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Zeng B, Wang H, Tao X, Shi H, Joskowicz L, Chen X. A bidirectional framework for fracture simulation and deformation-based restoration prediction in pelvic fracture surgical planning. Med Image Anal 2024; 97:103267. [PMID: 39053167 DOI: 10.1016/j.media.2024.103267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/05/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024]
Abstract
Pelvic fracture is a severe trauma with life-threatening implications. Surgical reduction is essential for restoring the anatomical structure and functional integrity of the pelvis, requiring accurate preoperative planning. However, the complexity of pelvic fractures and limited data availability necessitate labor-intensive manual corrections in a clinical setting. We describe in this paper a novel bidirectional framework for automatic pelvic fracture surgical planning based on fracture simulation and structure restoration. Our fracture simulation method accounts for patient-specific pelvic structures, bone density information, and the randomness of fractures, enabling the generation of various types of fracture cases from healthy pelvises. Based on these features and on adversarial learning, we develop a novel structure restoration network to predict the deformation mapping in CT images before and after a fracture for the precise structural reconstruction of any fracture. Furthermore, a self-supervised strategy based on pelvic anatomical symmetry priors is developed to optimize the details of the restored pelvic structure. Finally, the restored pelvis is used as a template to generate a surgical reduction plan in which the fragments are repositioned in an efficient jigsaw puzzle registration manner. Extensive experiments on simulated and clinical datasets, including scans with metal artifacts, show that our method achieves good accuracy and robustness: a mean SSIM of 90.7% for restorations, with translational errors of 2.88 mm and rotational errors of 3.18°for reductions in real datasets. Our method takes 52.9 s to complete the surgical planning in the phantom study, representing a significant acceleration compared to standard clinical workflows. Our method may facilitate effective surgical planning for pelvic fractures tailored to individual patients in clinical settings.
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Affiliation(s)
- Bolun Zeng
- Institute of Biomedical Manufacturing and Life Quality Engineering, School of Mechanical Engineering, Shanghai Jiao Tong University, China
| | - Huixiang Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xingguang Tao
- Department of Orthopedics, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Haochen Shi
- Institute of Biomedical Manufacturing and Life Quality Engineering, School of Mechanical Engineering, Shanghai Jiao Tong University, China
| | - Leo Joskowicz
- School of Computer Science and Engineering and the Edmond and Lily Safra Center for Brain Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, School of Mechanical Engineering, Shanghai Jiao Tong University, China; Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai 200240, China.
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2
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Jeong BH, Kim HK, Son YD. Depth estimation from monocular endoscopy using simulation and image transfer approach. Comput Biol Med 2024; 181:109038. [PMID: 39178804 DOI: 10.1016/j.compbiomed.2024.109038] [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: 11/30/2023] [Revised: 08/12/2024] [Accepted: 08/15/2024] [Indexed: 08/26/2024]
Abstract
Obtaining accurate distance or depth information in endoscopy is crucial for the effective utilization of navigation systems. However, due to space constraints, incorporating depth cameras into endoscopic systems is often impractical. Our goal is to estimate depth images directly from endoscopic images using deep learning. This study presents a three-step methodology for training a depth-estimation network model. Initially, simulated endoscopy images and corresponding depth maps are generated using Unity based on a colon surface model obtained from segmented computed tomography colonography data. Subsequently, a cycle generative adversarial network model is employed to enhance the realism of the simulated endoscopy images. Finally, a deep learning model is trained using the synthesized endoscopy images and depth maps to estimate depths accurately. The performance of the proposed approach is evaluated and compared against prior studies utilizing unsupervised training methods. The results demonstrate the superior precision of the proposed technique in estimating depth images within endoscopy. The proposed depth estimation method holds promise for advancing the field by enabling enhanced navigation, improved lesion marking capabilities, and ultimately leading to better clinical outcomes.
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Affiliation(s)
- Bong Hyuk Jeong
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, 21999, South Korea.
| | - Hang Keun Kim
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, 21999, South Korea; Department of Biomedical Engineering, Gachon University, Seongnam, 13120, South Korea.
| | - Young Don Son
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, 21999, South Korea; Department of Biomedical Engineering, Gachon University, Seongnam, 13120, South Korea.
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Bernth JE, Zhang G, Malas D, Abrahams G, Hayee B, Liu H. MorphGI: A Self-Propelling Soft Robotic Endoscope Through Morphing Shape. Soft Robot 2024; 11:670-683. [PMID: 38484296 DOI: 10.1089/soro.2023.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Colonoscopy is currently the best method for detecting bowel cancer, but fundamental design and construction have not changed significantly in decades. Conventional colonoscope (CC) is difficult to maneuver and can lead to pain with a risk of damaging the bowel due to its rigidity. We present the MorphGI, a robotic endoscope system that is self-propelling and made of soft material, thus easy to operate and inherently safe to patient. After verifying kinematic control of the distal bending segment, the system was evaluated in: a benchtop colon simulator, using multiple colon configurations; a colon simulator with force sensors; and surgically removed pig colon tissue. In the colon simulator, the MorphGI completed a colonoscopy in an average of 10.84 min. The MorphGI showed an average of 77% and 62% reduction in peak forces compared to a CC in high- and low-stiffness modes, respectively. Self-propulsion was demonstrated in the excised tissue test but not in the live pig test, due to anatomical differences between pig and human colons. This work demonstrates the core features of MorphGI.
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Affiliation(s)
- Julius E Bernth
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Guokai Zhang
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Dionysios Malas
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - George Abrahams
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Bu Hayee
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Hongbin Liu
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Institute of Automation, Chinese Academy of Sciences (CAS), Beijing, China
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Maida M, Dahiya DS, Shah YR, Tiwari A, Gopakumar H, Vohra I, Khan A, Jaber F, Ramai D, Facciorusso A. Screening and Surveillance of Colorectal Cancer: A Review of the Literature. Cancers (Basel) 2024; 16:2746. [PMID: 39123473 PMCID: PMC11312202 DOI: 10.3390/cancers16152746] [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: 07/13/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Colorectal cancer (CRC) has the highest mortality rate among men and is the second highest among women under fifty, with incidence and mortality rates rising in younger populations. Studies indicate that up to one-third of patients diagnosed before fifty have a family history or genetic factors, highlighting the need for earlier screening. Contrariwise, diagnosis in healthy subjects through screening strategies enables early-stage detection of the tumor and better clinical outcomes. In recent years, mortality rates of CRC in Western countries have been on a steady decline, which is largely attributed to widespread screening programs and advancements in treatment modalities. Indeed, early detection through screening significantly improves prognosis, with stark differences in survival rates between localized and metastatic disease. This article aims to provide a comprehensive review of the existing literature, delving into the performance and efficacy of various CRC screening strategies. It navigates through available screening tools, evaluating their efficacy and cost-effectiveness. The discussion extends to delineating target populations for screening, emphasizing the importance of tailored approaches for individuals at heightened risk.
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Affiliation(s)
- Marcello Maida
- Department of Medicine and Surgery, University of Enna ‘Kore’, 94100 Enna, Italy;
| | - Dushyant Singh Dahiya
- Division of Gastroenterology, Hepatology and Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, USA
| | - Yash R. Shah
- Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI 48341, USA
| | - Angad Tiwari
- Department of Internal Medicine, Maharani Laxmi Bai Medical College, Jhansi 284001, India;
| | - Harishankar Gopakumar
- Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL 61605, USA; (H.G.); (I.V.)
| | - Ishaan Vohra
- Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL 61605, USA; (H.G.); (I.V.)
| | - Aqsa Khan
- Department of Internal Medicine, Parkview Health, Fort Wayne, IN 46805, USA;
| | - Fouad Jaber
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, KS 64110, USA;
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, The University of Utah School of Medicine, Salt Lake City, UT 84132, USA;
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Biomedical Science, Foggia University Hospital, 71122 Foggia, Italy
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Li L, Ye Q, Hu T, Fang D, Wan R, Shi Y. Fully automated measurement of femoral neck axis line in anatomical coordinate system using CT images. Med Biol Eng Comput 2024; 62:1837-1849. [PMID: 38396278 DOI: 10.1007/s11517-024-03037-8] [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: 07/16/2023] [Accepted: 01/16/2024] [Indexed: 02/25/2024]
Abstract
The femoral neck is the most vulnerable site for fractures within the hip joint. Due to its complex three-dimensional structure and special blood supply mechanism, the treatment of femoral neck fractures is difficult and the healing probability is low. Using computers to accurately and automatically locate the femoral neck axis can detect the density of femoral neck, the neck-shaft angle and the anteversion angle, which effectively assists in the prevention and treatment of femoral neck fractures. Additionally, the traditional femoral neck axis positioning schemes have limitations in accuracy, automation and assistance to bone density measurement. Therefore, this paper proposes a new fully automatic femoral neck axis positioning method. First, the coronal plane's three-dimensional reconstruction highlights the details of the target bone, and then designs a coarse localization module based on multi-scale template matching to obtain the rough range of the femoral neck axis. Then, a detailed localization module based on the femoral neck virtual slices is used to obtain the contour centers and accurately locates the three-dimensional femoral neck axis. This method has been validated in comparison with the manual measurement method. Experimental results revealed that the extracted femoral neck axis in this study can achieve automation, ensure accuracy, and avoid subjective effects effectively and has the potential value to be applied in the prevention and treatment of femoral neck fractures.
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Affiliation(s)
- Li Li
- School of Electronic Information, Wuhan University, Wuhan, Hubei, China.
| | - Qiyao Ye
- School of Electronic Information, Wuhan University, Wuhan, Hubei, China
| | - Tan Hu
- School of Electronic Information, Wuhan University, Wuhan, Hubei, China
| | - Dongshen Fang
- School of Electronic Information, Wuhan University, Wuhan, Hubei, China
| | - Runyu Wan
- School of Electronic Information, Wuhan University, Wuhan, Hubei, China
| | - Yu Shi
- The First Clinical Medical School, Wuhan University, Wuhan, Hubei, China
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6
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Zheng J, Jin H, Tu Y. Differences in circulating lymphocyte subpopulations among patients with inflammatory polyps, colorectal adenomas and colorectal cancer. Arab J Gastroenterol 2024; 25:129-134. [PMID: 38413325 DOI: 10.1016/j.ajg.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/06/2023] [Accepted: 12/31/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND AND STUDY AIMS Colorectal cancer (CRC) may develop from focal changes within benign or precancerous polyps. The immune system's failure to detect and eradicate tumor cells due to immune surveillance evasion, allows cancer to develop and spread. This study aims to analyze the differences in circulating lymphocyte subpopulations in patients with colorectal inflammatory polyps, colorectal adenomas and CRC. PATIENTS AND METHODS We retrospectively reviewed patients from September 2016 to December 2019 at the Shaoxing Second Hospital. Using flow cytometry, the subset distribution and immunophenotype of T cells, CD4+ T cells, CD8+ T cells, B cells and NK cells were investigated in peripheral blood mononuclear cell samples. The counts of lymphocytes were determined by white blood cell counts. RESULTS In total, 518 patients were included in this study. The counts of lymphocytes, T cells and NK cells in patients with inflammatory polyps, colorectal adenomas and CRC were lower than controls. The counts and percentages of CD8+ T cells in patients with inflammatory polyps, colorectal adenomas and CRC were lower than controls. The counts of CD4+ T cells were lower in patients with CRC than inflammatory polyps. The percentages of CD4+ T cells in patients with inflammatory polyps, colorectal adenomas and CRC were higher than controls, but lower in the CRC than inflammatory polyps, colorectal adenomas. The counts and percentages of B cells were lower in CRC patients than colorectal adenomas patients. In addition, the percentages of B cells were higher in patients with inflammatory polyps and colorectal adenomas than in controls. CONCLUSIONS The decrease in counts of lymphocyte, T cells, CD8+ T cells and NK cells in patients may be related to the dysplasia of epithelial cells. Furthermore, the B cells and CD4+ T cells may be related to the malignant growth of the dysplastic epithelial cells.
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Affiliation(s)
- Jialai Zheng
- Departments of Molecular Medicine, Shaoxing Second Hospital, Shaoxing, Zhejiang, China.
| | - Haiyong Jin
- Departments of Laboratory Medicine, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
| | - Yongtao Tu
- Departments of Molecular Medicine, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
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Chawla T, Hurrell C, Keough V, Lindquist CM, Mohammed MF, Samson C, Sugrue G, Walsh C. Canadian Association of Radiologists Practice Guidelines for Computed Tomography Colonography. Can Assoc Radiol J 2024; 75:54-68. [PMID: 37411043 DOI: 10.1177/08465371231182975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Colon cancer is the third most common malignancy in Canada. Computed tomography colonography (CTC) provides a creditable and validated option for colon screening and assessment of known pathology in patients for whom conventional colonoscopy is contraindicated or where patients self-select to use imaging as their primary modality for initial colonic assessment. This updated guideline aims to provide a toolkit for both experienced imagers (and technologists) and for those considering launching this examination in their practice. There is guidance for reporting, optimal exam preparation, tips for problem solving to attain high quality examinations in challenging scenarios as well as suggestions for ongoing maintenance of competence. We also provide insight into the role of artificial intelligence and the utility of CTC in tumour staging of colorectal cancer. The appendices provide more detailed guidance into bowel preparation and reporting templates as well as useful information on polyp stratification and management strategies. Reading this guideline should equip the reader with the knowledge base to perform colonography but also provide an unbiased overview of its role in colon screening compared with other screening options.
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Affiliation(s)
- Tanya Chawla
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Valerie Keough
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chris M Lindquist
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mohammed F Mohammed
- Abdominal Radiology Section, Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Caroline Samson
- Département de Radiologie, Radio-oncologie et Médecine Nucléaire, Université de Montréal, Montreal, Quebec, Canada
| | - Gavin Sugrue
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Cynthia Walsh
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, Ontario, Canada
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Toth JF, Trivedi M, Gupta S. Screening for Colorectal Cancer: The Role of Clinical Laboratories. Clin Chem 2024; 70:150-164. [PMID: 38175599 PMCID: PMC10952004 DOI: 10.1093/clinchem/hvad198] [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: 07/10/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Colorectal cancer (CRC) is a leading cause of cancer incidence and mortality. Screening can result in reductions in incidence and mortality, but there are many challenges to uptake and follow-up. CONTENT Here, we will review the changing epidemiology of CRC, including increasing trends for early and later onset CRC; evidence to support current and emerging screening strategies, including noninvasive stool and blood-based tests; key challenges to ensuring uptake and high-quality screening; and the critical role that clinical laboratories can have in supporting health system and public health efforts to reduce the burden of CRC on the population. SUMMARY Clinical laboratories have the opportunity to play a seminal role in optimizing early detection and prevention of CRC.
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Affiliation(s)
- Joseph F Toth
- Department of Internal Medicine, University of California San Diego Health, La Jolla, CA, United States
| | - Mehul Trivedi
- Department of Internal Medicine, University of California San Diego Health, La Jolla, CA, United States
| | - Samir Gupta
- Department of Internal Medicine, University of California San Diego Health, La Jolla, CA, United States
- Department of Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
- Division of Gastroenterology and Hepatology, University of California San Diego Health, La Jolla, CA, United States
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Zhai H, Chen Z, Li L, Tao H, Wang J, Li K, Shao M, Cheng X, Wang J, Wu X, Wu C, Zhang X, Kettunen L, Wang H. Two-stage multi-task deep learning framework for simultaneous pelvic bone segmentation and landmark detection from CT images. Int J Comput Assist Radiol Surg 2024; 19:97-108. [PMID: 37322299 DOI: 10.1007/s11548-023-02976-1] [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: 12/31/2022] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Pelvic bone segmentation and landmark definition from computed tomography (CT) images are prerequisite steps for the preoperative planning of total hip arthroplasty. In clinical applications, the diseased pelvic anatomy usually degrades the accuracies of bone segmentation and landmark detection, leading to improper surgery planning and potential operative complications. METHODS This work proposes a two-stage multi-task algorithm to improve the accuracy of pelvic bone segmentation and landmark detection, especially for the diseased cases. The two-stage framework uses a coarse-to-fine strategy which first conducts global-scale bone segmentation and landmark detection and then focuses on the important local region to further refine the accuracy. For the global stage, a dual-task network is designed to share the common features between the segmentation and detection tasks, so that the two tasks mutually reinforce each other's performance. For the local-scale segmentation, an edge-enhanced dual-task network is designed for simultaneous bone segmentation and edge detection, leading to the more accurate delineation of the acetabulum boundary. RESULTS This method was evaluated via threefold cross-validation based on 81 CT images (including 31 diseased and 50 healthy cases). The first stage achieved DSC scores of 0.94, 0.97, and 0.97 for the sacrum, left and right hips, respectively, and an average distance error of 3.24 mm for the bone landmarks. The second stage further improved the DSC of the acetabulum by 5.42%, and this accuracy outperforms the state-of-the-arts (SOTA) methods by 0.63%. Our method also accurately segmented the diseased acetabulum boundaries. The entire workflow took ~ 10 s, which was only half of the U-Net run time. CONCLUSION Using the multi-task networks and the coarse-to-fine strategy, this method achieved more accurate bone segmentation and landmark detection than the SOTA method, especially for diseased hip images. Our work contributes to accurate and rapid design of acetabular cup prostheses.
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Affiliation(s)
- Haoyu Zhai
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian, 116024, China
| | - Zhonghua Chen
- Faculty of Information Technology, University of Jyväskylä, 40100, Jyvaskyla, Finland
| | - Lei Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116024, China
| | - Hairong Tao
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai, 200011, China
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai, 200011, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Jinwu Wang
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai, 200011, China
- Department of Orthopaedics and Bone and Joint Research Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Kang Li
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Moyu Shao
- Jiangsu Yunqianbai Digital Technology Co., LTD, Xuzhou, 221000, China
| | - Xiaomin Cheng
- Jiangsu Yunqianbai Digital Technology Co., LTD, Xuzhou, 221000, China
| | - Jing Wang
- School of Chemical Engineering and Technology, Xi'an JiaoTong University, Xi'an, 710049, China
| | - Xiang Wu
- School of Medical Information and Engineering, Xuzhou Medical University, Xuzhou, 221000, China
| | - Chuan Wu
- School of Medical Information and Engineering, Xuzhou Medical University, Xuzhou, 221000, China
| | - Xiao Zhang
- School of Medical Information and Engineering, Xuzhou Medical University, Xuzhou, 221000, China
| | - Lauri Kettunen
- Faculty of Information Technology, University of Jyväskylä, 40100, Jyvaskyla, Finland
| | - Hongkai Wang
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian, 116024, China.
- Liaoning Key Laboratory of Integrated Circuit and Biomedical Electronic System, Dalian, 116024, China.
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10
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Fong G, Herts B, Primak A, Segars P, Li X. Effect of tin spectral filtration on organ and effective dose in CT colonography and CT lung cancer screening. Med Phys 2024; 51:103-112. [PMID: 37962008 DOI: 10.1002/mp.16836] [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: 05/26/2023] [Revised: 10/07/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Studies of tin spectral filtration have demonstrated potential in reducing radiation dose while maintaining image quality for unenhanced computed tomography (CT) scans. The extent of dose reduction, however, was commonly measured using the change in the scanner's reported CTDIvol . This method does not account for how tin filtration affects patient organ and effective dose. PURPOSE To investigate the effect of tin filtration on patient organ and effective dose for CT Lung Cancer Screening (LCS) and CT Colonography (CTC). METHODS A previously-developed Monte Carlo program was adapted to model a 96-row CT scanner (Somatom Force, Siemens Healthineers) with tin filtration capabilities at 100 kV (100Sn) and 150 kV (150Sn). The program was then validated using experimental CTDIvol measurements at all available kV (70-150 kV) and tin-filtered kV options (100Sn and 150Sn). After validation, the program simulated LCS scans of the chest and CTC scan of the abdomen-pelvis for a population of 53 computational patient models from the extended cardiac-torso family. Each scan was performed using three different spectra: 120 kV, 100Sn, and 150Sn. CTDIvol -normalized organ doses and DLP-normalized effective doses, commonly referred to as dose conversion factors, were compared between the different spectra. RESULTS For all LCS and CTC scans, CTDIvol -normalized organ doses and DLP-normalized effective doses increased with increasing beam hardness (120 kV, 100Sn, 150 Sn). For LCS, relative for 120 kV, conversion factors for 100Sn produced a median increase in effective dose of 9%, with organ dose increases of 8% to lung, 5% to breast, 15% to thyroid, and 3% to skin. Conversion factors for 150Sn produced a median increase in effective dose of 20%, with organ dose increases of 16%, 18%, 26%, and 12% to these same organs, respectively. For CTC, relative for 120 kV, conversion factors for 100Sn produced a median increase in effective dose of 12%, with organ dose increases of 9% to colon, 10% to liver, 11% to stomach, and 4% to skin. Conversion factors for 150Sn produced a median increase in effective dose of 21%, with organ dose increases of 16%, 17%, 19%, and 10% to these same organs, respectively. CONCLUSIONS Results show that dose conversion factors are greater when using tin filtration and should be considered when evaluating tin's potential for dose reduction.
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Affiliation(s)
- Grant Fong
- Cleveland Clinic, Imaging Institute, Cleveland, Ohio, USA
| | - Brian Herts
- Cleveland Clinic, Imaging Institute, Cleveland, Ohio, USA
| | - Andrew Primak
- Siemens Medical Solutions USA Inc., Malvern, Pennsylvania, USA
| | - Paul Segars
- Duke University, Durham, North Carolina, USA
| | - Xiang Li
- Cleveland Clinic, Imaging Institute, Cleveland, Ohio, USA
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11
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Thomaschewski M, Lipp M, Engelke C, Harder J, Labod I, Keck T, Mittmann K. Near-infrared fluorescence tattooing: a new approach for endoscopic marking of tumors in minimally invasive colorectal surgery using a persistent near-infrared marker. Surg Endosc 2023; 37:9690-9697. [PMID: 37872429 PMCID: PMC10709472 DOI: 10.1007/s00464-023-10491-2] [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: 05/30/2023] [Accepted: 09/23/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION Intraoperative accurate localization of tumors in the lower gastrointestinal tract is essential to ensure oncologic radicality. In minimally invasive colon surgery, tactile identification of tumors is challenging due to diminished or absent haptics. In clinical practice, preoperative endoscopic application of a blue dye (ink) to the tumor site has become the standard for marking and identification of tumors in the colon. However, this method has the major limitation that accidental intraperitoneal spillage of the dye can significantly complicate the identification of anatomical structures and surgical planes. In this work, we describe a new approach of NIR fluorescent tattooing using a near-infrared (NIR) fluorescent marker instead of a blue dye (ink) for endoscopic tattooing. METHODS AFS81x is a newly developed NIR fluorescent marker. In an experimental study with four domestic pigs, the newly developed NIR fluorescent marker (AFS81x) was used for endoscopic tattooing of the colon. 7-12 endoscopic submucosal injections of AFS81x were placed per animal in the colon. On day 0, day 1, and day 10 after endoscopic tattooing with AFS81x, the visualization of the fluorescent markings in the colon was evaluated during laparoscopic surgery by two surgeons and photographically documented. RESULTS The detection rate of the NIR fluorescent tattoos at day 0, day 1, and day 10 after endoscopic tattooing was 100%. Recognizability of anatomical structures during laparoscopy was not affected in any of the markings, as the markings were not visible in the white light channel of the laparoscope, but only in the NIR channel or in the overlay of the white light and the NIR channel of the laparoscope. The brightness, the sharpness, and size of the endoscopic tattoos did not change significantly on day 1 and day 10, but remained almost identical compared to day 0. CONCLUSION The new approach of endoscopic NIR fluorescence tattooing using the newly developed NIR fluorescence marker AFS81x enables stable marking of colonic sites over a long period of at least 10 days without compromising the recognizability of anatomical structures and surgical planes in any way.
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Affiliation(s)
- Michael Thomaschewski
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Michael Lipp
- Department of Surgery, Clinic for Gastrointestinal and Colorectal Surgery, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Carsten Engelke
- Medical Clinic I, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jonas Harder
- Department of Gastroenterology, Hepatology & Interventional Endoscopy, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Isabell Labod
- EUREGIO BioMedtech Center, University of Applied Sciences Münster, Stegerwaldstr. 39, 48565, Steinfurt, Germany
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Karin Mittmann
- EUREGIO BioMedtech Center, University of Applied Sciences Münster, Stegerwaldstr. 39, 48565, Steinfurt, Germany.
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12
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Narayan AK, Miles RC, Milton A, Salazar G, Spalluto LB, Babagbemi K, Stowell JT, Flores EJ, Dako F, Weissman IA. Fostering Patient-Centered Equitable Care in Radiology: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:711-719. [PMID: 37255040 DOI: 10.2214/ajr.23.29261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Patient-centered care (PCC) and equity are two of the six core domains of quality health care, according to the Institute of Medicine. Exceptional imaging care requires radiology practices to provide patient-centered (i.e., respectful and responsive to individual patient preferences, needs, and values) and equitable (i.e., does not vary in quality on the basis of gender, ethnicity, geographic location, or socioeconomic status) care. Specific barriers that prevent the delivery of patient-centered equitable care include information gaps, breaches of trust, organizational medical culture, and financial incentives. Information gaps limit practitioners in understanding the lived experience of patients. Breaches of trust prevent patients from seeking needed medical care. Organizational medical cultures may not be centered around patient experiences. Financial incentives can impede practitioners' ability to spend the time and resources required to meet patient goals and needs. Intentional approaches that integrate core principles in both PCC and health equity are required to deliver high-quality patient-centered imaging care for diverse patient populations. The purpose of this AJR Expert Panel Narrative Review is to review the origins of the PCC movement in radiology, characterize connections between the PCC and health equity movements, and describe concrete examples of ways to foster patient-centered equitable care in radiology.
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Affiliation(s)
- Anand K Narayan
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, F6/178C, Madison, WI 53792-3252
| | | | - Arissa Milton
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, F6/178C, Madison, WI 53792-3252
| | - Gloria Salazar
- Department of Radiology, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Lucy B Spalluto
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
- Department of Radiology, Vanderbilt-Ingram Cancer Center, Nashville, TN
- Department of Radiology, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center, Nashville, TN
| | - Kemi Babagbemi
- Department of Radiology, Weill Cornell Medicine, New York, NY
| | | | - Efren J Flores
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Farouk Dako
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ian A Weissman
- Department of Radiology, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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Saravi B, Guzel HE, Zink A, Ülkümen S, Couillard-Despres S, Wollborn J, Lang G, Hassel F. Synthetic 3D Spinal Vertebrae Reconstruction from Biplanar X-rays Utilizing Generative Adversarial Networks. J Pers Med 2023; 13:1642. [PMID: 38138869 PMCID: PMC10744485 DOI: 10.3390/jpm13121642] [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: 10/16/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Computed tomography (CT) offers detailed insights into the internal anatomy of patients, particularly for spinal vertebrae examination. However, CT scans are associated with higher radiation exposure and cost compared to conventional X-ray imaging. In this study, we applied a Generative Adversarial Network (GAN) framework to reconstruct 3D spinal vertebrae structures from synthetic biplanar X-ray images, specifically focusing on anterior and lateral views. The synthetic X-ray images were generated using the DRRGenerator module in 3D Slicer by incorporating segmentations of spinal vertebrae in CT scans for the region of interest. This approach leverages a novel feature fusion technique based on X2CT-GAN to combine information from both views and employs a combination of mean squared error (MSE) loss and adversarial loss to train the generator, resulting in high-quality synthetic 3D spinal vertebrae CTs. A total of n = 440 CT data were processed. We evaluated the performance of our model using multiple metrics, including mean absolute error (MAE) (for each slice of the 3D volume (MAE0) and for the entire 3D volume (MAE)), cosine similarity, peak signal-to-noise ratio (PSNR), 3D peak signal-to-noise ratio (PSNR-3D), and structural similarity index (SSIM). The average PSNR was 28.394 dB, PSNR-3D was 27.432, SSIM was 0.468, cosine similarity was 0.484, MAE0 was 0.034, and MAE was 85.359. The results demonstrated the effectiveness of this approach in reconstructing 3D spinal vertebrae structures from biplanar X-rays, although some limitations in accurately capturing the fine bone structures and maintaining the precise morphology of the vertebrae were present. This technique has the potential to enhance the diagnostic capabilities of low-cost X-ray machines while reducing radiation exposure and cost associated with CT scans, paving the way for future applications in spinal imaging and diagnosis.
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Affiliation(s)
- Babak Saravi
- Department of Orthopedics and Trauma Surgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (S.Ü.); (G.L.)
- Department of Spine Surgery, Loretto Hospital, 79100 Freiburg, Germany; (A.Z.); (F.H.)
- Institute of Experimental Neuroregeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, 5020 Salzburg, Austria;
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Hamza Eren Guzel
- Department of Radiology, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir 35170, Türkiye;
| | - Alisia Zink
- Department of Spine Surgery, Loretto Hospital, 79100 Freiburg, Germany; (A.Z.); (F.H.)
| | - Sara Ülkümen
- Department of Orthopedics and Trauma Surgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (S.Ü.); (G.L.)
| | - Sebastien Couillard-Despres
- Institute of Experimental Neuroregeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, 5020 Salzburg, Austria;
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Jakob Wollborn
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Gernot Lang
- Department of Orthopedics and Trauma Surgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (S.Ü.); (G.L.)
| | - Frank Hassel
- Department of Spine Surgery, Loretto Hospital, 79100 Freiburg, Germany; (A.Z.); (F.H.)
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Issaka RB, Chan AT, Gupta S. AGA Clinical Practice Update on Risk Stratification for Colorectal Cancer Screening and Post-Polypectomy Surveillance: Expert Review. Gastroenterology 2023; 165:1280-1291. [PMID: 37737817 PMCID: PMC10591903 DOI: 10.1053/j.gastro.2023.06.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/20/2023] [Accepted: 06/30/2023] [Indexed: 09/23/2023]
Abstract
DESCRIPTION Since the early 2000s, there has been a rapid decline in colorectal cancer (CRC) mortality, due in large part to screening and removal of precancerous polyps. Despite these improvements, CRC remains the second leading cause of cancer deaths in the United States, with approximately 53,000 deaths projected in 2023. The aim of this American Gastroenterological Association (AGA) Clinical Practice Update Expert Review was to describe how individuals should be risk-stratified for CRC screening and post-polypectomy surveillance and to highlight opportunities for future research to fill gaps in the existing literature. METHODS This Expert Review was commissioned and approved by the American Gastroenterological Association (AGA) Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the CPUC and external peer review through standard procedures of Gastroenterology. These Best Practice Advice statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these Best Practice Advice statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. Best Practice Advice Statements BEST PRACTICE ADVICE 1: All individuals with a first-degree relative (defined as a parent, sibling, or child) who was diagnosed with CRC, particularly before the age of 50 years, should be considered at increased risk for CRC. BEST PRACTICE ADVICE 2: All individuals without a personal history of CRC, inflammatory bowel disease, hereditary CRC syndromes, other CRC predisposing conditions, or a family history of CRC should be considered at average risk for CRC. BEST PRACTICE ADVICE 3: Individuals at average risk for CRC should initiate screening at age 45 years and individuals at increased risk for CRC due to having a first-degree relative with CRC should initiate screening 10 years before the age at diagnosis of the youngest affected relative or age 40 years, whichever is earlier. BEST PRACTICE ADVICE 4: Risk stratification for initiation of CRC screening should be based on an individual's age, a known or suspected predisposing hereditary CRC syndrome, and/or a family history of CRC. BEST PRACTICE ADVICE 5: The decision to continue CRC screening in individuals older than 75 years should be individualized, based on an assessment of risks, benefits, screening history, and comorbidities. BEST PRACTICE ADVICE 6: Screening options for individuals at average risk for CRC should include colonoscopy, fecal immunochemical test, flexible sigmoidoscopy plus fecal immunochemical test, multitarget stool DNA fecal immunochemical test, and computed tomography colonography, based on availability and individual preference. BEST PRACTICE ADVICE 7: Colonoscopy should be the screening strategy used for individuals at increased CRC risk. BEST PRACTICE ADVICE 8: The decision to continue post-polypectomy surveillance for individuals older than 75 years should be individualized, based on an assessment of risks, benefits, and comorbidities. BEST PRACTICE ADVICE 9: Risk-stratification tools for CRC screening and post-polypectomy surveillance that emerge from research should be examined for real-world effectiveness and cost-effectiveness in diverse populations (eg, by race, ethnicity, sex, and other sociodemographic factors associated with disparities in CRC outcomes) before widespread implementation.
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Affiliation(s)
- Rachel B Issaka
- Public Health Sciences and Clinical Research Divisions, Fred Hutchinson Cancer Center, Seattle, Washington; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington.
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Samir Gupta
- Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California; Section of Gastroenterology, Jennifer Moreno Department of Medical Affairs Medical Center, San Diego, California
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Ha NT, Kamarova S, Youens D, Ho C, Bulsara MK, Doust J, Mcrobbie D, O'Leary P, Wright C, Trevithick R, Moorin R. Use of CT, ED presentation and hospitalisations 12 months before and after a diagnosis of cancer in Western Australia: a population-based retrospective cohort study. BMJ Open 2023; 13:e071052. [PMID: 37899144 PMCID: PMC10619095 DOI: 10.1136/bmjopen-2022-071052] [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: 12/13/2022] [Accepted: 10/12/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE To examine the use of CT, emergency department (ED)-presentation and hospitalisation and in 12 months before and after a diagnosis of cancer. DESIGN Population-based retrospective cohort study. SETTING West Australian linked administrative records at individual level. PARTICIPANTS 104 009 adults newly diagnosed with cancer in 2004-2014. MAIN OUTCOME MEASURES CT use, ED presentations, hospitalisations. RESULTS As compared with the rates in the 12th month before diagnosis, the rate of CT scans started to increase from 2 months before diagnosis with an increase in both ED presentations and hospitalisation from 1 month before the diagnosis. These rates peaked in the month of diagnosis for CT scans (477 (95% CI 471 to 482) per 1000 patients), and for hospitalisations (910 (95% CI 902 to 919) per 1000 patients), and the month prior to diagnosis for ED (181 (95% CI 178 to 184) per 1000 patients) then rapidly reduced after diagnosis but remained high for the next 12 months. While the patterns of the health services used were similar between 2004 and 2014, the rate of the health services used during after diagnosis was higher in 2014 versus 2004 except for CT use in patients with lymphohaematopoietic cancer with a significant reduction. CONCLUSION Our results showed an increase in demand for health services from 2 months before diagnosis of cancer. Increasing use of health services during and post cancer diagnosis may warrant further investigation to identify factors driving this change.
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Affiliation(s)
- Ninh Thi Ha
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Sviatlana Kamarova
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Nepean Blue Mountains Local Health District, New South Wales Health, Sydney, New South Wales, Australia
| | - David Youens
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Chau Ho
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Max K Bulsara
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- Biostatistics, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Jenny Doust
- Australian Women and Girls' Health Research (AWaGHR) Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Donald Mcrobbie
- School of Physical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter O'Leary
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Obstetrics and Gynaecology Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- PathWest Laboratory Medicine, QE2 Medical Centre, Nedlands, Western Australia, Australia
| | - Cameron Wright
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Division of Internal Medicine, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Richard Trevithick
- Western Australian Cancer Registry, Clinical Excellence Division, Department of Health, East Perth, Western Australia, Australia
| | - Rachael Moorin
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Chiu LS, Calderwood AH. Noninvasive Colorectal Cancer Prevention Options in Older Adults. J Clin Gastroenterol 2023; 57:855-862. [PMID: 37436836 DOI: 10.1097/mcg.0000000000001893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Colorectal cancer (CRC) is a leading cause of morbidity and mortality worldwide and its incidence increases with age. The proportion of older adults in the United States continues to rise, making CRC prevention a key health priority for our aging population. CRC is a largely preventable disease through screening and polyp surveillance, and noninvasive modalities represent an important option for older adults in whom the burdens and risks of invasive testing are higher compared with younger adults. This review highlights the evidence, risks, and benefits of noninvasive CRC screening and surveillance options in older adults and discusses the challenges of CRC prevention in this cohort.
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Affiliation(s)
- Laura S Chiu
- Department of Medicine, Section of Gastroenterology, Boston University School of Medicine, Boston, MA
| | - Audrey H Calderwood
- Department of Medicine, Section of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Qaseem A, Harrod CS, Crandall CJ, Wilt TJ, Balk EM, Cooney TG, Cross JT, Fitterman N, Maroto M, Obley AJ, Tice J, Tufte JE, Shamliyan T, Yost J. Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults: A Guidance Statement From the American College of Physicians (Version 2). Ann Intern Med 2023; 176:1092-1100. [PMID: 37523709 DOI: 10.7326/m23-0779] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
DESCRIPTION The purpose of this updated guidance statement is to guide clinicians on screening for colorectal cancer (CRC) in asymptomatic average-risk adults. The intended audience is all clinicians. The population is asymptomatic adults at average risk for CRC. METHODS This updated guidance statement was developed using recently published and critically appraised clinical guidelines from national guideline developers since the publication of the American College of Physicians' 2019 guidance statement, "Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults." The authors searched for national guidelines from the United States and other countries published in English using PubMed and the Guidelines International Network library from 1 January 2018 to 24 April 2023. The authors also searched for updates of guidelines included in the first version of our guidance statement. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument was used to assess the quality of eligible guidelines. Two guidelines were selected for adoption and adaptation by raters on the basis of the highest average overall AGREE II quality scores. The evidence reviews and modeling studies for these 2 guidelines were also used to synthesize the evidence of diagnostic test accuracy, effectiveness, and harms of CRC screening interventions and to develop our guidance statements. GUIDANCE STATEMENT 1 Clinicians should start screening for colorectal cancer in asymptomatic average-risk adults at age 50 years. GUIDANCE STATEMENT 2 Clinicians should consider not screening asymptomatic average-risk adults between the ages of 45 to 49 years. Clinicians should discuss the uncertainty around benefits and harms of screening in this population. GUIDANCE STATEMENT 3 Clinicians should stop screening for colorectal cancer in asymptomatic average-risk adults older than 75 years or in asymptomatic average-risk adults with a life expectancy of 10 years or less. GUIDANCE STATEMENT 4A Clinicians should select a screening test for colorectal cancer in consultation with their patient based on a discussion of benefits, harms, costs, availability, frequency, and patient values and preferences. GUIDANCE STATEMENT 4B Clinicians should select among a fecal immunochemical or high-sensitivity guaiac fecal occult blood test every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus a fecal immunochemical test every 2 years as a screening test for colorectal cancer. GUIDANCE STATEMENT 4C Clinicians should not use stool DNA, computed tomography colonography, capsule endoscopy, urine, or serum screening tests for colorectal cancer.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., C.S.H.)
| | - Curtis S Harrod
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., C.S.H.)
| | - Carolyn J Crandall
- David Geffen School of Medicine at UCLA, Los Angeles, California (C.J.C.)
| | - Timothy J Wilt
- Minneapolis VA Medical Center, Minneapolis, Minnesota (T.J.W.)
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18
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Santos DAR, Gaiteiro C, Santos M, Santos L, Dinis-Ribeiro M, Lima L. MicroRNA Biomarkers as Promising Tools for Early Colorectal Cancer Screening-A Comprehensive Review. Int J Mol Sci 2023; 24:11023. [PMID: 37446201 DOI: 10.3390/ijms241311023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
Colorectal cancer (CRC) ranks as the third most prevalent cancer worldwide. Early detection of this neoplasia has proven to improve prognosis, resulting in a 90% increase in survival. However, available CRC screening methods have limitations, requiring the development of new tools. MicroRNA biomarkers have emerged as a powerful screening tool, as they are highly expressed in CRC patients and easily detectable in several biological samples. While microRNAs are extensively studied in blood samples, recent interest has now arisen in other samples, such as stool samples, where they can be combined with existing screening methods. Among the microRNAs described in the literature, microRNA-21-5p and microRNA-92a-3p and their cluster have demonstrated high potential for early CRC screening. Furthermore, the combination of multiple microRNAs has shown improved performance in CRC detection compared to individual microRNAs. This review aims to assess the available data in the literature on microRNAs as promising biomarkers for early CRC screening, explore their advantages and disadvantages, and discuss the optimal study characteristics for analyzing these biomarkers.
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Affiliation(s)
- Daniela A R Santos
- Experimental Pathology and Therapeutics Group, Research Center of IPO Porto (CI-IPOP), RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
- School of Health, Polytechnic Institute of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Cristiana Gaiteiro
- Experimental Pathology and Therapeutics Group, Research Center of IPO Porto (CI-IPOP), RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
| | - Marlene Santos
- School of Health, Polytechnic Institute of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
- Centro de Investigação em Saúde e Ambiente (CISA), Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal
- Molecular Oncology & Viral Pathology, IPO-Porto Research Center (CI-IPO), Portuguese Institute of Oncology, 4200-072 Porto, Portugal
| | - Lúcio Santos
- Experimental Pathology and Therapeutics Group, Research Center of IPO Porto (CI-IPOP), RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
- Department of Surgical Oncology, Portuguese Institute of Oncology (IPO-Porto), 4200-072 Porto, Portugal
| | - Mário Dinis-Ribeiro
- Precancerous Lesions and Early Cancer Management Group, Research Center of IPO Porto (CI-IPOP), Rise@CI-IPOP (Health Research Group), Portuguese Institute of Oncology of Porto (IPO Porto), Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
| | - Luís Lima
- Experimental Pathology and Therapeutics Group, Research Center of IPO Porto (CI-IPOP), RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
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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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20
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Alhazmi W, Turki T. Applying Deep Transfer Learning to Assess the Impact of Imaging Modalities on Colon Cancer Detection. Diagnostics (Basel) 2023; 13:diagnostics13101721. [PMID: 37238207 DOI: 10.3390/diagnostics13101721] [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: 04/01/2023] [Revised: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
The use of medical images for colon cancer detection is considered an important problem. As the performance of data-driven methods relies heavily on the images generated by a medical method, there is a need to inform research organizations about the effective imaging modalities, when coupled with deep learning (DL), for detecting colon cancer. Unlike previous studies, this study aims to comprehensively report the performance behavior for detecting colon cancer using various imaging modalities coupled with different DL models in the transfer learning (TL) setting to report the best overall imaging modality and DL model for detecting colon cancer. Therefore, we utilized three imaging modalities, namely computed tomography, colonoscopy, and histology, using five DL architectures, including VGG16, VGG19, ResNet152V2, MobileNetV2, and DenseNet201. Next, we assessed the DL models on the NVIDIA GeForce RTX 3080 Laptop GPU (16GB GDDR6 VRAM) using 5400 processed images divided equally between normal colons and colons with cancer for each of the imaging modalities used. Comparing the imaging modalities when applied to the five DL models presented in this study and twenty-six ensemble DL models, the experimental results show that the colonoscopy imaging modality, when coupled with the DenseNet201 model under the TL setting, outperforms all the other models by generating the highest average performance result of 99.1% (99.1%, 99.8%, and 99.1%) based on the accuracy results (AUC, precision, and F1, respectively).
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Affiliation(s)
- Wael Alhazmi
- Department of Computer Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Turki Turki
- Department of Computer Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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21
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Britton I, Bradbury C, Srinivas S, Balasubramaniam R, Dale M, Morley-Davies A, Bednall R. CTC service heterogeneity and design of a workforce calculator. Clin Radiol 2023:S0009-9260(23)00144-7. [PMID: 37188552 DOI: 10.1016/j.crad.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 12/14/2022] [Accepted: 03/31/2023] [Indexed: 05/17/2023]
Abstract
AIM To determine the level of heterogeneity in delivery of computed tomography (CT) colonography services and develop a workforce calculator that accommodates the variation identified. MATERIALS AND METHODS A national survey, based on the "WHO workforce indicators of staffing need", established activity standards for essential tasks in delivery of the service. From these data a workforce calculator was designed to guide the required staffing and equipment resource by service size. RESULTS Activity standards were established as mode responses >70%. Service homogeneity was greater in areas where professional standards and guidance were available. The mean service size was 1,101. Did not attend (DNA) rates were lower where direct booking was available (p<0.0001). Service sizes were larger where radiographer reporting was embedded in reporting paradigms (p<0.024). CONCLUSION The survey identified benefits of radiographer-led direct booking and reporting. The workforce calculator derived from the survey provides a framework to guide the resourcing of expansion while maintaining standards.
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Affiliation(s)
- I Britton
- Imaging Department, University Hospital of North Midlands, Stoke-on-Trent, UK.
| | - C Bradbury
- Imaging Department, University Hospital of North Midlands, Stoke-on-Trent, UK
| | - S Srinivas
- Imaging Department, University Hospital of North Midlands, Stoke-on-Trent, UK
| | - R Balasubramaniam
- Imaging Department, University Hospital of North Midlands, Stoke-on-Trent, UK
| | - M Dale
- Imaging Department, University Hospital of North Midlands, Stoke-on-Trent, UK
| | - A Morley-Davies
- Cardiology Department, University Hospital of North Midlands, Stoke-on-Trent, UK
| | - R Bednall
- Quality Improvement Academy, University Hospital of North Midlands, Stoke-on-Trent, UK
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22
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Singh K, Liptrot S, Tou S, Mehigan B, McCormick P, Ravi N, Reynolds J, Al Chalabi H. A multicentre study assessing the role of routine colonoscopy after acute uncomplicated diverticulitis and the incidence of colorectal cancer diagnosis. Int J Colorectal Dis 2023; 38:84. [PMID: 36976397 DOI: 10.1007/s00384-023-04374-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE The low rates of colonic malignancy detected on interval colonoscopy for patients diagnosed with diverticulitis have led recent studies to question the utility of the practice. The aim of this study was to assess the detection rate of colorectal cancer on colonoscopy for patients with a first episode of acute uncomplicated diverticulitis across three separate centres in Ireland and the UK. METHODS A retrospective review was performed of patients with a first episode of acute, uncomplicated diverticulitis who underwent interval colonoscopy at three separate centres in the UK and Ireland between 2007 and 2019. The follow-up period was one year. RESULTS A total of 5485 patients were admitted with acute diverticulitis between the three centres. All patients had CT verified diverticulitis. A 90.8% (n = 4982) underwent subsequent colonic evaluation with colonoscopy. Of these, a histologically proven diagnosis of colorectal carcinoma was made in 1.28% (n = 64). CONCLUSION Routine colonoscopy following an episode of acute, uncomplicated diverticulitis may not be necessary in every patient. It may be appropriate to reserve this more invasive investigation for those with higher risk factors for malignancy.
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Affiliation(s)
- Kaushiki Singh
- Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, UK.
| | - Sarah Liptrot
- University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - Sam Tou
- University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | | | | | | | | | - Hasan Al Chalabi
- Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, UK
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23
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Kim DH. CT Colonography Is the Perfect Colorectal Screening Test That Unfortunately Few People Use Yet. Korean J Radiol 2023; 24:79-82. [PMID: 36725349 PMCID: PMC9892224 DOI: 10.3348/kjr.2022.0969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- David H Kim
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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24
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Heterogeneity in the Utilization of Fecal Occult Blood Testing and Colonoscopy among Migrants and Non-Migrants in Austria: Results of the Austrian Health Interview Survey. GASTROINTESTINAL DISORDERS 2023. [DOI: 10.3390/gidisord5010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Many European studies report lower participation in colorectal cancer screening among migrants than non-migrants. A major limitation of these studies is that usually, the heterogeneity of migrants cannot be accounted for. The aim of this investigation was to examine differences in the utilization of fecal occult blood testing and colonoscopy between non-migrants and the five largest migrant groups residing in Austria using data from the Austrian Health Interview Survey 2019. The two outcomes were compared between non-migrants and migrants using multivariable logistic regression adjusted for socioeconomic and health variables. Migrants from a Yugoslav successor state (OR = 0.61; 95%-CI: 0.44–0.83), Turkish (OR = 0.35; 95%-CI: 0.22–0.55), Hungarian (OR = 0.37; 95%-CI: 0.16–0.82) and German migrants (OR = 0.70; 95%-CI: 0.51–0.98) were less likely to have used a fecal occult blood test compared to non-migrants. Participation in colonoscopy was lower among Turkish migrants (OR = 0.42; 95%-CI: 0.27–0.67) and migrants from a Yugoslav successor state (OR = 0.56; 95%-CI: 0.42–0.75) than among non-migrants. The findings are consistent with studies from other countries and highlight barriers migrants face in accessing the health care system. To address these barriers, the heterogeneity of the population must be taken into account when developing educational materials in order to promote informed decisions about whether or not to participate in colorectal cancer screening.
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25
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Okada Y, Peng F, Perea J, Corchete L, Bujanda L, Li W, Goel A. Genome-wide methylation profiling identifies a novel gene signature for patients with synchronous colorectal cancer. Br J Cancer 2023; 128:112-120. [PMID: 36319845 PMCID: PMC9814149 DOI: 10.1038/s41416-022-02033-9] [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: 05/24/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND There are no robust tools for the diagnosis of synchronous colorectal cancer (SyCRC). Herein, we developed the first methylation signature to identify and characterise patients with SyCRC. METHODS For biomarker discovery, we analysed the genome-wide methylation profiles of 16 SyCRC and 18 solitary colorectal cancer (SoCRC) specimens. We thereafter established a methylation signature risk-scoring model to identify SyCRC in an independent cohort of 38 SyCRC and 42 SoCRC patients. In addition, we evaluated the prognostic value of the identified methylation profile. RESULTS We identified six differentially methylated CpG probes/sites that distinguished SyCRC from SoCRC. In the validation cohort, we developed a methylation panel that identified patients with SyCRC from not only larger tumour (AUC = 0.91) but also the paired remaining tumour (AUC = 0.93). Moreover, high risk scores of our panel were associated with the development of metachronous CRC among patients with SyCRC (AUC = 0.87) and emerged as an independent predictor for relapse-free survival (hazard ratio = 2.72; 95% CI = 1.12-6.61). Furthermore, the risk stratification model which combined with clinical risk factors was a diagnostic predictor of recurrence (AUC = 0.90). CONCLUSIONS Our novel six-gene methylation panel robustly identifies patients with SyCRC, which has the clinical potential to improve the diagnosis and management of patients with CRC.
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Affiliation(s)
- Yasuyuki Okada
- Department of Molecular Diagnostics and Experimental Therapeutics, Beckman Research Institute of City of Hope, Monrovia, CA, USA
- Department of Gastroenterology and Oncology, Tokushima University Graduate School, Tokushima, Japan
| | - Fuduan Peng
- Department of Biological Chemistry, School of Medicine, University of California Irvine, Irvine, CA, USA
| | - José Perea
- Molecular Medicine Unit. Department of Medicine, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
- Surgery Department, Vithas Arturo Soria University Hospital and School of Medicine, European University of Madrid, Madrid, Spain
| | - Luis Corchete
- Hematology Department, University Hospital of Salamanca, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Cancer Research Center (CiC-IBMCC, CSIC/USAL), Center for Biomedical Research in Network of Cancer (CIBERONC), Salamanca, Spain
| | - Luis Bujanda
- Gastroenterology Department, Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Wei Li
- Department of Biological Chemistry, School of Medicine, University of California Irvine, Irvine, CA, USA.
| | - Ajay Goel
- Department of Molecular Diagnostics and Experimental Therapeutics, Beckman Research Institute of City of Hope, Monrovia, CA, USA.
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
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26
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Alkabbany I, Ali AM, Mohamed M, Elshazly SM, Farag A. An AI-Based Colonic Polyp Classifier for Colorectal Cancer Screening Using Low-Dose Abdominal CT. SENSORS (BASEL, SWITZERLAND) 2022; 22:9761. [PMID: 36560132 PMCID: PMC9782078 DOI: 10.3390/s22249761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
Among the non-invasive Colorectal cancer (CRC) screening approaches, Computed Tomography Colonography (CTC) and Virtual Colonoscopy (VC), are much more accurate. This work proposes an AI-based polyp detection framework for virtual colonoscopy (VC). Two main steps are addressed in this work: automatic segmentation to isolate the colon region from its background, and automatic polyp detection. Moreover, we evaluate the performance of the proposed framework on low-dose Computed Tomography (CT) scans. We build on our visualization approach, Fly-In (FI), which provides "filet"-like projections of the internal surface of the colon. The performance of the Fly-In approach confirms its ability with helping gastroenterologists, and it holds a great promise for combating CRC. In this work, these 2D projections of FI are fused with the 3D colon representation to generate new synthetic images. The synthetic images are used to train a RetinaNet model to detect polyps. The trained model has a 94% f1-score and 97% sensitivity. Furthermore, we study the effect of dose variation in CT scans on the performance of the the FI approach in polyp visualization. A simulation platform is developed for CTC visualization using FI, for regular CTC and low-dose CTC. This is accomplished using a novel AI restoration algorithm that enhances the Low-Dose CT images so that a 3D colon can be successfully reconstructed and visualized using the FI approach. Three senior board-certified radiologists evaluated the framework for the peak voltages of 30 KV, and the average relative sensitivities of the platform were 92%, whereas the 60 KV peak voltage produced average relative sensitivities of 99.5%.
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Affiliation(s)
- Islam Alkabbany
- Computer Vision and Image Processing Laboratory, University of Louisville, Louisville, KY 40292, USA
| | - Asem M. Ali
- Computer Vision and Image Processing Laboratory, University of Louisville, Louisville, KY 40292, USA
| | - Mostafa Mohamed
- Computer Vision and Image Processing Laboratory, University of Louisville, Louisville, KY 40292, USA
| | | | - Aly Farag
- Computer Vision and Image Processing Laboratory, University of Louisville, Louisville, KY 40292, USA
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27
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Moshfeghifar F, Gholamalizadeh T, Ferguson Z, Schneider T, Nielsen MB, Panozzo D, Darkner S, Erleben K. LibHip: An open-access hip joint model repository suitable for finite element method simulation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 226:107140. [PMID: 36162245 DOI: 10.1016/j.cmpb.2022.107140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE population-based finite element analysis of hip joints allows us to understand the effect of inter-subject variability on simulation results. Developing large subject-specific population models is challenging and requires extensive manual effort. Thus, the anatomical representations are often subjected to simplification. The discretized geometries do not guarantee conformity in shared interfaces, leading to complications in setting up simulations. Additionally, these models are not openly accessible, challenging reproducibility. Our work provides multiple subject-specific hip joint finite element models and a novel semi-automated modeling workflow. METHODS we reconstruct 11 healthy subject-specific models, including the sacrum, the paired pelvic bones, the paired proximal femurs, the paired hip joints, the paired sacroiliac joints, and the pubic symphysis. The bones are derived from CT scans, and the cartilages are generated from the bone geometries. We generate the whole complex's volume mesh with conforming interfaces. Our models are evaluated using both mesh quality metrics and simulation experiments. RESULTS the geometry of all the models are inspected by our clinical expert and show high-quality discretization with accurate geometries. The simulations produce smooth stress patterns, and the variance among the subjects highlights the effect of inter-subject variability and asymmetry in the predicted results. CONCLUSIONS our work is one of the largest model repositories with respect to the number of subjects and regions of interest in the hip joint area. Our detailed research data, including the clinical images, the segmentation label maps, the finite element models, and software tools, are openly accessible on GitHub and the link is provided in Moshfeghifar et al.(2022)[1]. Our aim is to empower clinical researchers to have free access to verified and reproducible models. In future work, we aim to add additional structures to our models.
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Affiliation(s)
- Faezeh Moshfeghifar
- Department of Computer Science, University of Copenhagen, Copenhagen 2100, Denmark.
| | - Torkan Gholamalizadeh
- Department of Computer Science, University of Copenhagen, Copenhagen 2100, Denmark; 3Shape A/S, Copenhagen 1060, Denmark
| | - Zachary Ferguson
- Courant Institute of Mathematical Sciences, New York University, 60 5th Ave, New York, NY 10011, United States
| | - Teseo Schneider
- Department of Computer Science, University of Victoria, Victoria, BC V8P 5C2, Canada
| | - Michael Bachmann Nielsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Radiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniele Panozzo
- Courant Institute of Mathematical Sciences, New York University, 60 5th Ave, New York, NY 10011, United States
| | - Sune Darkner
- Department of Computer Science, University of Copenhagen, Copenhagen 2100, Denmark
| | - Kenny Erleben
- Department of Computer Science, University of Copenhagen, Copenhagen 2100, Denmark
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28
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Sali L, Ventura L, Mascalchi M, Falchini M, Mallardi B, Carozzi F, Milani S, Zappa M, Grazzini G, Mantellini P. Single CT colonography versus three rounds of faecal immunochemical test for population-based screening of colorectal cancer (SAVE): a randomised controlled trial. Lancet Gastroenterol Hepatol 2022; 7:1016-1023. [PMID: 36116454 DOI: 10.1016/s2468-1253(22)00269-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Colorectal cancer screening is recommended for people aged 50-75 years, but the optimal screening test and strategy are not established. We aimed to compare single CT colonography versus three faecal immunochemical test (FIT) rounds for population-based screening of colorectal cancer. METHODS This randomised controlled trial was done in Florence, Italy. Adults aged 54-65 years, never screened for colorectal cancer, were randomly assigned (1:2) by simple randomisation and invited by post to either a single CT colonography (CT colonography group) or three FIT rounds (FIT group; each round was done 2 years apart). Exclusion criteria included previous colorectal cancer, advanced adenoma, or inflammatory bowel disease, colonoscopy within the last 5 years or FIT within the last 2 years, and severe medical conditions. Participants who had a colonic mass or at least one polyp of 6 mm or more in diameter in the CT colonography group and those who had at least 20 μg haemoglobin per g faeces in the FIT group were referred for work-up optical colonoscopy. The primary outcome was detection rate for advanced neoplasia. Outcomes were assessed in the modified intention-to-screen and per-protocol populations. The trial is registered with ClinicalTrials.gov, NCT01651624. FINDINGS From Dec 12, 2012, to March 5, 2018, 14 981 adults were randomised and invited to screening interventions. 5242 (35·0%) individuals (2809 [53·6%] women and 2433 [46·4%] men) were assigned to the CT colonography group and 9739 (65·0%) individuals (5208 [53·5%] women and 4531 [46·5%] men) were assigned to the FIT group. Participation in the screening intervention was lower in the CT colonography group (1286 [26·7%] of the 4825 eligible invitees) than it was for the FIT group (6027 [64·9%] of the 9288 eligible invitees took part in at least one screening round, 4573 [49·2%] in at least two rounds, and 3105 [33·4%] in all three rounds). The detection rate for advanced neoplasia of CT colonography was significantly lower than the detection rate after three FIT rounds (1·4% [95% CI 1·1-1·8] vs 2·0% [1·7-2·3]; p=0·0094) in the modified intention-to-screen analysis, but the detection rate was significantly higher in the CT colonography group than in the FIT group (5·2% [95% CI 4·1-6·6] vs 3·1% [2·7-3·6]; p=0·0002]) in the per-protocol analysis. Referral rate to work-up optical colonoscopy (the secondary outcome of the trial) was significantly lower for the CT colonography group than for the FIT group after three FIT rounds (2·7% [95% CI 2·2-3·1] vs 7·5% [7·0-8·1]; p<0·0001) in the modified intention-to-screen analysis, whereas no significant difference was observed in the per-protocol analysis (10·0% [8·4-11·8] vs 11·6% [10·8-12·4]). No major complications were observed in the CT colonography group after screening and work-up optical colonoscopy, whereas three cases of bleeding were reported in the FIT group after work-up optical colonoscopy (two after the first FIT and one after the second FIT). INTERPRETATION Greater participation makes FIT more efficient than single CT colonography for detection of advanced neoplasia in population screening for colorectal cancer. Nonetheless, higher detection rate in participants and fewer work-up colonoscopies are possible advantages of CT colonography as a screening tool, which might deserve consideration in future trials. FUNDING Government of Tuscany and Cassa di Risparmio di Firenze Foundation. TRANSLATION For the Italian translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Lapo Sali
- Department of Biomedical, Experimental and Clinical Sciences Mario Serio, University of Florence, Florence, Italy; Department of Radiology, Istituto Fiorentino di Cura e Assistenza Hospital, Florence, Italy.
| | - Leonardo Ventura
- Oncological Network, Prevention and Research Institute, Florence, Italy
| | - Mario Mascalchi
- Department of Biomedical, Experimental and Clinical Sciences Mario Serio, University of Florence, Florence, Italy; Oncological Network, Prevention and Research Institute, Florence, Italy
| | - Massimo Falchini
- Department of Biomedical, Experimental and Clinical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Beatrice Mallardi
- Oncological Network, Prevention and Research Institute, Florence, Italy
| | - Francesca Carozzi
- Oncological Network, Prevention and Research Institute, Florence, Italy
| | - Stefano Milani
- Department of Biomedical, Experimental and Clinical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Marco Zappa
- Oncological Network, Prevention and Research Institute, Florence, Italy
| | - Grazia Grazzini
- Oncological Network, Prevention and Research Institute, Florence, Italy
| | - Paola Mantellini
- Oncological Network, Prevention and Research Institute, Florence, Italy
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29
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Zimmerer D, Full PM, Isensee F, Jager P, Adler T, Petersen J, Kohler G, Ross T, Reinke A, Kascenas A, Jensen BS, O'Neil AQ, Tan J, Hou B, Batten J, Qiu H, Kainz B, Shvetsova N, Fedulova I, Dylov DV, Yu B, Zhai J, Hu J, Si R, Zhou S, Wang S, Li X, Chen X, Zhao Y, Marimont SN, Tarroni G, Saase V, Maier-Hein L, Maier-Hein K. MOOD 2020: A Public Benchmark for Out-of-Distribution Detection and Localization on Medical Images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:2728-2738. [PMID: 35468060 DOI: 10.1109/tmi.2022.3170077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Detecting Out-of-Distribution (OoD) data is one of the greatest challenges in safe and robust deployment of machine learning algorithms in medicine. When the algorithms encounter cases that deviate from the distribution of the training data, they often produce incorrect and over-confident predictions. OoD detection algorithms aim to catch erroneous predictions in advance by analysing the data distribution and detecting potential instances of failure. Moreover, flagging OoD cases may support human readers in identifying incidental findings. Due to the increased interest in OoD algorithms, benchmarks for different domains have recently been established. In the medical imaging domain, for which reliable predictions are often essential, an open benchmark has been missing. We introduce the Medical-Out-Of-Distribution-Analysis-Challenge (MOOD) as an open, fair, and unbiased benchmark for OoD methods in the medical imaging domain. The analysis of the submitted algorithms shows that performance has a strong positive correlation with the perceived difficulty, and that all algorithms show a high variance for different anomalies, making it yet hard to recommend them for clinical practice. We also see a strong correlation between challenge ranking and performance on a simple toy test set, indicating that this might be a valuable addition as a proxy dataset during anomaly detection algorithm development.
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30
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Beukema KR, Simmering JA, Brusse-Keizer M, John S, Quispel R, Mensink PB. Factors influencing endoscopic estimation of colon polyp size in a colon model. Clin Endosc 2022; 55:540-548. [PMID: 35898152 PMCID: PMC9329641 DOI: 10.5946/ce.2022.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/20/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND/AIMS Colorectal polyps are removed to prevent progression to colorectal cancer. Polyp size is an important factor for risk stratification of malignant transformation. Endoscopic size estimation correlates poorly with pathological reports and several factors have been suggested to influence size estimation. We aimed to gain insight into the factors influencing endoscopic polyp size estimation. METHODS Images of polyps in an artificial model were obtained at 1, 3, and 5 cm from the colonoscope's tip. Participants were asked to estimate the diameter and volume of each polyp. RESULTS Fifteen endoscopists from three large-volume centers participated in this study. With an intraclass correlation coefficient of 0.66 (95% confidence interval [CI], 0.62-0.71) for diameter and 0.56 (95% CI, 0.50-0.62) for volume. Polyp size estimated at 3 cm from the colonoscope's tip yielded the best results. A lower distance between the tip and the polyp was associated with a larger estimated polyp size. CONCLUSION Correct endoscopic estimation of polyp size remains challenging. This finding can affect size estimation skills and future training programs for endoscopists.
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Affiliation(s)
- Koen Robert Beukema
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Jaimy A Simmering
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands.,Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Marjolein Brusse-Keizer
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Sneha John
- Department of Gastroenterology, Gold Coast University Hospital, Southport, Australia
| | - Rutger Quispel
- Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Peter B Mensink
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands
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31
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Awidi M, Bagga A. Artificial intelligence and machine learning in colorectal cancer. Artif Intell Gastrointest Endosc 2022; 3:31-43. [DOI: 10.37126/aige.v3.i3.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/24/2022] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is a heterogeneous illness characterized by various epigenetic and microenvironmental changes and is the third-highest cause of cancer-related death in the US. Artificial intelligence (AI) with its ability to allow automatic learning and improvement from experiences using statistical methods and Deep learning has made a distinctive contribution to the diagnosis and treatment of several cancer types. This review discusses the uses and application of AI in CRC screening using automated polyp detection assistance technologies to the development of computer-assisted diagnostic algorithms capable of accurately detecting polyps during colonoscopy and classifying them. Furthermore, we summarize the current research initiatives geared towards building computer-assisted diagnostic algorithms that aim at improving the diagnostic accuracy of benign from premalignant lesions. Considering the evolving transition to more personalized and tailored treatment strategies for CRC, the review also discusses the development of machine learning algorithms to understand responses to therapies and mechanisms of resistance as well as the future roles that AI applications may play in assisting in the treatment of CRC with the aim to improve disease outcomes. We also discuss the constraints and limitations of the use of AI systems. While the medical profession remains enthusiastic about the future of AI and machine learning, large-scale randomized clinical trials are needed to analyze AI algorithms before they can be used.
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Affiliation(s)
- Muhammad Awidi
- Internal Medicine, Beth Israel Lahey Health, Burlington, MA 01805, United States
| | - Arindam Bagga
- Internal Medicine, Tufts Medical Center, Boston, MA 02111, United States
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32
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O'Connor B, Boakye-Ansa NK, Brown CA, Flores EJ, Ross AB, Martin MD, Robbins JB, Narayan AK. Predictors of CT Colonography Use: Results From the 2019 National Health Interview Cross-Sectional Survey. J Am Coll Radiol 2022; 19:874-880. [PMID: 35490713 DOI: 10.1016/j.jacr.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE CT colonography (CTC) is a minimally invasive screening test with high sensitivity for colonic polyps (>1 cm). Prior studies suggest that CTC utilization remains low. However, there are few studies evaluating recent CTC utilization and predictors of CTC utilization. Our purpose was to estimate recent nationwide CTC utilization and evaluate predictors of CTC utilization using 2019 nationally representative cross-sectional survey data. METHODS Participants between ages 50 and 75 without colorectal cancer history in the 2019 National Health Interview Survey cross-sectional data were included. Proportion of participants reporting utilization of CTC was estimated, accounting for complex survey design elements. Multiple variable logistic regression analyses evaluated predictors of CTC utilization. Analyses were conducted accounting for complex survey design elements to obtain valid estimates for the civilian, noninstitutionalized US population. RESULTS In all, 13,709 respondents were included, and 1.4% reported undergoing CTC, of whom 39.9% underwent CTC within the last year, 18.5% within the last 2 years, 13.0% within the last 3 years, 7.8% within the last 5 years, 11.2% within the last 10 years, and 9.6% underwent CTC 10 years ago or more. Multiple variable logistic regression analyses revealed that Hispanic (odds ratio 2.67, 95% confidence interval 1.66-4.29, P < .001) and Black (odds ratio 2.47, 95% confidence interval 1.60-3.82, P < .001) participants were more likely than White participants to undergo CTC. CONCLUSION Survey results suggest that nationwide utilization of CTC remains low. Black and Hispanic participants were more likely than White participants to report undergoing CTC. Promotion of CTC may reduce racial and ethnic disparities in colorectal cancer screening.
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Affiliation(s)
- Brandon O'Connor
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, Texas.
| | | | | | - Efren J Flores
- Massachusetts General Hospital, Boston, Massachusetts; and Associate Chair, Equity, Inclusion and Community Health, Massachusetts General Brigham Enterprise Radiology, Boston, Massachusetts
| | - Andrew B Ross
- Musculoskeletal Fellowship Program Director, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Maria D Martin
- Director, Diversity and Inclusion, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jessica B Robbins
- Assistant Residency Program Director and Vice Chair of Faculty Development and Enrichment, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Anand K Narayan
- Vice Chair, Equity, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; and Vice Chair of the ACR PFCC Outreach Committee
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Balhorn J, Su'a B, Jin J, Peng S, Weston M, Israel L, Connolly A, Hill AG, Taneja A. Changing the routine: a move to patient initiated follow up to improve surgical outpatient clinic. ANZ J Surg 2022; 92:1394-1400. [PMID: 35429226 PMCID: PMC9324913 DOI: 10.1111/ans.17676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 11/27/2022]
Abstract
Introduction Patient initiated follow up (PIFU) allows patients to initiate a hospital follow up appointment on an ‘as required’ basis in contrast to the traditional physician‐initiated model. We present a clinical pathway for patients referred with rectal bleeding at a large tertiary public hospital in South Auckland, New Zealand and demonstrate the utility of PIFU and its impact on reducing follow up appointments. Method The purpose of the pathway was to allow standardized care by the clinicians and allow for PIFU. Two separate protocols were developed ‐ ‘Painful PR bleeding’ and ‘Painless PR bleeding’. A new clinic (NC) was started following these protocols, and this was compared to historical controls (HC). The primary outcome was the rate of follow up appointments. Results There were 133 patients in the NC and 135 in the HC, with significantly less follow ups in the NC (6% versus 45%, p < 0.0001). A small percentage of patients in the NC group were directly discharged (10%) whilst 70% of patients were discharged with a PIFU card. Thirty phone calls were made using PIFU, with 10 patients returning to clinic and 20 requiring advice and reassurance only. At 5 year follow up, there was a single colorectal malignancy found in both groups. Conclusion Initiating a protocol that includes patient initiated follow up vastly reduces the need for routine return to clinic for the majority of patients, without sacrificing patient care. A protocolised approach to clinic for other areas in general surgery should be considered.
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Affiliation(s)
- Joshua Balhorn
- The Department of General Surgery Middlemore Hospital Auckland New Zealand
- Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand
| | - Bruce Su'a
- The Department of General Surgery Middlemore Hospital Auckland New Zealand
- Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand
| | - James Jin
- The Department of General Surgery Middlemore Hospital Auckland New Zealand
- Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand
| | - Sze‐Lin Peng
- The Department of General Surgery Middlemore Hospital Auckland New Zealand
- Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand
| | - Maree Weston
- The Department of General Surgery Middlemore Hospital Auckland New Zealand
- Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand
| | - Lincoln Israel
- The Department of General Surgery Middlemore Hospital Auckland New Zealand
- Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand
| | - Andrew Connolly
- The Department of General Surgery Middlemore Hospital Auckland New Zealand
- Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand
| | - Andrew G. Hill
- The Department of General Surgery Middlemore Hospital Auckland New Zealand
- Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand
| | - Ashish Taneja
- The Department of General Surgery Middlemore Hospital Auckland New Zealand
- Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand
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Diagnostic accuracy of ultra-low-dose CT colonography for the detection of colorectal polyps: a feasibility study. Jpn J Radiol 2022; 40:831-839. [PMID: 35344130 DOI: 10.1007/s11604-022-01266-1] [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: 11/12/2021] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this feasibility study was to evaluate the diagnostic accuracy of ultra-low-dose CT colonography using iterative reconstruction algorithms with reference to standard colonoscopy. MATERIALS AND METHODS Prior to this study, a phantom study was performed to investigate the optimal protocol for ultra-low-dose CT colonography. A total of 206 patients with average/high risk of colorectal cancer were recruited. After undergoing full bowel preparation, the patients were scanned in the prone and supine positions with the CT conditions set to 120 kV, standard deviation 45 to 50, and an adaptive iterative reconstruction algorithm applied. Two expert readers read the images independently. The main outcome measures were the per-patient and per-polyp accuracies for the detection of polyps ≥ 10 mm, with colonoscopy results as the reference standard. RESULTS Two hundred patients (102 females, mean age 67.5 years) underwent both ultra-low-dose CT colonography and colonoscopy on the same day. The mean radiation exposure dose was 0.64 ± 0.34 mSv. On colonoscopy, 39 patients had 45 polyps ≥ 10 mm (non-polypoid morphology 7), including 4 cancers. Per-patient sensitivity, specificity, and accuracy of CT colonography for polyps ≥ 10 mm were 0.74, 0.96, and 0.92 for reader one, and 0.74, 0.99, and 0.94 for reader two, respectively. Per-polyp sensitivities for polyps ≥ 10 mm were 0.73 for reader one and 0.71 for reader two. On subgroup analysis by morphology, non-polypoid polyps ≥ 10 mm were not detected by both readers. CONCLUSION Extreme ultra-low-dose CT colonography had an insufficient diagnostic performance for the detection of polyps ≥ 10 mm, because it was unable to detect non-polypoid polyps. This study showed that the problem with ultra-low-dose CT colonography was the lack of detectability of small-size polyps, especially non-polypoid polyps. To use ultra-low-dose CT colonography clinically, it is necessary to resolve the problems identified by this study.
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Automatic Detection and Segmentation of Colorectal Cancer with Deep Residual Convolutional Neural Network. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3415603. [PMID: 35341149 PMCID: PMC8947925 DOI: 10.1155/2022/3415603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 11/22/2022]
Abstract
Early and automatic detection of colorectal tumors is essential for cancer analysis, and the same is implemented using computer-aided diagnosis (CAD). A computerized tomography (CT) image of the colon is being used to identify colorectal carcinoma. Digital imaging and communication in medicine (DICOM) is a standard medical imaging format to process and analyze images digitally. Accurate detection of tumor cells in the complex digestive tract is necessary for optimal treatment. The proposed work is divided into two phases. The first phase involves the segmentation, and the second phase is the extraction of the colon lesions with the observed segmentation parameters. A deep convolutional neural network (DCNN) based residual network approach for the colon and polyps' segmentation from the CT images is applied over the 2D CT images. The residual stack block is being added to the hidden layers with short skip nuance, which helps to retain spatial information. ResNet-enabled CNN is employed in the current work to achieve complete boundary segmentation of the colon cancer region. The results obtained through segmentation serve as features for further extraction and classification of benign as well as malignant colon cancer. Performance evaluation metrics indicate that the proposed network model has effectively segmented and classified colorectal tumors with dice scores of 91.57% (on average), sensitivity = 98.28, specificity = 98.68, and accuracy = 98.82.
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Fully automated deep-learning section-based muscle segmentation from CT images for sarcopenia assessment. Clin Radiol 2022; 77:e363-e371. [DOI: 10.1016/j.crad.2022.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022]
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Perez NP, Baez YA, Stapleton SM, Muniappan A, Oseni TS, Goldstone RN, Chang DC. Racially Conscious Cancer Screening Guidelines: A Path Towards Culturally Competent Science. Ann Surg 2022; 275:259-270. [PMID: 33064394 DOI: 10.1097/sla.0000000000003983] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review the racial composition of the study populations that the current USPSTF screening guidelines for lung, breast, and colorectal cancer are based on, and the effects of their application across non-white individuals. SUMMARY OF BACKGROUND DATA USPSTF guidelines commonly become the basis for establishing standards of care, yet providers are often unaware of the racial composition of the study populations they are based on. METHODS We accessed the USPSTF screening guidelines for lung, breast, and colorectal cancer via their website, and reviewed all referenced publications for randomized controlled trials (RCTs), focusing on the racial composition of their study populations. We then used PubMed to identify publications addressing the generalizability of such guidelines across non-white individuals. Lastly, we reviewed all guidelines published by non-USPSTF organizations to identify the availability of race-specific recommendations. RESULTS Most RCTs used as basis for the current USPSTF guidelines either did not report race, or enrolled cohorts that were not representative of the U.S. population. Several studies were identified demonstrating the broad application of such guidelines across non-white individuals can lead to underdiagnosis and higher levels of advanced disease. Nearly all guideline-issuing bodies fail to provide race-specific recommendations, despite often acknowledging increased disease burden among non-whites. CONCLUSION Concerted efforts to overcome limitations in the generalizability of RCTs are required to provide screening guidelines that are truly applicable to non-white populations. Broader policy changes to improve the pipeline for minority populations into science and medicine are needed to address the ongoing lack of diversity in these fields.
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Affiliation(s)
- Numa P Perez
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts
- Massachusetts General Hospital, Healthcare Transformation Lab, Boston, Massachusetts
- Massachusetts General Hospital, Codman Center for Clinical Effectiveness in Surgery, Boston, Massachusetts
| | - Yefri A Baez
- Massachusetts General Hospital, Codman Center for Clinical Effectiveness in Surgery, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Sahael M Stapleton
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts
- Massachusetts General Hospital, Codman Center for Clinical Effectiveness in Surgery, Boston, Massachusetts
| | - Ashok Muniappan
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts
| | - Tawakalitu S Oseni
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts
| | - Robert N Goldstone
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts
| | - David C Chang
- Massachusetts General Hospital, Codman Center for Clinical Effectiveness in Surgery, Boston, Massachusetts
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Abstract
Most patients with colorectal cancer (CRC) were diagnosed in advanced stage and the prognosis is poor. Therefore, early detection and prevention of CRC are very important. As with other cancers, there is also the tertiary prevention for CRC. The primary prevention is etiological prevention, which is mainly the treatment of adenoma or inflammation for preventing the development into cancer. The secondary prevention is the early diagnosis and early treatment for avoiding progressing to advanced cancer. The tertiary prevention belongs to the broad category of prevention, mainly for advanced CRC, through surgical treatment and postoperative adjuvant chemotherapy, radiotherapy, targeted therapy, immunotherapy for preventing tumor recurrence or metastasis. This consensus is based on the recent domestic and international consensus guidelines and the latest progress of international researches in the past five years. This consensus opinion seminar was hosted by the Chinese Society of Gastroenterology and Cancer Collaboration Group of Chinese Society of Gastroenterology, and was organized by the Division of Gastroenterology and Hepatology & Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University. The consensus opinion contains 60 statement clauses, the standard and basis of the evidence-based medicine grade and voting grade of the statement strictly complied with the relevant international regulations and practice.
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Wesp P, Grosu S, Graser A, Maurus S, Schulz C, Knösel T, Fabritius MP, Schachtner B, Yeh BM, Cyran CC, Ricke J, Kazmierczak PM, Ingrisch M. Deep learning in CT colonography: differentiating premalignant from benign colorectal polyps. Eur Radiol 2022; 32:4749-4759. [PMID: 35083528 PMCID: PMC9213389 DOI: 10.1007/s00330-021-08532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/06/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022]
Abstract
Objectives To investigate the differentiation of premalignant from benign colorectal polyps detected by CT colonography using deep learning. Methods In this retrospective analysis of an average risk colorectal cancer screening sample, polyps of all size categories and morphologies were manually segmented on supine and prone CT colonography images and classified as premalignant (adenoma) or benign (hyperplastic polyp or regular mucosa) according to histopathology. Two deep learning models SEG and noSEG were trained on 3D CT colonography image subvolumes to predict polyp class, and model SEG was additionally trained with polyp segmentation masks. Diagnostic performance was validated in an independent external multicentre test sample. Predictions were analysed with the visualisation technique Grad-CAM++. Results The training set consisted of 107 colorectal polyps in 63 patients (mean age: 63 ± 8 years, 40 men) comprising 169 polyp segmentations. The external test set included 77 polyps in 59 patients comprising 118 polyp segmentations. Model SEG achieved a ROC-AUC of 0.83 and 80% sensitivity at 69% specificity for differentiating premalignant from benign polyps. Model noSEG yielded a ROC-AUC of 0.75, 80% sensitivity at 44% specificity, and an average Grad-CAM++ heatmap score of ≥ 0.25 in 90% of polyp tissue. Conclusions In this proof-of-concept study, deep learning enabled the differentiation of premalignant from benign colorectal polyps detected with CT colonography and the visualisation of image regions important for predictions. The approach did not require polyp segmentation and thus has the potential to facilitate the identification of high-risk polyps as an automated second reader. Key Points • Non-invasive deep learning image analysis may differentiate premalignant from benign colorectal polyps found in CT colonography scans. • Deep learning autonomously learned to focus on polyp tissue for predictions without the need for prior polyp segmentation by experts. • Deep learning potentially improves the diagnostic accuracy of CT colonography in colorectal cancer screening by allowing for a more precise selection of patients who would benefit from endoscopic polypectomy, especially for patients with polyps of 6–9 mm size. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08532-2.
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Affiliation(s)
- Philipp Wesp
- Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - Sergio Grosu
- Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Anno Graser
- Radiologie München, Burgstraße 7, 80331, Munich, Germany
| | - Stefan Maurus
- Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Christian Schulz
- Department of Medicine II, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Thomas Knösel
- Department of Pathology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Matthias P Fabritius
- Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Balthasar Schachtner
- Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Max-Lebsche-Platz 31, 81377, Munich, Germany
| | - Benjamin M Yeh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA, 94117, USA
| | - Clemens C Cyran
- Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Philipp M Kazmierczak
- Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Michael Ingrisch
- Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
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Ahmed F, Brewington C, Chang KJ, Moreno CC, Gollub M, Yee J. Letter to the editor regarding: Multicentre, prospective, randomised study comparing the diagnostic yield of colon capsule endoscopy versus CT colonography in a screening population (the TOPAZ study). Gut 2022; 71:214-215. [PMID: 33637597 DOI: 10.1136/gutjnl-2021-324396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/20/2021] [Indexed: 01/01/2023]
Affiliation(s)
- Firas Ahmed
- Radiology, Columbia University, New York, New York, USA
| | | | | | | | - Marc Gollub
- Radiology, Memorial Sloan Kettering Cancer Institute, New York, New York, USA
| | - Judy Yee
- Radiology, Montefiore Hospital and Medical Center, Bronx, New York, USA
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Burr NE, Plumb A, Sood R, Rembacken B, Tolan DJM. CT colonography remains an important test for colorectal cancer. Gut 2022; 71:217-218. [PMID: 33753420 DOI: 10.1136/gutjnl-2021-324399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/16/2022]
Affiliation(s)
| | - Andrew Plumb
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ruchit Sood
- Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK
| | | | - Damian J M Tolan
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK
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Abstract
Despite strong evidence of effectiveness, colorectal cancer (CRC) screening remains underused. Currently, there are several options for CRC screening, each with its own performance characteristics and considerations for practice. This Review aims to cover current CRC screening guidelines and highlight future blood-based and imaging-based options for screening. In current practice, the leading non-invasive option is the faecal immunochemical test (FIT) based on its high specificity, good sensitivity, low cost and ease of use in mailed outreach programmes. There are currently five blood-based CRC screening tests in varying stages of evaluation, including one that is currently sold in the USA as a laboratory-developed test. There are ongoing studies on the diagnostic accuracy and longitudinal performance of blood tests and they have the potential to disrupt the CRC screening landscape. Imaging-based options, including the colon capsule, MR colonography and the CT capsule, are also being tested in active studies. As the world attempts to recover from the COVID-19 pandemic and adapts to the start of CRC screening among people at average risk starting at age 45 years, non-invasive options will become increasingly important.
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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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Colorectal Cancer Screening: Have We Addressed Concerns and Needs of the Target Population? GASTROINTESTINAL DISORDERS 2021. [DOI: 10.3390/gidisord3040018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Despite the recognized benefits of colorectal cancer (CRC) screening, uptake is still suboptimal in many countries. In addressing this issue, one important element that has not received sufficient attention is population preference. Our review provides a comprehensive summary of the up-to-date evidence relative to this topic. Four OVID databases were searched: Ovid MEDLINE® ALL, Biological Abstracts, CAB Abstracts, and Global Health. Among the 742 articles generated, 154 full texts were selected for a more thorough evaluation based on predefined inclusion criteria. Finally, 83 studies were included in our review. The general population preferred either colonoscopy as the most accurate test, or fecal occult blood test (FOBT) as the least invasive for CRC screening. The emerging blood test (SEPT9) and capsule colonoscopy (nanopill), with the potential to overcome the pitfalls of the available techniques, were also favored. Gender, age, race, screening experience, education and beliefs, the perceived risk of CRC, insurance, and health status influence one’s test preference. To improve uptake, CRC screening programs should consider offering test alternatives and tailoring the content and delivery of screening information to the public’s preferences. Other logistical measures in terms of the types of bowel preparation, gender of endoscopist, stool collection device, and reward for participants can also be useful.
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Bellini D, Panvini N, Vicini S, Rengo M, Lucchesi P, Caruso D, Carbone I, Laghi A. Low-volume reduced bowel preparation regimen for CT colonography: a randomized noninferiority trial. Abdom Radiol (NY) 2021; 46:4556-4566. [PMID: 34143258 DOI: 10.1007/s00261-021-03176-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine whether the quality of a low-volume reduced bowel preparation (LV-RBP) for CT Colonography (CTC) is noninferior to full-volume reduced bowel preparation (FV-RBP) regimen. METHODS In this randomized controlled trial, consecutive participants referred for CTC were randomly assigned to receive LV-RBP (52.5 g of PMF104 in 500 mL of water) or FV-RBP (105 g of PMF104 in 1000 mL of water). Images were independently reviewed by five blinded readers who rated the quality of bowel preparation from 0 (best score) to 3 (worst score). The primary outcome was the noninferiority of LV-RBP to FV-RBP in the proportion of colonic segments scored 0 for cleansing quality, with noninferiority margin of 10%. Volume of residual fluids, colonic distension, lesions and polyps detection rates and patient tolerability were secondary outcomes. RESULTS From March 2019 to January 2020, 110 participants (mean age 65 years ± 14 [standard deviation]; 74 women) were allocated to LV-RBP (n = 55) or FV-RBP (n = 55) arms. There were 92% segment scored 0 in colon cleansing quality in LV-RBP and 94% in FV-RBP for prone scans, and 94% vs 92% for supine scans. Risk difference was - 2.1 (95% CI -5.9 to 1.7) and 1.5 (95% CI -2.4 to 5.4) for prone and supine positions, respectively. Residual fluids and colonic distension were also noninferior in LV-RBP. LV-RBP was associated with a lower number of evacuations during preparation (7 ± 5 vs 10 ± 6, p = 0.002). CONCLUSION The LV-RBP for CTC demonstrated noninferior quality of colon cleansing with improved gastrointestinal tolerability compared to FV-RBP regimen.
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Affiliation(s)
- Davide Bellini
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome - I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Nicola Panvini
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome - I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy.
| | - Simone Vicini
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome - I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Marco Rengo
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome - I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Paola Lucchesi
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome - I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Damiano Caruso
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Iacopo Carbone
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome - I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Andrea Laghi
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
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Li K, Fathan MI, Patel K, Zhang T, Zhong C, Bansal A, Rastogi A, Wang JS, Wang G. Colonoscopy polyp detection and classification: Dataset creation and comparative evaluations. PLoS One 2021; 16:e0255809. [PMID: 34403452 PMCID: PMC8370621 DOI: 10.1371/journal.pone.0255809] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/25/2021] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer (CRC) is one of the most common types of cancer with a high mortality rate. Colonoscopy is the preferred procedure for CRC screening and has proven to be effective in reducing CRC mortality. Thus, a reliable computer-aided polyp detection and classification system can significantly increase the effectiveness of colonoscopy. In this paper, we create an endoscopic dataset collected from various sources and annotate the ground truth of polyp location and classification results with the help of experienced gastroenterologists. The dataset can serve as a benchmark platform to train and evaluate the machine learning models for polyp classification. We have also compared the performance of eight state-of-the-art deep learning-based object detection models. The results demonstrate that deep CNN models are promising in CRC screening. This work can serve as a baseline for future research in polyp detection and classification.
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Affiliation(s)
- Kaidong Li
- Department of Electrical Engineering and Computer Science, The University of Kansas, Lawrence, KS, United States of America
| | - Mohammad I. Fathan
- Department of Electrical Engineering and Computer Science, The University of Kansas, Lawrence, KS, United States of America
| | - Krushi Patel
- Department of Electrical Engineering and Computer Science, The University of Kansas, Lawrence, KS, United States of America
| | - Tianxiao Zhang
- Department of Electrical Engineering and Computer Science, The University of Kansas, Lawrence, KS, United States of America
| | - Cuncong Zhong
- Department of Electrical Engineering and Computer Science, The University of Kansas, Lawrence, KS, United States of America
| | - Ajay Bansal
- Gastroenterology, Hepatology and Motility, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Amit Rastogi
- Gastroenterology, Hepatology and Motility, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Jean S. Wang
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, United States of America
| | - Guanghui Wang
- Department of Computer Science, Ryerson University, Toronto, ON, Canada
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Samuel G, Kratzer M, Asagbra O, Kinderwater J, Poola S, Udom J, Lambert K, Mian M, Ali E. Facilitators and barriers to colorectal cancer screening in an outpatient setting. World J Clin Cases 2021; 9:5850-5859. [PMID: 34368304 PMCID: PMC8316930 DOI: 10.12998/wjcc.v9.i21.5850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/07/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related deaths in the United States. Still, 1 in 3 adults aged 50 years to 75 years have not been screened for CRC. Early detection and management of precancerous or malignant lesions has been shown to improve overall mortality.
AIM To determine the most significant facilitators and barriers to CRC screening in an outpatient clinic in rural North Carolina. The results of this study can then be used for quality improvement to increase the rate of patients ages 50 to 75 who are up to date on CRC screening.
METHODS This retrospective study examined 2428 patients aged 50 years to 75 years in an outpatient clinic. Patients were up to date on CRC screening if they had fecal occult blood test or fecal immunochemical test in the past one year, Cologuard in the past three years, flexible sigmoidoscopy/virtual colonoscopy in the past five years, or colonoscopy in the past ten years. Data on patient socioeconomic status, comorbid conditions, and other determinants of health compliance were included as covariates.
RESULTS Age [odds ratio (OR) = 1.058; P = 0.017], no-show rate percent (OR= 0.962; P < 0.05), patient history of obstructive sleep apnea (OR = 1.875; P = 0.025), compliance with flu vaccinations (OR = 1.673; P < 0.05), compliance with screening mammograms (OR = 2.130; P < 0.05), and compliance with screening pap smears (OR = 2.708; P < 0.05) were important factors in determining whether a patient will receive CRC screening. Race, gender, insurance or employment status, use of blood thinners, family history of CRC, or other comorbid conditions including diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and end-stage renal disease were not found to have a statistically significant effect on patient adherence to CRC screening.
CONCLUSION Patient age, history of sleep apnea, and compliance with other health maintenance tests were significant facilitators to CRC screening, while no-show rate percent was a significant barrier in our patient population. This study will be of benefit to physicians in addressing and improving the CRC screening rates in our community.
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Affiliation(s)
- Gbeminiyi Samuel
- Division of Gastroenterology, East Carolina University/Vidant Medical Center, Greenville, NC 27834, United States
| | - MaryKate Kratzer
- Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, NC 27834, United States
| | - Oghale Asagbra
- Department of Health Services and Information Management, East Carolina University, Greenville, NC 27834, United States
| | - Josef Kinderwater
- Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, NC 27834, United States
| | - Shiva Poola
- Department of Internal Medicine/Pediatrics, Brody School of Medicine/Vidant Medical Center, Greenville, NC 27834, United States
| | - Jennifer Udom
- Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, NC 27834, United States
| | - Karissa Lambert
- Division of Gastroenterology, East Carolina University/Vidant Medical Center, Greenville, NC 27834, United States
| | - Muna Mian
- Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, NC 27834, United States
| | - Eslam Ali
- Division of Gastroenterology, East Carolina University/Vidant Medical Center, Greenville, NC 27834, United States
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48
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Peterse EFP, Meester RGS, de Jonge L, Omidvari AH, Alarid-Escudero F, Knudsen AB, Zauber AG, Lansdorp-Vogelaar I. Comparing the Cost-Effectiveness of Innovative Colorectal Cancer Screening Tests. J Natl Cancer Inst 2021; 113:154-161. [PMID: 32761199 PMCID: PMC7850547 DOI: 10.1093/jnci/djaa103] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 05/18/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022] Open
Abstract
Background Colorectal cancer (CRC) screening with colonoscopy and the fecal immunochemical test (FIT) is underused. Innovative tests could increase screening acceptance. This study determined which of the available alternatives is most promising from a cost-effectiveness perspective. Methods The previously validated Microsimulation Screening Analysis-Colon model was used to evaluate the cost-effectiveness of screening with capsule endoscopy every 5 or 10 years, computed tomographic colonography every 5 years, the multi-target stool DNA test every 1 or 3 years, and the methylated SEPT9 DNA plasma assay (mSEPT9) every 1 or 2 years. We also compared these strategies with annual FIT screening and colonoscopy screening every 10 years. Quality-adjusted life-years gained (QALYG), number of colonoscopies, and incremental cost-effectiveness ratios were projected. We assumed a willingness-to-pay threshold of $100 000 per QALYG. Results Among the alternative tests, computed tomographic colonography every 5 years, annual mSEPT9, and annual multi-target stool DNA screening had incremental cost-effectiveness ratios of $1092, $63 253, and $214 974 per QALYG, respectively. Other screening strategies were more costly and less effective than (a combination of) these 3. Under the assumption of perfect adherence, annual mSEPT9 screening resulted in more QALYG, CRC cases averted, and CRC deaths averted than annual FIT screening but led to a high rate of colonoscopy referral (51% after 3 years, 69% after 5 years). The alternative tests were not cost-effective compared with FIT and colonoscopy. Conclusions This study suggests that for individuals not willing to participate in FIT or colonoscopy screening, mSEPT9 is the test of choice if the high colonoscopy referral rate is acceptable to them.
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Affiliation(s)
- Elisabeth F P Peterse
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Reinier G S Meester
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Lucie de Jonge
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Amir-Houshang Omidvari
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Fernando Alarid-Escudero
- Drug Policy Program, Center for Research and Teaching in Economics (CIDE)-CONACyT, Aguascalientes, AGS, Mexico
| | - Amy B Knudsen
- Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ann G Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
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49
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Lin JS, Perdue LA, Henrikson NB, Bean SI, Blasi PR. Screening for Colorectal Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 325:1978-1998. [PMID: 34003220 DOI: 10.1001/jama.2021.4417] [Citation(s) in RCA: 241] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Colorectal cancer (CRC) remains a significant cause of morbidity and mortality in the US. OBJECTIVE To systematically review the effectiveness, test accuracy, and harms of screening for CRC to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials for relevant studies published from January 1, 2015, to December 4, 2019; surveillance through March 26, 2021. STUDY SELECTION English-language studies conducted in asymptomatic populations at general risk of CRC. DATA EXTRACTION AND SYNTHESIS Two reviewers independently appraised the articles and extracted relevant study data from fair- or good-quality studies. Random-effects meta-analyses were conducted. MAIN OUTCOMES AND MEASURES Colorectal cancer incidence and mortality, test accuracy in detecting cancers or adenomas, and serious adverse events. RESULTS The review included 33 studies (n = 10 776 276) on the effectiveness of screening, 59 (n = 3 491 045) on the test performance of screening tests, and 131 (n = 26 987 366) on the harms of screening. In randomized clinical trials (4 trials, n = 458 002), intention to screen with 1- or 2-time flexible sigmoidoscopy vs no screening was associated with a decrease in CRC-specific mortality (incidence rate ratio, 0.74 [95% CI, 0.68-0.80]). Annual or biennial guaiac fecal occult blood test (gFOBT) vs no screening (5 trials, n = 419 966) was associated with a reduction of CRC-specific mortality after 2 to 9 rounds of screening (relative risk at 19.5 years, 0.91 [95% CI, 0.84-0.98]; relative risk at 30 years, 0.78 [95% CI, 0.65-0.93]). In observational studies, receipt of screening colonoscopy (2 studies, n = 436 927) or fecal immunochemical test (FIT) (1 study, n = 5.4 million) vs no screening was associated with lower risk of CRC incidence or mortality. Nine studies (n = 6497) evaluated the test accuracy of screening computed tomography (CT) colonography, 4 of which also reported the test accuracy of colonoscopy; pooled sensitivity to detect adenomas 6 mm or larger was similar between CT colonography with bowel prep (0.86) and colonoscopy (0.89). In pooled values, commonly evaluated FITs (14 studies, n = 45 403) (sensitivity, 0.74; specificity, 0.94) and stool DNA with FIT (4 studies, n = 12 424) (sensitivity, 0.93; specificity, 0.85) performed better than high-sensitivity gFOBT (2 studies, n = 3503) (sensitivity, 0.50-0.75; specificity, 0.96-0.98) to detect cancers. Serious harms of screening colonoscopy included perforations (3.1/10 000 procedures) and major bleeding (14.6/10 000 procedures). CT colonography may have harms resulting from low-dose ionizing radiation. It is unclear if detection of extracolonic findings on CT colonography is a net benefit or harm. CONCLUSIONS AND RELEVANCE There are several options to screen for colorectal cancer, each with a different level of evidence demonstrating its ability to reduce cancer mortality, its ability to detect cancer or precursor lesions, and its risk of harms.
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Affiliation(s)
- Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Leslie A Perdue
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nora B Henrikson
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Sarah I Bean
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Paula R Blasi
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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50
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Knudsen AB, Rutter CM, Peterse EFP, Lietz AP, Seguin CL, Meester RGS, Perdue LA, Lin JS, Siegel RL, Doria-Rose VP, Feuer EJ, Zauber AG, Kuntz KM, Lansdorp-Vogelaar I. Colorectal Cancer Screening: An Updated Modeling Study for the US Preventive Services Task Force. JAMA 2021; 325:1998-2011. [PMID: 34003219 PMCID: PMC8409520 DOI: 10.1001/jama.2021.5746] [Citation(s) in RCA: 152] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance The US Preventive Services Task Force (USPSTF) is updating its 2016 colorectal cancer screening recommendations. Objective To provide updated model-based estimates of the benefits, burden, and harms of colorectal cancer screening strategies and to identify strategies that may provide an efficient balance of life-years gained (LYG) from screening and colonoscopy burden to inform the USPSTF. Design, Setting, and Participants Comparative modeling study using 3 microsimulation models of colorectal cancer screening in a hypothetical cohort of 40-year-old US individuals at average risk of colorectal cancer. Exposures Screening from ages 45, 50, or 55 years to ages 70, 75, 80, or 85 years with fecal immunochemical testing (FIT), multitarget stool DNA testing, flexible sigmoidoscopy alone or with FIT, computed tomography colonography, or colonoscopy. All persons with an abnormal noncolonoscopy screening test result were assumed to undergo follow-up colonoscopy. Screening intervals varied by test. Full adherence with all procedures was assumed. Main Outcome and Measures Estimated LYG relative to no screening (benefit), lifetime number of colonoscopies (burden), number of complications from screening (harms), and balance of incremental burden and benefit (efficiency ratios). Efficient strategies were those estimated to require fewer additional colonoscopies per additional LYG relative to other strategies. Results Estimated LYG from screening strategies ranged from 171 to 381 per 1000 40-year-olds. Lifetime colonoscopy burden ranged from 624 to 6817 per 1000 individuals, and screening complications ranged from 5 to 22 per 1000 individuals. Among the 49 strategies that were efficient options with all 3 models, 41 specified screening beginning at age 45. No single age to end screening was predominant among the efficient strategies, although the additional LYG from continuing screening after age 75 were generally small. With the exception of a 5-year interval for computed tomography colonography, no screening interval predominated among the efficient strategies for each modality. Among the strategies highlighted in the 2016 USPSTF recommendation, lowering the age to begin screening from 50 to 45 years was estimated to result in 22 to 27 additional LYG, 161 to 784 additional colonoscopies, and 0.1 to 2 additional complications per 1000 persons (ranges are across screening strategies, based on mean estimates across models). Assuming full adherence, screening outcomes and efficient strategies were similar by sex and race and across 3 scenarios for population risk of colorectal cancer. Conclusions and Relevance This microsimulation modeling analysis suggests that screening for colorectal cancer with stool tests, endoscopic tests, or computed tomography colonography starting at age 45 years provides an efficient balance of colonoscopy burden and life-years gained.
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Affiliation(s)
- Amy B. Knudsen
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | | | - Anna P. Lietz
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
| | - Claudia L. Seguin
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Leslie A. Perdue
- Kaiser Permanente Evidence-based Practice Center and Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Jennifer S. Lin
- Kaiser Permanente Evidence-based Practice Center and Center for Health Research, Kaiser Permanente, Portland, Oregon
| | | | - V. Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Eric J. Feuer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Ann G. Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karen M. Kuntz
- Department of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
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