanese Society of Medical Oncology (JSMO) to convene a special virtual guidelines meeting in March 2021 to adapt the ESMO 2020 guidelines to take into account the ethnic differences associated with the treatment of localised colon cancer in Asian patients. These guidelines represent the consensus opinions reached by experts in the treatment of patients with localised colon cancer representing the oncological societies of Japan (JSMO), China (CSCO), India (ISMPO), Korea (KSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS). The voting was based on scientific evidence and was independent of the current treatment practices and drug availability and reimbursement situations in the different Asian countries.
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Affiliation(s)
- T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
| | - G Argilés
- Luis Diaz Laboratory, MSKCC, Sloan Kettering Institute, New York, USA
| | - E Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - E Martinelli
- Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - H Taniguchi
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - D Arnold
- Asklepios Tumorzentrum Hamburg, AK Altona, Hamburg, Germany
| | - S Mishima
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Y Li
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - B K Smruti
- Department of Medical Oncology, Lilavati Hospital and Research Centre and Bombay Hospital, Mumbai, India
| | - J B Ahn
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Seoul, Korea
| | - I Faud
- Department of Radiotherapy & Oncology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - C E Chee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - K-H Yeh
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - P-C Lin
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - C Chua
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - H H Hasbullah
- Oncology Unit, Faculty of Medicine, UiTM Sg Buloh, Selangor, Malaysia
| | - M A Lee
- Division of Medical Oncology, Department of Internal Medicine, Cancer Research Institute, College of Medicine, St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - A Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Y Sun
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - G Curigliano
- Istituto Europeo di Oncologia, IRCCS and University of Milano, Milan, Italy
| | - H Bando
- Department of Clinical Oncology, Aichi Cancer Center, Nagoya, Japan
| | - F Lordick
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases, University Cancer Center, Leipzig University Medical Center, Leipzig, Germany
| | - T Yamanaka
- Department of Biostatistics, Yokohama City University, Kanagawa, Japan
| | - J Tabernero
- Department of Medical Oncology, Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), UVic-UCC, IOB-Quiron, Barcelona, Spain
| | - E Baba
- Department of Oncology and Social Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - A Cervantes
- CIBERONC, Department of Medical Oncology, Institute of Health Research, INCLIVIA, University of Valencia, Valencia, Spain
| | - A Ohtsu
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - S Peters
- Oncology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - C Ishioka
- Department of Clinical Oncology, Tohoku University School of Medicine, Sendai, Japan
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Computed tomographic colonography versus double-contrast barium enema for the preoperative evaluation of rectal cancer. Surg Today 2021; 52:755-762. [PMID: 34816321 DOI: 10.1007/s00595-021-02411-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE We investigated whether or not computed tomographic colonography (CTC) is a viable alternative to double-contrast barium enema (BE) for a preoperative rectal cancer evaluation. METHODS The size and distance from the anal canal to the lower or upper tumor borders were laterally measured in 147 patients who underwent CTC and BE. Measurements were grouped into early cancer, advanced, and after chemoradiation therapy (CRT). RESULTS In the early and advanced cancer groups, all lesions were visualized by BE. In contrast, 3 (7.8%) early and 8 (7.3%) advanced cases, located at the anterior wall near the anal canal, were not visualized by CTC because of liquid level formation. In the CRT group, 16 (23.5%) and 4 (5.8%) cases were not visualized by CTC and BE, respectively. The BE and CTC size measurements were similar among cohorts. However, the distance from the anal canal's superior margin tended to be longer with BE, especially in early cancer. The differences in distance from the anal canal were significantly larger in the early cancer group than in the other two groups (p = 0.0024). CONCLUSION CTC may be a viable alternative imaging modality in some cases. However, BE should be employed in anterior wall cases near the anal canal and CRT cases.
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Almeida-Lousada H, Mestre A, Ramalhete S, Price AJ, de Mello RA, Marreiros AD, Neves RPD, Castelo-Branco P. Screening for Colorectal Cancer Leading into a New Decade: The "Roaring '20s" for Epigenetic Biomarkers? Curr Oncol 2021; 28:4874-4893. [PMID: 34898591 PMCID: PMC8628779 DOI: 10.3390/curroncol28060411] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 12/16/2022] Open
Abstract
Colorectal cancer (CRC) has an important bearing (top five) on cancer incidence and mortality in the world. The etiology of sporadic CRC is related to the accumulation of genetic and epigenetic alterations that result in the appearance of cancer hallmarks such as abnormal proliferation, evasion of immune destruction, resistance to apoptosis, replicative immortality, and others, contributing to cancer promotion, invasion, and metastasis. It is estimated that, each year, at least four million people are diagnosed with CRC in the world. Depending on CRC staging at diagnosis, many of these patients die, as CRC is in the top four causes of cancer death in the world. New and improved screening tests for CRC are needed to detect the disease at an early stage and adopt patient management strategies to decrease the death toll. The three pillars of CRC screening are endoscopy, radiological imaging, and molecular assays. Endoscopic procedures comprise traditional colonoscopy, and more recently, capsule-based endoscopy. The main imaging modality remains Computed Tomography (CT) of the colon. Molecular approaches continue to grow in the diversity of biomarkers and the sophistication of the technologies deployed to detect them. What started with simple fecal occult blood tests has expanded to an armamentarium, including mutation detection and identification of aberrant epigenetic signatures known to be oncogenic. Biomarker-based screening methods have critical advantages and are likely to eclipse the classical modalities of imaging and endoscopy in the future. For example, imaging methods are costly and require highly specialized medical personnel. In the case of endoscopy, their invasiveness limits compliance from large swaths of the population, especially those with average CRC risk. Beyond mere discomfort and fear, there are legitimate iatrogenic concerns associated with endoscopy. The risks of perforation and infection make endoscopy best suited for a confirmatory role in cases where there are positive results from other diagnostic tests. Biomarker-based screening methods are largely non-invasive and are growing in scope. Epigenetic biomarkers, in particular, can be detected in feces and blood, are less invasive to the average-risk patient, detect early-stage CRC, and have a demonstrably superior patient follow-up. Given the heterogeneity of CRC as it evolves, optimal screening may require a battery of blood and stool tests, where each can leverage different pathways perturbed during carcinogenesis. What follows is a comprehensive, systematic review of the literature pertaining to the screening and diagnostic protocols used in CRC. Relevant articles were retrieved from the PubMed database using keywords including: "Screening", "Diagnosis", and "Biomarkers for CRC". American and European clinical trials in progress were included as well.
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Affiliation(s)
- Hélder Almeida-Lousada
- Faculty of Medicine and Biomedical Sciences (FMCB), Campus de Gambelas, University of Algarve, 8005-139 Faro, Portugal; (H.A.-L.); (A.M.); (S.R.); (R.A.d.M.); (A.D.M.)
- Algarve Biomedical Center Research Institute (ABC-RI), 8005-139 Faro, Portugal
| | - André Mestre
- Faculty of Medicine and Biomedical Sciences (FMCB), Campus de Gambelas, University of Algarve, 8005-139 Faro, Portugal; (H.A.-L.); (A.M.); (S.R.); (R.A.d.M.); (A.D.M.)
- Algarve Biomedical Center Research Institute (ABC-RI), 8005-139 Faro, Portugal
| | - Sara Ramalhete
- Faculty of Medicine and Biomedical Sciences (FMCB), Campus de Gambelas, University of Algarve, 8005-139 Faro, Portugal; (H.A.-L.); (A.M.); (S.R.); (R.A.d.M.); (A.D.M.)
- Algarve Biomedical Center Research Institute (ABC-RI), 8005-139 Faro, Portugal
| | - Aryeh J. Price
- School of Law, University of California, Berkeley, CA 94704, USA;
| | - Ramon Andrade de Mello
- Faculty of Medicine and Biomedical Sciences (FMCB), Campus de Gambelas, University of Algarve, 8005-139 Faro, Portugal; (H.A.-L.); (A.M.); (S.R.); (R.A.d.M.); (A.D.M.)
- Division of Medical Oncology, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo 04037-004, Brazil
- Precision Oncology & Health Economics Group (ONCOPRECH), Post-Graduation Program in Medicine, Nine of July University (UNINOVE), São Paulo 01525-000, Brazil
| | - Ana D. Marreiros
- Faculty of Medicine and Biomedical Sciences (FMCB), Campus de Gambelas, University of Algarve, 8005-139 Faro, Portugal; (H.A.-L.); (A.M.); (S.R.); (R.A.d.M.); (A.D.M.)
- Algarve Biomedical Center Research Institute (ABC-RI), 8005-139 Faro, Portugal
| | - Ricardo Pires das Neves
- CNC—Center for Neuroscience and Cell Biology, CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-517 Coimbra, Portugal
- IIIUC—Institute of Interdisciplinary Research, University of Coimbra, 3004-517 Coimbra, Portugal
- Correspondence: (R.P.d.N.); (P.C.-B.); Tel.: +351-231-249-170 (R.P.d.N.); +351-289-800-100 (ext. 7813) (P.C.-B.)
| | - Pedro Castelo-Branco
- Faculty of Medicine and Biomedical Sciences (FMCB), Campus de Gambelas, University of Algarve, 8005-139 Faro, Portugal; (H.A.-L.); (A.M.); (S.R.); (R.A.d.M.); (A.D.M.)
- Algarve Biomedical Center Research Institute (ABC-RI), 8005-139 Faro, Portugal
- Champalimaud Research Program, Champalimaud Center for the Unknown, 1400-038 Lisbon, Portugal
- Correspondence: (R.P.d.N.); (P.C.-B.); Tel.: +351-231-249-170 (R.P.d.N.); +351-289-800-100 (ext. 7813) (P.C.-B.)
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Computed Tomography Colonography Angiography (CTC-A) prior to colectomy for cancer: A new tool for surgeons. J Visc Surg 2021; 159:136-143. [PMID: 34794900 DOI: 10.1016/j.jviscsurg.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The pre-operative work-up for non-metastatic colon cancer includes colonoscopy and thoraco-abdomino-pelvic computed tomography (CT) with intravenous (IV) contrast. Colonoscopic determination of the anatomical location of the tumor may be erroneous, particularly with a long redundant colon (dolichocolon), and the search for synchronous colon neoplasms is limited when the endoscope cannot traverse the tumor-bearing segment. While computed tomography colonography angiography (CTC-A) makes it possible to assess distant tumor metastasis, it remains limited for the assessment of loco-regional extension. CTC-A requires specific colonic preparation, controlled colonic insufflation with CO2, and an injection of IV contrast. CTC-A provides a 3-D view of the overall morphology of the colon and precisely localizes the site of the colonic tumor. Merging the images of the colon with those of mesenteric and colonic vessels provides a representation of anatomical vascular variations. This information could help the surgeon to better plan the colectomy. The use of two-dimensional images of CTC-A with sections perpendicular to the major axis of the tumor-bearing colonic segment can provide precise information on the degree of parietal extension and be useful in evaluating the value of neo-adjuvant chemotherapy.
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11
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Lin N, Qiu J, Song J, Yu C, Fang Y, Wu W, Yang W, Wang Y. Application of nano-carbon and titanium clip combined labeling in robot-assisted laparoscopic transverse colon cancer surgery. BMC Surg 2021; 21:257. [PMID: 34030673 PMCID: PMC8142471 DOI: 10.1186/s12893-021-01248-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 05/13/2021] [Indexed: 12/15/2022] Open
Abstract
Background Robot-assisted laparoscopic transverse colon tumor surgery requires precise tumor localization. The purpose of this study was to evaluate the safety and efficacy of nano-carbon and titanium clip combination labeling methods in robot-assisted transverse colon tumor surgery. Methods From January 2018 to January 2019, the clinical data of 16 patients who come from FuZhou, China underwent preoperative nano-carbon and titanium clip combined with robot-assisted laparoscopic transverse colon cancer surgery were retrospectively analyzed. Results Of the 16 patients, no signs of abdominal pain, fever, or diarrhea were observed after colonoscopy. Two titanium clips were seen on all of the 16 patients' abdominal plain films. Nano-carbon staining sites were observed during the operation, and no staining disappeared or abdominal cavity contamination. All patients underwent R0 resection. The average number of lymph nodes harvsted was 18.23 ± 5.04 (range, 9–32). The average time to locate the lesion under the laparoscopic was 3.03 ± 1.26 min (range, 1–6 min), and the average operation time was 321.43 ± 49.23 min (range, 240–400 min). All were consistent with the surgical plan, and there was no intraoperative change of surgical procedure or conversion to open surgery. Conclusion Preoperative colonoscopy combined with nano-carbon and titanium clip is safe and effective in robot-assisted transverse colon cancer surgery. A At the same time, the labeling method shows potential in shortening the operation time, ensuring sufficient safety margin and reducing complications.
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Affiliation(s)
- Nan Lin
- Department of General Surgery, 900 Hospital of the Joint Logistics Team, Fuzhou, China
| | - Jiandong Qiu
- Department of Oncological Surgery, Sanming First Hospital Affiliated to Fujian Medical University, Fuzhou, China
| | - Junchuan Song
- Department of General Surgery, Dongfang Hospital, Xiamen University, Xiamen, China
| | - Changwei Yu
- Clinical Institute of Fuzhou General Hospital, Fujian Medical University, Fuzhou, China
| | - Yongchao Fang
- Department of General Surgery, Dongfang Hospital, Xiamen University, Xiamen, China
| | - Weihang Wu
- Department of General Surgery, 900 Hospital of the Joint Logistics Team, Fuzhou, China
| | - Weijin Yang
- Department of General Surgery, 900 Hospital of the Joint Logistics Team, Fuzhou, China
| | - Yu Wang
- Department of General Surgery, 900 Hospital of the Joint Logistics Team, Fuzhou, China.
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12
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Foley KG, Pearson B, Riddell Z, Taylor SA. Opportunities in cancer imaging: a review of oesophageal, gastric and colorectal malignancies. Clin Radiol 2021; 76:748-762. [PMID: 33579518 DOI: 10.1016/j.crad.2021.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/13/2021] [Indexed: 02/07/2023]
Abstract
The incidence of gastrointestinal (GI) malignancy is increasing worldwide. In particular, there is a concerning rise in incidence of GI cancer in younger adults. Direct endoscopic visualisation of luminal tumour sites requires invasive procedures, which are associated with certain risks, but remain necessary because of limitations in current imaging techniques and the continuing need to obtain tissue for diagnosis and genetic analysis; however, management of GI cancer is increasingly reliant on non-invasive, radiological imaging to diagnose, stage, and treat these malignancies. Oesophageal, gastric, and colorectal malignancies require specialist investigation and treatment due to the complex nature of the anatomy, biology, and subsequent treatment strategies. As cancer imaging techniques develop, many opportunities to improve tumour detection, diagnostic accuracy and treatment monitoring present themselves. This review article aims to report current imaging practice, advances in various radiological modalities in relation to GI luminal tumour sites and describes opportunities for GI radiologists to improve patient outcomes.
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Affiliation(s)
- K G Foley
- Department of Clinical Radiology, Royal Glamorgan Hospital, Llantrisant, UK.
| | - B Pearson
- National Imaging Academy Wales (NIAW), Pencoed, UK
| | - Z Riddell
- National Imaging Academy Wales (NIAW), Pencoed, UK
| | - S A Taylor
- Centre for Medical Imaging, UCL, London, UK
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13
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Tan MB, Tan KP, Beh JCY, Chan EYK, Chin KFW, Chin ZY, Chua WM, Chong AWL, Gu GT, Hou W, Lai ACY, Lee RZ, Liew PJR, Lim MYS, Lim JLL, Tan Z, Tan E, Tan GSL, Tan TSE, Tan EJ, Tan ASM, Yan YY, Lim WEH. SingHealth Radiology Archives pictorial essay Part 2: gastroenterology, musculoskeletal, and obstetrics and gynaecology cases. Singapore Med J 2021; 62:8-15. [PMID: 33619570 DOI: 10.11622/smedj.2021008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Singapore Health Services cluster (SingHealth) radiology film archives are a valuable repository of local radiological cases dating back to the 1950s. Some of the cases in the archives are of historical medical interest, i.e. cerebral angiography in the workup of patients with hemiplegia. Other cases are of historical social interest, being conditions seen during earlier stages of Singapore's development, i.e. bound feet. The archives form a unique portal into the development of local radiology as well as the national development of Singapore. A selection from the archives is published in commemoration of the International Day of Radiology in 2020, as well as the 200th anniversary of the Singapore General Hospital in 2021. This pictorial essay comprises gastroenterology, musculoskeletal and obstetrics and gynaecology cases from the archives.
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Affiliation(s)
- Mark Bangwei Tan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Kim Ping Tan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | | | | | | | - Zong Yi Chin
- SingHealth Diagnostic Radiology Residency Programme, Singapore
| | - Wei Ming Chua
- SingHealth Diagnostic Radiology Residency Programme, Singapore
| | | | - Gary Tianyu Gu
- SingHealth Diagnostic Radiology Residency Programme, Singapore
| | - Wenlu Hou
- SingHealth Diagnostic Radiology Residency Programme, Singapore
| | - Anna Chooi Yan Lai
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | | | | | - May Yi Shan Lim
- SingHealth Diagnostic Radiology Residency Programme, Singapore
| | | | - Zehao Tan
- SingHealth Diagnostic Radiology Residency Programme, Singapore
| | - Eelin Tan
- SingHealth Diagnostic Radiology Residency Programme, Singapore
| | | | | | - Eu Jin Tan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | | | - Yet Yen Yan
- Department of Radiology, Changi General Hospital, Singapore
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14
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Circulating non-coding RNA cluster predicted the tumorigenesis and development of colorectal carcinoma. Aging (Albany NY) 2020; 12:23047-23066. [PMID: 33234723 PMCID: PMC7746361 DOI: 10.18632/aging.104055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/27/2020] [Indexed: 12/24/2022]
Abstract
Carcinoembryonic antigen (CEA) is the most significant plasma biomarker in colorectal cancer (CRC), which is mainly used to diagnose and monitor the recurrence of CRC. However, due to the low sensitivity of CEA, it is more recommended for postoperative surveillance rather than early diagnosis. It is necessary to find efficient biomarkers for CRC. In this study, the expression of plasma non-coding RNAs was confirmed in three independent cohorts with total 1201 participants. First, 12 non-coding RNAs were screened from 9 plasma samples by using microarray. The expression of selected non-coding RNAs was further validated by multiphase detection and risk score analysis. We found that miR-20b-5p, miR-329-3p, miR-374b-5p, miR-503-5p, XLOC_001120 and ENSG00000243766.2 were significantly elevated in CRC plasma, and the AUC in training and validation set was 0.996 and 0.954, respectively. Moreover, miR-20b-5p, miR-329-3p and miR-503-5p were found elevated in plasma from larger tumors (5 cm as the cutoff) in CRC patients, and the merged AUC in training and validation set was 0.896 and 0.881. In conclusion, a panel of 6 non-coding RNAs showed their important clinical value for the early diagnosis of CRC. Among, miR-20b-5p, miR-329-3p and miR-503-5p might be the potential markers for evaluating larger tumor size of CRC.
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15
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Argilés G, Tabernero J, Labianca R, Hochhauser D, Salazar R, Iveson T, Laurent-Puig P, Quirke P, Yoshino T, Taieb J, Martinelli E, Arnold D. Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2020; 31:1291-1305. [PMID: 32702383 DOI: 10.1016/j.annonc.2020.06.022] [Citation(s) in RCA: 582] [Impact Index Per Article: 145.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- G Argilés
- Department of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Spain
| | - J Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), UVic-UCC, IOB-Quiron, Barcelona, Spain
| | - R Labianca
- Department Oncology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - R Salazar
- Department of Medical Oncology, Catalan Institute of Oncology, Oncobell Program (IDIBELL), CIBERONC, Hospitalet de Llobregat, Barcelona, Spain
| | - T Iveson
- University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - P Laurent-Puig
- Assitance Publique-Hôpitaux de Paris AP-HP Paris Centre, Paris, France; Paris Cancer Institute CARPEM, Centre de Recherche des Cordeliers, Paris Sorbonne University, Paris University, Paris, France; INSERM, CNRS, Paris, France
| | - P Quirke
- Pathology and Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - T Yoshino
- National Cancer Centre Hospital East, Kashiwa, Japan
| | - J Taieb
- Assitance Publique-Hôpitaux de Paris AP-HP Paris Centre, Paris, France; Paris Cancer Institute CARPEM, Centre de Recherche des Cordeliers, Paris Sorbonne University, Paris University, Paris, France; INSERM, CNRS, Paris, France; Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - E Martinelli
- Università degli Studi della Campania Luigi Vanvitelli, Department of Precision Medicine, Naples, Italy
| | - D Arnold
- Asklepios Tumorzentrum Hamburg, AK Altona, Hamburg, Germany
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Zeinali-Rafsanjani B, Jalli R, Saeedi-Moghadam M, Pishdad P. Magnetic resonance spectroscopy and its application in colorectal cancer diagnosis and screening: A narrative review. J Med Imaging Radiat Sci 2020; 51:654-661. [PMID: 32718849 DOI: 10.1016/j.jmir.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 06/28/2020] [Accepted: 07/10/2020] [Indexed: 12/01/2022]
Abstract
There are several slightly invasive methods to detect colorectal carcinoma (CRC) including colonoscopy and sigmoidoscopy; but there is no noninvasive, accurate screening test. It is recommended to initiate screening at the age of 50 for non-familial CRC. Laboratory tests are routinely suggested if internal observation and imaging are recommended for further evaluation. Spectroscopic-based imaging, such as magnetic resonance spectroscopy (MRS) is an interesting and promising tool with the potential to be an alternative to some minimally invasive procedures, such as biopsy. Accordingly, MRS might be a suitable substitution for invasive methods, such as colonoscopy. This article aimed to review the studies that have evaluated the MRS technique as a screening tool in CRC.
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Affiliation(s)
- Banafsheh Zeinali-Rafsanjani
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Nuclear Medicine and Molecular Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Jalli
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Saeedi-Moghadam
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Parisa Pishdad
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
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17
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Update on Flexible Sigmoidoscopy, Computed Tomographic Colonography, and Capsule Colonoscopy. Gastrointest Endosc Clin N Am 2020; 30:569-583. [PMID: 32439089 DOI: 10.1016/j.giec.2020.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This article reviews alternative colorectal cancer (CRC) screening tests, including flexible sigmoidoscopy (FS), computed tomography (CT) colonography, and colon capsule endoscopy. FS has abundant and convincing evidence supporting its use for CRC screening and is a commonly used CRC test worldwide. CT colonography has demonstrated convincing results for CRC screening, but concerns regarding cost, accuracy for flat or sessile neoplasia, reproducibility, extracolonic findings, and lack of coverage have limited its use and development. Colon capsule endoscopy has demonstrated encouraging results for polyp detection in average-risk individuals, but is not approved for CRC screening at the current time.
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18
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Anayama T, Sato T, Hirohashi K, Miyazaki R, Yamamoto M, Okada H, Orihashi K, Inoue K, Kobayashi M, Yoshida M, Hanazaki K. Near-infrared fluorescent solid material for visualizing indwelling devices implanted for medical use. Surg Endosc 2020; 34:4206-4213. [PMID: 32430529 DOI: 10.1007/s00464-020-07634-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/13/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND In clinical practice, various devices are implanted into the body for medical reasons. As X-ray fluoroscopy is necessary to visualize medical devices implanted into the body, the development of a less-invasive visualization method is highly desired. This study aimed to investigate the clinical applicability of our novel solid material that emits near-infrared fluorescence. METHODS We developed a solid resin material that emits near-infrared fluorescence. This material incorporates a near-infrared fluorescent pigment, with quantum yield ≥ 20 times than that of indocyanine green. It can be sterilized for medical treatment. This resin material is designed to be molded into a catheter and inserted into the body with an endoscope clip. In this preclinical experiment using a swine model, the resin material was embedded into the body of the swine and visualized with a near-infrared fluorescence camera system. RESULTS Endoscopic clips were placed in the mucosa of the stomach, esophagus, and large intestine, and the indwelling ureteral catheters were successfully visualized by near-infrared fluorescence laparoscopy. CONCLUSIONS We confirmed the tissue permeability of the fluorescence emitted by our novel near-infrared fluorescent material and the possibility of its clinical application. This material may allow visualization of devices embedded in the body.
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Affiliation(s)
- Takashi Anayama
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kohasu Oko, Nankoku, 783-8505, Japan.
| | - Takayuki Sato
- Department of Cardiovascular Control, Kochi Medical School, Nankoku, Japan
| | - Kentaro Hirohashi
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kohasu Oko, Nankoku, 783-8505, Japan
| | - Ryohei Miyazaki
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kohasu Oko, Nankoku, 783-8505, Japan
| | - Marino Yamamoto
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kohasu Oko, Nankoku, 783-8505, Japan
| | - Hironobu Okada
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kohasu Oko, Nankoku, 783-8505, Japan
| | | | - Keiji Inoue
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Michiya Kobayashi
- Cancer Treatment Center, Kochi Medical School Hospital, Nankoku, Japan
| | - Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Kazuhiro Hanazaki
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku, Japan
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19
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Sha J, Chen J, Lv X, Liu S, Chen R, Zhang Z. Computed tomography colonography versus colonoscopy for detection of colorectal cancer: a diagnostic performance study. BMC Med Imaging 2020; 20:51. [PMID: 32423413 PMCID: PMC7236500 DOI: 10.1186/s12880-020-00446-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/23/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Colonoscopy is the reference standard for the detection of colorectal cancer but it is an invasive technique and has the risk of bowel perforation and bleeding. Unlike colonoscopy, sedation is not required in computed tomography colonography and requires additional reassurance endoscopy. The objectives of the study were to compare the diagnostic performance of computed tomography colonography against colonoscopy for a diagnosis of colorectal cancer. METHODS Data regarding any polyp ≥10 mm diameter (ø) and < 10 mm ø but suspicious polyps of computed tomography colonography (n = 318), colonoscopy (n = 318), and surgical pathology (n = 77) for symptomatic colorectal cancer patients were collected and analyzed. Lesion ulceration, extramural invasion, and/ or lesion shouldering was considered as a suspicious polyp. Beneficial scores for decision making of curative surgeries were evaluated for each modality. The cost of diagnosis of colorectal cancer was also evaluated. RESULTS Either of diagnosis showed polyps ≥10 mm ø in 27 patients and polyps of 50 patients were < 10 mm ø but suspicious. Therefore, a total of 77 patients were subjected to surgery. With respect to surgical pathology, sensitivities for computed tomographic colonography and colonoscopy were 0.961 and 0.831. For detection of ≥10 mm ø polyp, benefit score for computed tomographic colonography and colonoscopy were 0-0.906 diagnostic confidence and 0.035-0.5 diagnostic confidence. For polyps, ≥ 10 mm ø but not too many large polyps, colonoscopy had the risk of underdiagnosis. For < 10 mm ø but suspicious polyps, < 0.6 mm ø and < 2.2 mm ⌀ polyps could not be detected by computed tomographic colonography and colonoscopy, respectively. The computed tomographic colonography had less cost than colonoscopy (1345 ± 135 ¥/ patient vs. 1715 ± 241 ¥/ patient, p < 0.0001) for diagnosis of colorectal cancer. CONCLUSION Computed tomographic colonography would be a non-inferior alternative than colonoscopy for a diagnosis of colorectal cancer. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Junping Sha
- Department of Radiology, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao, 433000, Hubei, China
| | - Jun Chen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Xuguang Lv
- Department of Radiology, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao, 433000, Hubei, China
| | - Shaoxin Liu
- Department of Radiology, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao, 433000, Hubei, China
| | - Ruihong Chen
- Department of Gastroenterology, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao, 433000, Hubei, China
| | - Zhibing Zhang
- Department of Radiology, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao, 433000, Hubei, China.
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20
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Li J, Peng W, Yang P, Chen R, Gu Q, Qian W, Ji D, Wang Q, Zhang Z, Tang J, Sun Y. MicroRNA-1224-5p Inhibits Metastasis and Epithelial-Mesenchymal Transition in Colorectal Cancer by Targeting SP1-Mediated NF-κB Signaling Pathways. Front Oncol 2020; 10:294. [PMID: 32231999 PMCID: PMC7083241 DOI: 10.3389/fonc.2020.00294] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/19/2020] [Indexed: 01/12/2023] Open
Abstract
MicroRNAs (miRNAs) are small non-coding RNAs that play pivotal roles in cancer initiation and progression. However, the roles and molecular mechanisms of miRNAs in colorectal cancer (CRC) progression remain unclear. Here, we show that downregulation of miR-1224-5p in CRC is negatively correlated with SP1 expression and metastasis in patients and xenografted mouse models. Gain- and loss-of-function assays reveal that miR-1224-5p suppresses the migration, invasion, and epithelial–mesenchymal transition (EMT) of CRC cells in vitro and in vivo by directly targeting SP1. Moreover, SP1 promotes the phosphorylation of p65, which results in EMT progress in CRC cells. Clinical analysis reveals that miR-1224-5p and SP1 expression are remarkably associated with advanced clinical features and unfavorable prognosis of patients with CRC. Further study confirms that hypoxia accounts for the depletion of miR-1224-5p in CRC. The enhancement of hypoxia during epithelial–mesenchymal transition and metastasis of CRC cells is abolished by miR-1224-5p. Our findings provide the first evidence that miR-1224-5p is a potential therapeutic target and prognostic biomarker for patients with CRC.
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Affiliation(s)
- Jie Li
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, China.,Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wen Peng
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, China.,Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Peng Yang
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, China.,Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ranran Chen
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, China.,Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiou Gu
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, China.,Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenwei Qian
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, China.,Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dongjian Ji
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, China.,Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qingyuan Wang
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, China.,Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhiyuan Zhang
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, China.,Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Junwei Tang
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, China.,Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yueming Sun
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, China.,Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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21
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Computed tomography colonography: Radiographer independent preliminary clinical evaluation for intraluminal pathology. Radiography (Lond) 2019; 25:359-364. [DOI: 10.1016/j.radi.2019.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 04/24/2019] [Accepted: 04/28/2019] [Indexed: 01/22/2023]
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22
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Hissong E, Pittman ME. Colorectal carcinoma screening: Established methods and emerging technology. Crit Rev Clin Lab Sci 2019; 57:22-36. [PMID: 31603697 DOI: 10.1080/10408363.2019.1670614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Colorectal carcinoma screening programs have shown success in lowering both the incidence and mortality rate of colorectal carcinoma at a population level, in part because this carcinoma is relatively slow growing and has an identifiable premalignant lesion. Still, many patients do not undergo the recommended screening for colorectal carcinoma, and of those who do, a subset may be over- or under-diagnosed by the currently available testing methods. The primary purpose of this article is to review the data regarding currently available colorectal cancer screening modalities, which include fecal occult blood testing, direct colonic visualization, and noninvasive imaging techniques. In addition, readers will be introduced to a variety of biomarkers that may serve as stand-alone or adjunct tests in the future. Finally, there is a brief discussion of the current epidemiologic considerations that public health officials must address as they create population screening guidelines. The data we provide as laboratory physicians and scientists are critical to the construction of appropriate recommendations that ultimately decrease the burden of disease from colorectal carcinoma.
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Affiliation(s)
- Erika Hissong
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York City, NY, USA
| | - Meredith E Pittman
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York City, NY, USA
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Abstract
CLINICAL PROBLEM Colorectal cancer (CRC) is a major cause of cancer-related morbidity and mortality. Most colorectal cancers derive from benign precursor lesions, so-called adenomatous polyps, over a long period of time. Colorectal cancer screening is based on the detection of precancerous polyps and early stage CRC in asymptomatic individuals to reduce CRC incidence and mortality. The protective effect of screening programs can be improved by increasing the screening rates. PRACTICAL RECOMMENDATIONS Apart from the established examinations, CT colonography (CTC) has been proposed as an optional test for colorectal cancer screening. The detection rates of CTC for large polyps and cancer are similar to the ones of colonoscopy and superior to stool-based tests. CTC is therefore the radiological test of choice for the detection of colorectal neoplasia. It has replaced double contrast barium enema for almost all indications. As a minimally invasive procedure, CTC has a high safety profile and good patient acceptance. The evaluation of extracolonic organs in addition to the colon can increase examination efficacy. The option to choose CTC as a CRC screening test has the potential to increase the overall screening rates.
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Hong JT, Kim ER. Current state and future direction of screening tool for colorectal cancer. World J Meta-Anal 2019; 7:184-208. [DOI: 10.13105/wjma.v7.i5.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/25/2019] [Accepted: 05/28/2019] [Indexed: 02/06/2023] Open
Abstract
As the second-most-common cause of cancer death, colorectal cancer (CRC) has been recognized as one of the biggest health concerns in advanced countries. The 5-year survival rate for patients with early-stage CRC is significantly better than that for patients with CRC detected at a late stage. The primary target for CRC screening and prevention is advanced neoplasia, which includes both CRC itself, as well as benign but histologically advanced adenomas that are at increased risk for progression to malignancy. Prevention of CRC through detection of advanced adenomas is important. It is, therefore, necessary to develop more efficient detection methods to enable earlier detection and therefore better prognosis. Although a number of CRC diagnostic methods are currently used for early detection, including stool-based tests, traditional colonoscopy, etc., they have not shown optimal results due to several limitations. Hence, development of more reliable screening methods is required in order to detect the disease at an early stage. New screening tools also need to be able to accurately diagnose CRC and advanced adenoma, help guide treatment, and predict the prognosis along with being relatively simple and non-invasive. As part of such efforts, many proposals for the early detection of colorectal neoplasms have been introduced. For example, metabolomics, referring to the scientific study of the metabolism of living organisms, has been shown to be a possible approach for discovering CRC-related biomarkers. In addition, a growing number of high-performance screening methodologies could facilitate biomarker identification. In the present, evidence-based review, the authors summarize the current state as recognized by the recent guideline recommendation from the American Cancer Society, US Preventive Services Task Force and the United States Multi-Society Task Force and discuss future direction of screening tools for colorectal cancer. Further, we highlight the most interesting publications on new screening tools, like molecular biomarkers and metabolomics, and discuss these in detail.
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Affiliation(s)
- Ji Taek Hong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24253, South Korea
| | - Eun Ran Kim
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
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Obaro AE, Plumb AA, North MP, Halligan S, Burling DN. Computed tomographic colonography: how many and how fast should radiologists report? Eur Radiol 2019; 29:5784-5790. [PMID: 30963278 PMCID: PMC6795616 DOI: 10.1007/s00330-019-06175-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/07/2019] [Accepted: 03/15/2019] [Indexed: 12/17/2022]
Abstract
Objectives To determine if polyp detection at computed tomographic colonography (CTC) is associated with (a) the number of CTC examinations interpreted per day and (b) the length of time spent scrutinising the scan. Methods Retrospective observational study from two hospitals. We extracted Radiology Information System data for CTC examinations from Jan 2012 to Dec 2015. For each examination, we determined how many prior CTCs had been interpreted by the reporting radiologist on that day and how long radiologists spent on interpretation. For each radiologist, we calculated their referral rate (proportion deemed positive for 6 mm+ polyp/cancer), positive predictive value (PPV) and endoscopic/surgically proven polyp detection rate (PDR). We also calculated the mean time each radiologist spent interpreting normal studies (“negative interpretation time”). We used multilevel logistic regression to investigate the relationship between the number of scans reported each day, negative interpretation time and referral rate, PPV and PDR. Results Five thousand one hundred ninety-one scans were interpreted by seven radiologists; 892 (17.2%) were reported as positive, and 534 (10.3%) had polyps confirmed. Both referral rate and PDR reduced as more CTCs were reported on a given day (p < 0.001), the odds reducing by 7% for each successive CTC interpreted. Radiologists reporting more slowly than their colleagues detected more polyps (p = 0.028), with each 16% increase in interpretation time associated with a 1% increase in PDR. PPV was unaffected. Conclusions Reporting multiple CTCs on a given day and rapid CTC interpretation are associated with decreased polyp detection. Radiologists should be protected from requirements to report too many CTCs or too quickly. Key Points • CT colonography services should protect radiologists from a need to report too fast (> 20 min per case) or for too long (> 4 cases consecutively without a break). • Professional bodies should consider introducing a target minimum interpretation time for CT colonography examinations as a quality marker.
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Affiliation(s)
- Anu E Obaro
- Centre for Medical Imaging, Podium Level 2, University College London Hospital, Euston Rd, London, NW1 2BU, UK.,St Mark's Academic Institute, St Mark's Hospital, Harrow, UK
| | - Andrew A Plumb
- Centre for Medical Imaging, Podium Level 2, University College London Hospital, Euston Rd, London, NW1 2BU, UK.
| | - Michael P North
- St Mark's Academic Institute, St Mark's Hospital, Harrow, UK
| | - Steve Halligan
- Centre for Medical Imaging, Podium Level 2, University College London Hospital, Euston Rd, London, NW1 2BU, UK
| | - David N Burling
- St Mark's Academic Institute, St Mark's Hospital, Harrow, UK
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Moreno C, Kim DH, Bartel TB, Cash BD, Chang KJ, Feig BW, Fowler KJ, Garcia EM, Kambadakone AR, Lambert DL, Levy AD, Marin D, Peterson CM, Scheirey CD, Smith MP, Weinstein S, Carucci LR. ACR Appropriateness Criteria ® Colorectal Cancer Screening. J Am Coll Radiol 2019; 15:S56-S68. [PMID: 29724427 DOI: 10.1016/j.jacr.2018.03.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/19/2022]
Abstract
This review summarizes the relevant literature regarding colorectal screening with imaging. For individuals at average or moderate risk for colorectal cancer, CT colonography is usually appropriate for colorectal cancer screening. After positive results on a fecal occult blood test or immunohistochemical test, CT colonography is usually appropriate for colorectal cancer detection. For individuals at high risk for colorectal cancer (eg, hereditary nonpolyposis colorectal cancer, ulcerative colitis, or Crohn colitis), optical colonoscopy is preferred because of its ability to obtain biopsies to detect dysplasia. After incomplete colonoscopy, CT colonography is usually appropriate for colorectal cancer screening for individuals at average, moderate, or high risk. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - David H Kim
- Co-author and Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | | | - Brooks D Cash
- University of South Alabama, Mobile, Alabama; American Gastroenterological Association
| | | | - Barry W Feig
- University of Texas MD Anderson Cancer Center, Houston, Texas; American College of Surgeons
| | | | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | | | - Drew L Lambert
- University of Virginia Health System, Charlottesville, Virginia
| | - Angela D Levy
- Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Martin P Smith
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Montminy EM, Karlitz JJ, Landreneau SW. Progress of colorectal cancer screening in United States: Past achievements and future challenges. Prev Med 2019; 120:78-84. [PMID: 30579938 DOI: 10.1016/j.ypmed.2018.12.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/08/2018] [Accepted: 12/10/2018] [Indexed: 12/31/2022]
Abstract
The United States has seen progress with colorectal cancer with both falling incidence and mortality rates. Factoring into this decline, the significance of early detection and removal of precancerous lesions through screening must be underscored. With the advancement of screening modalities, attention has been directed towards optimizing the quality of screening and detecting adenomas. Colorectal cancer screening has been a major agenda item for national gastroenterology societies, culminating in a major victory with passage of the Balanced Budget Act that allowed for Medicare coverage of colorectal cancer screening. Colonoscopy as the primary screening modality was solidified in the 1990s after landmark studies demonstrated its superiority over modalities for detecting precancerous polyps. Despite progress, colorectal cancer screening disparities between race and gender continue to exist. Legislative efforts are on-going and include the SCREEN Act and Dent Act that aim to further improve access to screening. The National Colorectal Cancer Roundtable has launched colorectal cancer screening initiatives targeting at risk populations. Today, the current goal of these initiatives is to reach colorectal screening rate of 80% of eligible patients by 2018. With these initiatives, efforts to narrow the gaps in screening disparities and lower overall mortality have been prioritized and continued by the medical community. This review article details colorectal cancer screening progress to date and highlights major studies and initiatives that have solidified its success in the United States.
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Affiliation(s)
- Eric M Montminy
- Tulane University School of Medicine, Department of Internal Medicine, New Orleans, LA 70112.
| | - Jordan J Karlitz
- Tulane University Medical Center, Department of Gastroenterology, New Orleans, LA 70112; Southeast Louisiana Veterans Health Care System, Department of Gastroenterology, New Orleans, LA 70112
| | - Stephen W Landreneau
- Louisiana State University School of Medicine, Department of Gastroenterology, New Orleans, LA 70112
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Thorén F, Johnsson ÅA, Brandberg J, Hellström M. CT colonography: implementation, indications, and technical performance - a follow-up national survey. Acta Radiol 2019; 60:271-277. [PMID: 29898606 DOI: 10.1177/0284185118780899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Computed tomography colonography (CTC) is an accepted complement or alternative to optical colonoscopy (OC) but its implementation is incompletely analyzed, and technical performance varies between centers. PURPOSE To evaluate implementation, indications, and technical performance of CTC in Sweden and to evaluate compliance to international guidelines. MATERIAL AND METHODS A structured, self-assessed questionnaire regarding implementation and technical performance of CTC was sent to all eligible radiology departments in Sweden. Eighty-six out of 89 departments replied. Comparisons were made with similar national surveys from 2004 and 2009. RESULTS The number of centers performing CTC gradually increased from 23 in 2004 to 77 in 2016. In parallel, centers performing barium enema (BE) examinations have decreased from 89 in 2004 to 13 in 2016. Main reasons stated for still performing BE were lack of resources regarding CTC/OC. Main reasons for not performing CTC were lack of suitable software, lack of machine/reading time, and lack of experience. The majority of centers follow international CTC guidelines. An important exception is fecal tagging, which was implemented in only 63% of the centers. Incomplete OC remains a major indication for CTC, while preoperative CTC in colorectal cancer and follow-up after diverticulitis have emerged as new indications. CONCLUSION CTC today is well implemented in routine healthcare but still lacking in capacity. Indications have expanded over time, and most departments perform "state of the art" CTC, although fecal tagging is incompletely implemented.
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Sosna J, Kettanie A, Fraifeld S, Bar-Ziv J, Carel RS. Prevalence of polyps ≥6 mm on follow-up CT colonography in a cohort with no significant colon polyps at baseline. Clin Imaging 2019; 55:1-7. [PMID: 30690226 DOI: 10.1016/j.clinimag.2019.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 12/13/2022]
Abstract
AIM Assess the prevalence of neoplasia ≥6 mm at repeat CT colonoscopy (CTC) in individuals with no significant lesions at baseline. METHODS Individuals aged ≥18 years, with/without CRC risk factors, with no polyps ≥6 mm on baseline CTC (negative baseline) who underwent repeat CTC in a large HMO from 2001 to 2011 were retrospectively identified. Studies were reviewed by board-certified radiologists with experience interpreting CTC. Demographic details, CRC risk factors, and the number, size, and location of incident lesions were noted. Findings were classified using the C-RADS scale. Lesion prevalence at CTC-2 was determined, and study interval and risk characteristics of patients with- and without findings were compared. RESULTS Our study included 636 individuals (369 men [58.0%]; mean age 59.9 years) with negative baseline CTC who underwent repeat CTC after a mean 4.6 year interval (SD 1.6 years). At baseline, 469/636 (73.7%) were at average risk for CRC; 418 remained at average risk for CTC-2 with 51 (8.0%) developing new risk factors in the interval between studies. At CTC-2, 47 participants (7.4%) presented 52 significant neoplasia: 35 polyps 6-9 mm, 14 polyps ≥10 mm, and 3 masses in 3/636 participants (0.47%). 2/3 masses, 6/14 polyps ≥10 mm (42.9%), and 12/25 polyps 6-9 mm (48.0%) were in individuals with risk factors for CRC. Histopathology was available for 12/52 lesions (23.1%): 8 tubular adenomas, 2 villous adenomas, 1 hamartomatous polyp, 1 case of normal tissue. CONCLUSION A mean 4.6 years after negative-baseline CTC, neoplasia ≥6 mm were seen in 7.4% of participants, including masses in 0.47%, supporting recommendations for a 5-year study interval.
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Affiliation(s)
- Jacob Sosna
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem 91120l, Israel; Department of Radiology, Beth Israel Deaconess Medical Center, Harvard School of Medicine, Boston, MA 02215, USA; MOR Institute for Medical Data, Bnei Brak 51377, Israel.
| | - Amir Kettanie
- Hebrew University-Hadassah School of Medicine, Jerusalem 91120, Israel
| | - Shifra Fraifeld
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem 91120l, Israel
| | - Jacob Bar-Ziv
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem 91120l, Israel; University of Haifa, School of Public Health, Faculty of Social Welfare & Health Sciences, Haifa 34988, Israel.
| | - Rafael S Carel
- MOR Institute for Medical Data, Bnei Brak 51377, Israel; University of Haifa, School of Public Health, Faculty of Social Welfare & Health Sciences, Haifa 34988, Israel.
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Yang X, Lovell JF, Zhang Y. Ingestible Contrast Agents for Gastrointestinal Imaging. Chembiochem 2019; 20:462-473. [PMID: 30421487 DOI: 10.1002/cbic.201800589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 12/17/2022]
Abstract
Gastrointestinal (GI) ailments cover a wide variety of diseases involving the esophagus, stomach, small intestine, large intestine, and rectum. They bring about many inconveniences in daily life in chronic diseases and can even be life threatening in acute cases. Rapid and safe detection approaches are essential for early diagnosis and timely management. Contrast agents for GI imaging can enhance contrast to distinguish abnormal lesions from normal structures. Computed tomography and magnetic resonance imaging are two important diagnostic tools for the evaluation of GI conditions. This review mainly involves several common GI diseases, including inflammatory diseases, intestinal tumors, diarrhea, constipation, and gastroesophageal reflux diseases. Selected contrast agents, such as barium sulfate, iodine-based agents, gadolinium-based agents, and others, are summarized. Going forward, continued endeavors are being made to develop more emerging contrast agents for other imaging modalities.
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Affiliation(s)
- Xingyue Yang
- School of Chemical Engineering and Technology, Tianjin University, Tianjin, 301636, China
| | - Jonathan F Lovell
- Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY, 14260, USA
| | - Yumiao Zhang
- School of Chemical Engineering and Technology, Tianjin University, Tianjin, 301636, China
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Cross AJ, Wooldrage K, Robbins EC, Pack K, Brown JP, Hamilton W, Thompson MR, Flashman KG, Halligan S, Thomas-Gibson S, Vance M, Saunders BP, Atkin W. Whole-colon investigation vs. flexible sigmoidoscopy for suspected colorectal cancer based on presenting symptoms and signs: a multicentre cohort study. Br J Cancer 2019; 120:154-164. [PMID: 30563992 PMCID: PMC6342953 DOI: 10.1038/s41416-018-0335-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/17/2018] [Accepted: 10/24/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients with suspected colorectal cancer (CRC) usually undergo colonoscopy. Flexible sigmoidoscopy (FS) may be preferred if proximal cancer risk is low. We investigated which patients could undergo FS alone. METHODS Cohort study of 7375 patients (≥55 years) referred with suspected CRC to 21 English hospitals (2004-2007), followed using hospital records and cancer registries. We calculated yields and number of needed whole-colon examinations (NNE) to diagnose one cancer by symptoms/signs and subsite. We considered narrow (haemoglobin <11 g/dL men; <10 g/dL women) and broad (<13 g/dL men; <12 g/dL women) anaemia definitions and iron-deficiency anaemia (IDA). RESULTS One hundred and twenty-seven proximal and 429 distal CRCs were diagnosed. A broad anaemia definition identified 80% of proximal cancers; a narrow definition with IDA identified 39%. In patients with broad definition anaemia and/or abdominal mass, proximal cancer yield and NNE were 4.8% (97/2022) and 21. In patients without broad definition anaemia and/or abdominal mass, with rectal bleeding or increased stool frequency (41% of cohort), proximal cancer yield and NNE were 0.4% (13/3031) and 234. CONCLUSION Most proximal cancers are accompanied by broad definition anaemia. In patients without broad definition anaemia and/or abdominal mass, with rectal bleeding or increased stool frequency, proximal cancer is rare and FS should suffice.
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Affiliation(s)
- Amanda J Cross
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Kate Wooldrage
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Emma C Robbins
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kevin Pack
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jeremy P Brown
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - William Hamilton
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Michael R Thompson
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Karen G Flashman
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Steve Halligan
- University College London Centre for Medical Imaging, University College London, London, UK
| | | | - Margaret Vance
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK
| | | | - Wendy Atkin
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
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Rutter MD, Beintaris I, Valori R, Chiu HM, Corley DA, Cuatrecasas M, Dekker E, Forsberg A, Gore-Booth J, Haug U, Kaminski MF, Matsuda T, Meijer GA, Morris E, Plumb AA, Rabeneck L, Robertson DJ, Schoen RE, Singh H, Tinmouth J, Young GP, Sanduleanu S. World Endoscopy Organization Consensus Statements on Post-Colonoscopy and Post-Imaging Colorectal Cancer. Gastroenterology 2018; 155:909-925.e3. [PMID: 29958856 DOI: 10.1053/j.gastro.2018.05.038] [Citation(s) in RCA: 196] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/25/2018] [Accepted: 05/15/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Colonoscopy examination does not always detect colorectal cancer (CRC)- some patients develop CRC after negative findings from an examination. When this occurs before the next recommended examination, it is called interval cancer. From a colonoscopy quality assurance perspective, that term is too restrictive, so the term post-colonoscopy colorectal cancer (PCCRC) was created in 2010. However, PCCRC definitions and methods for calculating rates vary among studies, making it impossible to compare results. We aimed to standardize the terminology, identification, analysis, and reporting of PCCRCs and CRCs detected after other whole-colon imaging evaluations (post-imaging colorectal cancers [PICRCs]). METHODS A 20-member international team of gastroenterologists, pathologists, and epidemiologists; a radiologist; and a non-medical professional met to formulate a series of recommendations, standardize definitions and categories (to align with interval cancer terminology), develop an algorithm to determine most-plausible etiologies, and develop standardized methodology to calculate rates of PCCRC and PICRC. The team followed the Appraisal of Guidelines for Research and Evaluation II tool. A literature review provided 401 articles to support proposed statements; evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The statements were voted on anonymously by team members, using a modified Delphi approach. RESULTS The team produced 21 statements that provide comprehensive guidance on PCCRCs and PICRCs. The statements present standardized definitions and terms, as well as methods for qualitative review, determination of etiology, calculation of PCCRC rates, and non-colonoscopic imaging of the colon. CONCLUSIONS A 20-member international team has provided standardized methods for analysis of etiologies of PCCRCs and PICRCs and defines its use as a quality indicator. The team provides recommendations for clinicians, organizations, researchers, policy makers, and patients.
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Affiliation(s)
- Matthew D Rutter
- University Hospital of North Tees, Stockton-on-Tees, UK; Northern Institute for Cancer Research, Newcastle University, UK.
| | | | - Roland Valori
- Gloucestershire Hospitals National Health Service Foundation Trust, Gloucestershire, UK
| | | | - Douglas A Corley
- San Francisco Medical Center, Kaiser Permanente Division of Research, San Francisco, California
| | - Miriam Cuatrecasas
- Hospital Clínic and Tumour Bank-Biobank, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | | | - Anna Forsberg
- Institution of Medicine Solna Karolinska Institutet, Stockholm, Sweden
| | | | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology, Bremen Institute for Prevention Research and Social Medicine, Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Michal F Kaminski
- The Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland
| | | | - Gerrit A Meijer
- Netherlands Cancer Institute, Amsterdam, The Netherlands; University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eva Morris
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's Institute of Oncology, St James's University Hospital, Leeds, UK
| | | | - Linda Rabeneck
- Cancer Care Ontario, University of Toronto, Toronto, Ontario, Canada
| | - Douglas J Robertson
- Veterans Affairs Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | | | | | - Jill Tinmouth
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Affiliation(s)
- Dan Li
- Corresponding author. Department of Gastroenterology, Kaiser Permanente Medical Center, Santa Clara, CA 95051, USA.
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Obaro AE, Burling DN, Plumb AA. Colon cancer screening with CT colonography: logistics, cost-effectiveness, efficiency and progress. Br J Radiol 2018; 91:20180307. [PMID: 29927637 DOI: 10.1259/bjr.20180307] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Colorectal cancer (CRC) incidence and mortality can be significantly reduced by population screening. Several different screening methods are currently in use, and this review focuses specifically on the imaging technique computed tomographic colonography (CTC). The challenges and logistics of CTC screening, as well as the importance of test accuracy, uptake, quality assurance and cost-effectiveness will be discussed. With comparable advanced adenoma detection rates to colonoscopy (the most commonly used whole-colon investigation), CTC is a less-invasive alternative, requiring less laxative, and with the potential benefit that it permits assessment of extra colonic structures. Three large-scale European trials have contributed valuable evidence supporting the use of CTC in population screening, and highlight the importance of selecting appropriate clinical management pathways based on initial CTC findings. Future research into CTC-screening will likely focus on radiologist training and CTC quality assurance, with identification of evidence-based key performance indicators that are associated with clinically-relevant outcomes such as the incidence of post-test interval cancers (CRC occurring after a presumed negative CTC). In comparison to other CRC screening techniques, CTC offers a safe and accurate option that is particularly useful when colonoscopy is contraindicated. Forthcoming cost-effectiveness analyses which evaluate referral thresholds, the impact of extra-colonic findings and real-world uptake will provide useful information regarding the feasibility of future CTC population screening.
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Affiliation(s)
- Anu E Obaro
- 1 Centre for Medical Imaging, University College London , London , UK.,2 St Mark's Academic Institute, St Mark's Hospital , Harrow , UK
| | - David N Burling
- 2 St Mark's Academic Institute, St Mark's Hospital , Harrow , UK
| | - Andrew A Plumb
- 1 Centre for Medical Imaging, University College London , London , UK
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JOURNAL CLUB: Extracolonic Findings at CT Colonography: Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018; 211:25-39. [DOI: 10.2214/ajr.17.19495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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CT Colonography Performance for the Detection of Polyps and Cancer in Adults ≥ 65 Years Old: Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018; 211:40-51. [DOI: 10.2214/ajr.18.19515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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A comparison of computer-assisted detection (CAD) programs for the identification of colorectal polyps: performance and sensitivity analysis, current limitations and practical tips for radiologists. Clin Radiol 2018; 73:593.e11-593.e18. [PMID: 29602538 DOI: 10.1016/j.crad.2018.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 02/13/2018] [Indexed: 01/27/2023]
Abstract
AIM To directly compare the accuracy and speed of analysis of two commercially available computer-assisted detection (CAD) programs in detecting colorectal polyps. MATERIALS AND METHOD In this retrospective single-centre study, patients who had colorectal polyps identified on computed tomography colonography (CTC) and subsequent lower gastrointestinal endoscopy, were analysed using two commercially available CAD programs (CAD1 and CAD2). Results were compared against endoscopy to ascertain sensitivity and positive predictive value (PPV) for colorectal polyps. Time taken for CAD analysis was also calculated. RESULTS CAD1 demonstrated a sensitivity of 89.8%, PPV of 17.6% and mean analysis time of 125.8 seconds. CAD2 demonstrated a sensitivity of 75.5%, PPV of 44.0% and mean analysis time of 84.6 seconds. CONCLUSION The sensitivity and PPV for colorectal polyps and CAD analysis times can vary widely between current commercially available CAD programs. There is still room for improvement. Generally, there is a trade-off between sensitivity and PPV, and so further developments should aim to optimise both. Information on these factors should be made routinely available, so that an informed choice on their use can be made. This information could also potentially influence the radiologist's use of CAD results.
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de Lara Bendahán V, Rivas Rivas M, de la Vega Olías MC, Vega Ruiz V. Contribution of the virtual colonoscopy in a case of intestinal intussusception. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 110:197-198. [PMID: 29313697 DOI: 10.17235/reed.2017.5261/2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The present paper describes a case of ileocecal intussusception detected by ultrasound and confirmed by CT, including the imaging characteristics allowing its diagnosis. The patient was referred for colonoscopy, which could not be completed, to assess the cause of intussusception. Then it was decided to resort to Virtual colonoscopy, which allowed to identify and characterize a cecal neoplasm serving as a lead point for the intussusception.
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Affiliation(s)
| | | | | | - Vicente Vega Ruiz
- UGC Cirugía General y del Aparato Digestivo, Hospital Universitario Puerto Real
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Abstract
Since the introduction of CT colonography (CTC) in the mid-1990s, there have been continuous advancements in the examination technique and advanced visualization software for interpretation. This review will cover the origins of CTC as a natural extension of abdominal CT imaging, and discuss the evolution of CTC through the subsequent clinical phases of feasibility, validation, and implementation.
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Westwood M, Corro Ramos I, Lang S, Luyendijk M, Zaim R, Stirk L, Al M, Armstrong N, Kleijnen J. Faecal immunochemical tests to triage patients with lower abdominal symptoms for suspected colorectal cancer referrals in primary care: a systematic review and cost-effectiveness analysis. Health Technol Assess 2018. [PMID: 28643629 DOI: 10.3310/hta21330] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most common cancer in the UK. Presenting symptoms that can be associated with CRC usually have another explanation. Faecal immunochemical tests (FITs) detect blood that is not visible to the naked eye and may help to select patients who are likely to benefit from further investigation. OBJECTIVES To assess the effectiveness of FITs [OC-Sensor (Eiken Chemical Co./MAST Diagnostics, Tokyo, Japan), HM-JACKarc (Kyowa Medex/Alpha Laboratories Ltd, Tokyo, Japan), FOB Gold (Sentinel/Sysmex, Sentinel Diagnostics, Milan, Italy), RIDASCREEN Hb or RIDASCREEN Hb/Hp complex (R-Biopharm, Darmstadt, Germany)] for primary care triage of people with low-risk symptoms. METHODS Twenty-four resources were searched to March 2016. Review methods followed published guidelines. Summary estimates were calculated using a bivariate model or a random-effects logistic regression model. The cost-effectiveness analysis considered long-term costs and quality-adjusted life-years (QALYs) that were associated with different faecal occult blood tests and direct colonoscopy referral. Modelling comprised a diagnostic decision model, a Markov model for long-term costs and QALYs that were associated with CRC treatment and progression, and a Markov model for QALYs that were associated with no CRC. RESULTS We included 10 studies. Using a single sample and 10 µg Hb/g faeces threshold, sensitivity estimates for OC-Sensor [92.1%, 95% confidence interval (CI) 86.9% to 95.3%] and HM-JACKarc (100%, 95% CI 71.5% to 100%) indicated that both may be useful to rule out CRC. Specificity estimates were 85.8% (95% CI 78.3% to 91.0%) and 76.6% (95% CI 72.6% to 80.3%). Triage using FITs could rule out CRC and avoid colonoscopy in approximately 75% of symptomatic patients. Data from our systematic review suggest that 22.5-93% of patients with a positive FIT and no CRC have other significant bowel pathologies. The results of the base-case analysis suggested minimal difference in QALYs between all of the strategies; no triage (referral straight to colonoscopy) is the most expensive. Faecal immunochemical testing was cost-effective (cheaper and more, or only slightly less, effective) compared with no triage. Faecal immunochemical testing was more effective and costly than guaiac faecal occult blood testing, but remained cost-effective at a threshold incremental cost-effectiveness ratio of £30,000. The results of scenario analyses did not differ substantively from the base-case. Results were better for faecal immunochemical testing when accuracy of the guaiac faecal occult blood test (gFOBT) was based on studies that were more representative of the correct population. LIMITATIONS Only one included study evaluated faecal immunochemical testing in primary care; however, all of the other studies evaluated faecal immunochemical testing at the point of referral. Further, validation data for the Faecal haemoglobin, Age and Sex Test (FAST) score, which includes faecal immunochemical testing, showed no significant difference in performance between primary and secondary care. There were insufficient data to adequately assess FOB Gold, RIDASCREEN Hb or RIDASCREEN Hb/Hp complex. No study compared FIT assays, or FIT assays versus gFOBT; all of the data included in this assessment refer to the clinical effectiveness of individual FIT methods and not their comparative effectiveness. CONCLUSIONS Faecal immunochemical testing is likely to be a clinically effective and cost-effective strategy for triaging people who are presenting, in primary care settings, with lower abdominal symptoms and who are at low risk for CRC. Further research is required to confirm the effectiveness of faecal immunochemical testing in primary care practice and to compare the performance of different FIT assays. STUDY REGISTRATION This study is registered as PROSPERO CRD42016037723. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Isaac Corro Ramos
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Shona Lang
- Kleijnen Systematic Reviews Ltd, York, UK
| | - Marianne Luyendijk
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Remziye Zaim
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Lisa Stirk
- Kleijnen Systematic Reviews Ltd, York, UK
| | - Maiwenn Al
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | | | - Jos Kleijnen
- School for Public Health and Primary Care (Care and Public Health Research Institute), Maastricht University, Maastricht, the Netherlands
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Obaro AE, Plumb AA, Fanshawe TR, Torres US, Baldwin-Cleland R, Taylor SA, Halligan S, Burling DN. Post-imaging colorectal cancer or interval cancer rates after CT colonography: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2018; 3:326-336. [PMID: 29472116 DOI: 10.1016/s2468-1253(18)30032-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND CT colonography is highly sensitive for colorectal cancer, but interval or post-imaging colorectal cancer rates (diagnosis of cancer after initial negative CT colonography) are unknown, as are their underlying causes. We did a systematic review and meta-analysis of post-CT colonography and post-imaging colorectal cancer rates and causes to address this gap in understanding. METHODS We systematically searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. We included randomised, cohort, cross-sectional, or case-control studies published between Jan 1, 1994, and Feb 28, 2017, using CT colonography done according to international consensus standards with the aim of detecting cancer or polyps, and reporting post-imaging colorectal cancer rates or sufficient data to allow their calculation. We excluded studies in which all CT colonographies were done because of incomplete colonoscopy or if CT colonography was done with knowledge of colonoscopy findings. We contacted authors of component studies for additional data where necessary for retrospective CT colonography image review and causes for each post-imaging colorectal cancer. Two independent reviewers extracted data from the study reports. Our primary outcome was prevalence of post-imaging colorectal cancer 36 months after CT colonography. We used random-effects meta-analysis to estimate pooled post-imaging colorectal cancer rates, expressed using the total number of cancers and total number of CT colonographies as denominators, and per 1000 person-years. This study is registered with PROSPERO, number CRD42016042437. FINDINGS 2977 articles were screened and 12 studies were eligible for analysis. These studies reported data for 19 867 patients (aged 18-96 years; of 11 590 with sex data available, 6532 [56%] were female) between March, 2002, and May, 2015. At a mean of 34 months' follow-up (range 3-128·4 months), CT colonography detected 643 colorectal cancers. 29 post-imaging colorectal cancers were subsequently diagnosed. The pooled post-imaging colorectal cancer rate was 4·42 (95% CI 3·03-6·42) per 100 cancers detected, corresponding to 1·61 (1·11-2·33) post-imaging colorectal cancers per 1000 CT colonographies or 0·64 (0·44-0·92) post-imaging colorectal cancers per 1000 person-years. Heterogeneity was low (I2=0%). 17 (61%) of 28 post-imaging colorectal cancers were attributable to perceptual error and were visible in retrospect. INTERPRETATION CT colonography does not lead to an excess of post-test cancers relative to colonoscopy within 3-5 years, and the low 5-year post-imaging colorectal cancer rate confirms that the recommended screening interval of 5 years is safe. Since most post-imaging colorectal cancers arise from perceptual errors, radiologist training and quality assurance could help to reduce post-imaging colorectal cancer rates. FUNDING St Mark's Hospital Foundation and the UK National Institute for Health Research via the UCL/UCLH Biomedical Research Centre.
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Affiliation(s)
- Anu E Obaro
- Centre for Medical Imaging, University College London, London, UK; St Mark's Academic Institute, St Mark's Hospital, Harrow, London, UK
| | - Andrew A Plumb
- Centre for Medical Imaging, University College London, London, UK.
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | | | | | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - David N Burling
- St Mark's Academic Institute, St Mark's Hospital, Harrow, London, UK
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Bevan R, Rutter MD. Colorectal Cancer Screening-Who, How, and When? Clin Endosc 2018; 51:37-49. [PMID: 29397655 PMCID: PMC5806924 DOI: 10.5946/ce.2017.141] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/20/2017] [Indexed: 12/17/2022] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide. It is amenable to screening as it occurs in premalignant, latent, early, and curable stages. PubMed, Cochrane Database of Systematic Reviews, and national and international CRC screening guidelines were searched for CRC screening methods, populations, and timing. CRC screening can use direct or indirect tests, delivered opportunistically or via organized programs. Most CRCs are diagnosed after 60 years of age; most screening programs apply to individuals 50-75 years of age. Screening may reduce disease-specific mortality by detecting CRC in earlier stages, and CRC incidence by detecting premalignant polyps, which can subsequently be removed. In randomized controlled trials (RCTs) guaiac fecal occult blood testing (gFOBt) was found to reduce CRC mortality by 13%-33%. Fecal immunochemical testing (FIT) has no RCT data comparing it to no screening, but is superior to gFOBt. Flexible sigmoidoscopy (FS) trials demonstrated an 18% reduction in CRC incidence and a 28% reduction in CRC mortality. Currently, RCT evidence for colonoscopy screening is scarce. Although not yet corroborated by RCTs, it is likely that colonoscopy is the best screening modality for an individual. From a population perspective, organized programs are superior to opportunistic screening. However, no nation can offer organized population-wide colonoscopy screening. Thus, organized programs using cheaper modalities, such as FS/FIT, can be tailored to budget and capacity.
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Affiliation(s)
- Roisin Bevan
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Durham, UK
| | - Matthew D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Durham, UK
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
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Persinger D, Basson MD. Occult Spigelian Hernia Presenting as Inability to Complete Colon Cancer Screening in a Patient with a History of Rectal Cancer. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1181-1184. [PMID: 29109391 PMCID: PMC5687119 DOI: 10.12659/ajcr.905840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 62 Final Diagnosis: Spigelian hernia Symptoms: Abdominal discomfort Medication: — Clinical Procedure: Hernia repair and colonoscopy Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Daniel Persinger
- Department of Surgery, University of North Dakota School of Medicine and the Health Sciences, Grand Forks, ND, USA
| | - Marc D Basson
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA.,Department of Pathology, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA.,Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
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Atkin W, Wooldrage K, Shah U, Skinner K, Brown JP, Hamilton W, Kralj-Hans I, Thompson MR, Flashman KG, Halligan S, Thomas-Gibson S, Vance M, Cross AJ. Is whole-colon investigation by colonoscopy, computerised tomography colonography or barium enema necessary for all patients with colorectal cancer symptoms, and for which patients would flexible sigmoidoscopy suffice? A retrospective cohort study. Health Technol Assess 2017; 21:1-80. [PMID: 29153075 PMCID: PMC5712787 DOI: 10.3310/hta21660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND For patients referred to hospital with suspected colorectal cancer (CRC), it is current standard clinical practice to conduct an examination of the whole colon and rectum. However, studies have shown that an examination of the distal colorectum using flexible sigmoidoscopy (FS) can be a safe and clinically effective investigation for some patients. These findings require validation in a multicentre study. OBJECTIVES To investigate the links between patient symptoms at presentation and CRC risk by subsite, and to provide evidence of whether or not FS is an effective alternative to whole-colon investigation (WCI) in patients whose symptoms do not suggest proximal or obstructive disease. DESIGN A multicentre retrospective study using data collected prospectively from two randomised controlled trials. Additional data were collected from trial diagnostic procedure reports and hospital records. CRC diagnoses within 3 years of referral were sourced from hospital records and national cancer registries via the Health and Social Care Information Centre. SETTING Participants were recruited to the two randomised controlled trials from 21 NHS hospitals in England between 2004 and 2007. PARTICIPANTS Men and women aged ≥ 55 years referred to secondary care for the investigation of symptoms suggestive of CRC. MAIN OUTCOME MEASURE Diagnostic yield of CRC at distal (to the splenic flexure) and proximal subsites by symptoms/clinical signs at presentation. RESULTS The data set for analysis comprised 7380 patients, of whom 59% were women (median age 69 years, interquartile range 62-76 years). Change in bowel habit (CIBH) was the most frequently presenting symptom (73%), followed by rectal bleeding (38%) and abdominal pain (29%); 26% of patients had anaemia. CRC was diagnosed in 551 patients (7.5%): 424 (77%) patients with distal CRC, 122 (22%) patients with cancer proximal to the descending colon and five patients with both proximal and distal CRC. Proximal cancer was diagnosed in 96 out of 2021 (4.8%) patients with anaemia and/or an abdominal mass. The yield of proximal cancer in patients without anaemia or an abdominal mass who presented with rectal bleeding with or without a CIBH or with a CIBH to looser and/or more frequent stools as a single symptom was low (0.5%). These low-risk groups for proximal cancer accounted for 41% (3032/7380) of the cohort; only three proximal cancers were diagnosed in 814 low-risk patients examined by FS (diagnostic yield 0.4%). LIMITATIONS A limitation to this study is that changes to practice since the trial ended, such as new referral guidelines and improvements in endoscopy quality, potentially weaken the generalisability of our findings. CONCLUSIONS Symptom profiles can be used to determine whether or not WCI is necessary. Most proximal cancers were diagnosed in patients who presented with anaemia and/or an abdominal mass. In patients without anaemia or an abdominal mass, proximal cancer diagnoses were rare in those with rectal bleeding with or without a CIBH or with a CIBH to looser and/or more frequent stools as a single symptom. FS alone should be a safe and clinically effective investigation in these patients. A cost-effectiveness analysis of symptom-based tailoring of diagnostic investigations for CRC is recommended. TRIAL REGISTRATION Current Controlled Trials ISRCTN95152621. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 66. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Wendy Atkin
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kate Wooldrage
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Urvi Shah
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kate Skinner
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jeremy P Brown
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Willie Hamilton
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Ines Kralj-Hans
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Michael R Thompson
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Karen G Flashman
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Steve Halligan
- University College London Centre for Medical Imaging, University College London, London, UK
| | - Siwan Thomas-Gibson
- Department of Surgery and Cancer, Imperial College London, London, UK
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK
| | - Margaret Vance
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK
| | - Amanda J Cross
- Department of Surgery and Cancer, Imperial College London, London, UK
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Usefulness of preoperative CT colonography for colon cancer. Asian J Surg 2017; 40:438-443. [DOI: 10.1016/j.asjsur.2016.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/06/2016] [Accepted: 04/11/2016] [Indexed: 01/18/2023] Open
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Mendelson RM, Sutherland T, Little A. Computed tomography colonography: underutilised in Australia. Med J Aust 2017; 207:139-140. [DOI: 10.5694/mja16.00684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/27/2016] [Indexed: 12/20/2022]
Affiliation(s)
| | - Tom Sutherland
- University of Melbourne and St Vincent's Hospital, Melbourne, Vic
| | - Andrew Little
- University of Melbourne and St Vincent's Hospital, Melbourne, Vic
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Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Levin TR, Lieberman D, Robertson DJ. Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2017; 153:307-323. [PMID: 28600072 DOI: 10.1053/j.gastro.2017.05.013] [Citation(s) in RCA: 446] [Impact Index Per Article: 63.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This document updates the colorectal cancer (CRC) screening recommendations of the U.S. Multi-Society Task Force of Colorectal Cancer (MSTF), which represents the American College of Gastroenterology, the American Gastroenterological Association, and The American Society for Gastrointestinal Endoscopy. CRC screening tests are ranked in 3 tiers based on performance features, costs, and practical considerations. The first-tier tests are colonoscopy every 10 years and annual fecal immunochemical test (FIT). Colonoscopy and FIT are recommended as the cornerstones of screening regardless of how screening is offered. Thus, in a sequential approach based on colonoscopy offered first, FIT should be offered to patients who decline colonoscopy. Colonoscopy and FIT are recommended as tests of choice when multiple options are presented as alternatives. A risk-stratified approach is also appropriate, with FIT screening in populations with an estimated low prevalence of advanced neoplasia and colonoscopy screening in high prevalence populations. The second-tier tests include CT colonography every 5 years, the FIT-fecal DNA test every 3 years, and flexible sigmoidoscopy every 5 to 10 years. These tests are appropriate screening tests, but each has disadvantages relative to the tier 1 tests. Because of limited evidence and current obstacles to use, capsule colonoscopy every 5 years is a third-tier test. We suggest that the Septin9 serum assay (Epigenomics, Seattle, Wash) not be used for screening. Screening should begin at age 50 years in average-risk persons, except in African Americans in whom limited evidence supports screening at 45 years. CRC incidence is rising in persons under age 50, and thorough diagnostic evaluation of young persons with suspected colorectal bleeding is recommended. Discontinuation of screening should be considered when persons up to date with screening, who have prior negative screening (particularly colonoscopy), reach age 75 or have <10 years of life expectancy. Persons without prior screening should be considered for screening up to age 85, depending on age and comorbidities. Persons with a family history of CRC or a documented advanced adenoma in a first-degree relative age <60 years or 2 first-degree relatives with these findings at any age are recommended to undergo screening by colonoscopy every 5 years, beginning 10 years before the age at diagnosis of the youngest affected relative or age 40, whichever is earlier. Persons with a single first-degree relative diagnosed at ≥60 years with CRC or an advanced adenoma can be offered average-risk screening options beginning at age 40 years.
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Affiliation(s)
- Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana.
| | | | - Jason A Dominitz
- VA Puget Sound Health Care System, University of Washington, Seattle, Washington
| | | | | | - Tonya Kaltenbach
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | | | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Cunningham C, Leong K, Clark S, Plumb A, Taylor S, Geh I, Karandikar S, Moran B. Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) - Diagnosis, Investigations and Screening. Colorectal Dis 2017. [PMID: 28632312 DOI: 10.1111/codi.13703] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
| | - Kai Leong
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Susan Clark
- Imperial College and St Mark's Hospital, Harrow, London, UK
| | | | | | - Ian Geh
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - Brendan Moran
- Basingstoke & North Hampshire Hospital, Basingstoke, UK
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49
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Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Levin TR, Lieberman D, Robertson DJ. Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2017; 112:1016-1030. [PMID: 28555630 DOI: 10.1038/ajg.2017.174] [Citation(s) in RCA: 423] [Impact Index Per Article: 60.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This document updates the colorectal cancer (CRC) screening recommendations of the U.S. Multi-Society Task Force of Colorectal Cancer (MSTF), which represents the American College of Gastroenterology, the American Gastroenterological Association, and The American Society for Gastrointestinal Endoscopy. CRC screening tests are ranked in 3 tiers based on performance features, costs, and practical considerations. The first-tier tests are colonoscopy every 10 years and annual fecal immunochemical test (FIT). Colonoscopy and FIT are recommended as the cornerstones of screening regardless of how screening is offered. Thus, in a sequential approach based on colonoscopy offered first, FIT should be offered to patients who decline colonoscopy. Colonoscopy and FIT are recommended as tests of choice when multiple options are presented as alternatives. A risk-stratified approach is also appropriate, with FIT screening in populations with an estimated low prevalence of advanced neoplasia and colonoscopy screening in high prevalence populations. The second-tier tests include CT colonography every 5 years, the FIT-fecal DNA test every 3 years, and flexible sigmoidoscopy every 5 to 10 years. These tests are appropriate screening tests, but each has disadvantages relative to the tier 1 tests. Because of limited evidence and current obstacles to use, capsule colonoscopy every 5 years is a third-tier test. We suggest that the Septin9 serum assay (Epigenomics, Seattle, Wash) not be used for screening. Screening should begin at age 50 years in average-risk persons, except in African Americans in whom limited evidence supports screening at 45 years. CRC incidence is rising in persons under age 50, and thorough diagnostic evaluation of young persons with suspected colorectal bleeding is recommended. Discontinuation of screening should be considered when persons up to date with screening, who have prior negative screening (particularly colonoscopy), reach age 75 or have <10 years of life expectancy. Persons without prior screening should be considered for screening up to age 85, depending on age and comorbidities. Persons with a family history of CRC or a documented advanced adenoma in a first-degree relative age <60 years or 2 first-degree relatives with these findings at any age are recommended to undergo screening by colonoscopy every 5 years, beginning 10 years before the age at diagnosis of the youngest affected relative or age 40, whichever is earlier. Persons with a single first-degree relative diagnosed at ≥60 years with CRC or an advanced adenoma can be offered average-risk screening options beginning at age 40 years.
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Affiliation(s)
- Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Jason A Dominitz
- VA Puget Sound Health Care System, University of Washington, Seattle, Washington, USA
| | | | | | - Tonya Kaltenbach
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | | | | | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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50
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Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Levin TR, Lieberman D, Robertson DJ. Colorectal cancer screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2017; 86:18-33. [PMID: 28600070 DOI: 10.1016/j.gie.2017.04.003] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/06/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana, USA.
| | | | - Jason A Dominitz
- VA Puget Sound Health Care System, University of Washington, Seattle, Washington, USA
| | | | | | - Tonya Kaltenbach
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | | | | | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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