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Vališ J, Fousková M, Janstová D, Habartová L, Petrtýl J, Petruželka L, Synytsya A, Setnička V. Automated classification pipeline for real-time in vivo examination of colorectal tissue using Raman spectroscopy. Spectrochim Acta A Mol Biomol Spectrosc 2024; 313:124152. [PMID: 38503254 DOI: 10.1016/j.saa.2024.124152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 03/21/2024]
Abstract
Colorectal cancer is the third most common malignancy worldwide and one of the leading causes of death in oncological patients with its diagnosis typically involving confirmation by tissue biopsy. In vivo Raman spectroscopy, an experimental diagnostic method less invasive than a biopsy, has shown great potential to discriminate between normal and cancerous tissue. However, the complex and often manual processing of Raman spectra along with the absence of a suitable instant classifier are the main obstacles to its adoption in clinical practice. This study aims to address these issues by developing a real-time automated classification pipeline coupled with a user-friendly application tailored for non-spectroscopists. First, in addition to routine colonoscopy, 377 subjects underwent in vivo acquisitions of Raman spectra of healthy tissue, adenomatous polyps, or cancerous tissue, which were conducted using a custom-made microprobe. The spectra were then loaded into the pipeline and pre-processed in several steps, including standard normal variate transformation and finite impulse response filtration. The quality of the pre-processed spectral data was checked based on their signal-to-noise ratio before the suitable spectra were decomposed and classified using a combination of principal component analysis and a support vector machine, respectively. After five-fold cross-validation, the developed classifier exhibited 100% sensitivity toward adenocarcinoma and adenomatous polyps. The overall accuracy was 96.9% and 79.2% for adenocarcinoma and adenomatous polyps respectively. In addition, an application with a graphical user interface was developed to facilitate the use of our data pipeline by medical professionals in a clinical environment. Overall, the combination of supervised and unsupervised machine learning with algorithmic pre-processing of in vivo Raman spectra appears to be a viable way of reducing the relatively large number of biopsies currently needed to definitively diagnose colorectal cancer.
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Affiliation(s)
- Jan Vališ
- Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology, Prague, Technická 5, 166 28 Prague 6, Czech Republic
| | - Markéta Fousková
- Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology, Prague, Technická 5, 166 28 Prague 6, Czech Republic
| | - Daniela Janstová
- Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology, Prague, Technická 5, 166 28 Prague 6, Czech Republic
| | - Lucie Habartová
- Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology, Prague, Technická 5, 166 28 Prague 6, Czech Republic
| | - Jaromír Petrtýl
- 4(th) Department of Internal Medicine, General University Hospital in Prague and 1(St) Faculty of Medicine, Charles University in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - Luboš Petruželka
- Department of Oncology, General University Hospital in Prague and 1(St) Faculty of Medicine, Charles University in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - Alla Synytsya
- Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology, Prague, Technická 5, 166 28 Prague 6, Czech Republic
| | - Vladimír Setnička
- Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology, Prague, Technická 5, 166 28 Prague 6, Czech Republic.
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Ho YM, Merollini KMD, Gordon LG. Frequency of colorectal surveillance colonoscopies for adenomatous polyps: systematic review and meta-analysis. J Gastroenterol Hepatol 2024; 39:37-46. [PMID: 37967829 DOI: 10.1111/jgh.16397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/14/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND AND AIM The purpose of this study was to assess evidence on the frequency of polyp surveillance colonoscopies performed earlier than the recommended follow-up intervals in clinical practice guidelines. METHODS A systematic review was performed based on electronic searches in PubMed and Embase. Research articles, letters to the editors, and review articles, published before April 2022, were included. Studies that focused on the intervals of polyp surveillance in adult populations were selected. The Risk Of Bias In Non-randomized Studies of Exposure (ROBINS-E) was used to assess the risk of bias. A meta-analysis was performed with Forest plots to illustrate the results. RESULTS In total, 16 studies, comprising 11 172 patients from Australia, Europe, and North America, were included for analysis. The quality of the studies was moderate. Overall, 38% (95% CI: 30-47%) of colonoscopies were undertaken earlier than their respective national clinical guidelines. In risk-stratified surveillance, 10 studies contained data relating to low-risk polyp surveillance intervals and 30% (95% CI: 29-31%) of colonoscopies were performed earlier than recommended. Eight studies contained data relating to intermediate-risk polyp surveillance and 15% (95% CI: 14-17%) of colonoscopies were performed earlier than recommended. One study showed that 6% (95% CI: 4-10%) of colonoscopies performed for high-risk polyp surveillance were performed earlier than recommended. CONCLUSIONS A significant proportion of polyp surveillance was performed earlier than the guidelines suggested. This provides evidence of the potential overuse of healthcare resources and the opportunity to improve hospital efficiency.
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Affiliation(s)
- Yiu Ming Ho
- Department of Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Katharina M D Merollini
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Sunshine Coast Health Institute, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Louisa G Gordon
- Department of Health Economics, Department of Population Health, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- School of Public Health, The University of Queensland, St. Lucia, Queensland, Australia
- School of Nursing, The Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Shibagaki K, Ishimura N, Kotani S, Fukuyama C, Takahashi Y, Kishimoto K, Yazaki T, Kataoka M, Omachi T, Kinoshita Y, Hasegawa N, Oka A, Mishima Y, Mishiro T, Oshima N, Kawashima K, Nagase M, Araki A, Kadota K, Ishihara S. Endoscopic differential diagnosis between foveolar-type gastric adenoma and gastric hyperplastic polyps in Helicobacter pylori-naïve patients. Gastric Cancer 2023; 26:1002-1011. [PMID: 37543537 DOI: 10.1007/s10120-023-01420-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Foveolar-type gastric adenoma (FGA) occurs in Helicobacter pylori (Hp)-naïve individuals and morphologically mimics Hp-naïve gastric hyperplastic polyp (HpN-GHP). FGA is often difficult to distinguish from HpN-GHP even by biopsy, due to its low-grade histologic atypia. We conducted a retrospective study to create an endoscopic diagnostic index. METHODS We analyzed 51 FGAs in 41 patients and 36 HpN-GHPs in 24 patients. All lesions were photographed by white-light endoscopy (WLE) and narrow-band imaging with magnification endoscopy (NBIME). Three experts and three non-experts reviewed the WLE and WLE+NBIME images to assess six items for lesion diagnosis. We analyzed correlations between the diagnostic items and histologic features and compared the diagnostic accuracy between modalities. We created a composite diagnostic index and calculated its accuracy and consistency. RESULTS FGAs more frequently showed the following features vs. HpN-GHPs: bright-red color (94.1% vs. 44.4%), peripheral hyperplasia (58.8% vs. 8.3%), papillary/gyrus-like microstructure (96.1% vs. 33.3%), visible capillaries (70.6% vs. 38.9%), and demarcation line (98.0% vs. 41.7%) (P < 0.05). White-zone thickening was seen only in HpN-GHPs (52.8%). Diagnostic accuracy (mean, WLE vs. WLE+NBIME) was 90.8 ± 1.1% vs. 93.5 ± 2.4% (P = 0.15) for experts and 88.5 ± 3.0% vs. 86.6 ± 3.5% (P = 0.51) for non-experts. When satisfying the four criteria (bright-red color, papillary/gyrus-like microstructure, demarcation line, and absent white-zone thickening), sensitivity and specificity for FGA were 90.2% and 94.4%, respectively, with a kappa value of ≥ 0.6 for interobserver diagnostic agreement. CONCLUSIONS Composite diagnostic index contributes to the reproducible, accurate, preoperative differential diagnosis of FGA and HpN-GHP.
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Affiliation(s)
- Kotaro Shibagaki
- Department of Endoscopy, Shimane University Hospital, 89-1 Enya, Izumo, Shimane, 693-8501, Japan.
| | - Norihisa Ishimura
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Satoshi Kotani
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Chika Fukuyama
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Yusuke Takahashi
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Kenichi Kishimoto
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Tomotaka Yazaki
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Masatoshi Kataoka
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Taisuke Omachi
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Yasuhito Kinoshita
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Nobuaki Hasegawa
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Akihiko Oka
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Yoshiyuki Mishima
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Tsuyoshi Mishiro
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Naoki Oshima
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Kousaku Kawashima
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Mamiko Nagase
- Department of Pathology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Asuka Araki
- Department of Pathology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Kyuichi Kadota
- Department of Pathology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Shunji Ishihara
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
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Obadina D, Haider H, Micic D, Sakuraba A. Older Age at First Screening Colonoscopy is Associated With an Increased Risk of Colorectal Adenomas and Cancer. J Clin Gastroenterol 2023; 57:804-809. [PMID: 35997687 DOI: 10.1097/mcg.0000000000001751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/08/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The goal of colorectal cancer (CRC) screening is to detect precancerous polyps before cancer development or identification of cancer at an early stage. Guidelines have recommended screening colonoscopy to start at age 45. Our aim was to determine the impact of delays in performing the first screening colonoscopy on the risk of adenoma or CRC detection. METHODS We analyzed colonoscopy and histopathology data of average CRC risk patients who had their first screening colonoscopy between 2010 and 2017. Univariate and multivariable logistic regression was performed to determine the association between demographic variables and the risk of adenomas or CRC. RESULTS A total of 1155 average risk patients underwent their initial screening colonoscopy during the study period. Median age was 54 years (range of 45-87) and 58.2% were females. In multivariable analysis, older age at first screening colonoscopy was significantly associated with the detection of adenomatous polyps (odds ratio 1.05, 95% confidence interval 1.04-1.07, P <0.001) and CRC (odds ratio 1.11, 95% confidence interval 1.06-1.16, P <0.001). The association between age and risk of adenomatous polyps (F-test 35.43, P =0.0019) and CRC (F-test 36.94, P =0.0017) fit an exponential growth model. It was estimated that the detection rate doubled every 14.20 years and 4.75 years for adenomas and CRC, respectively. CONCLUSION We found that older age at the initial performance of a screening colonoscopy was associated with increased detection of adenomatous polyps and CRC. This work highlights the need for guideline adherence for the prevention of CRC development.
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Affiliation(s)
- David Obadina
- Pritzker School of Medicine, The University of Chicago
| | - Haider Haider
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | - Dejan Micic
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | - Atsushi Sakuraba
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, IL
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Redwood DG, Prewitt JJ, Holt MC, Gerrish SS. Elevated Adenomatous Polyp Detection Rate Among Alaska Native and American Indian People in Interior Alaska, 2018-2022. Public Health Rep 2023; 138:56S-60S. [PMID: 36683459 PMCID: PMC10515984 DOI: 10.1177/00333549221143204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES Colorectal cancer (CRC) incidence and mortality are twice as high among Alaska Native people as among non-Hispanic White people in the United States; as such, colonoscopy is a recommended screening test for Alaska Native people. Adenoma detection rate (ADR) is measured in patients at average risk of CRC undergoing initial screening colonoscopy and reflects the prevalence of precancerous polyps in a screened population. We evaluated the ADR among Alaska Native people living in Interior Alaska. METHODS This project evaluated the ADR among Alaska Native and American Indian adults aged ≥40 years (N = 460) living in Interior Alaska, using a retrospective medical record review of patients referred for screening colonoscopy from February 1, 2018, through March 31, 2022. The main outcome measure was ADR, stratified by age and sex. RESULTS The ADR was 45.0% overall: 43.0% among women and 47.1% among men. Among patients aged ≥50 years, the ADR was 67.1%: 62.7% among women and 70.7% among men. Among patients aged 40-49 years, the ADR was 34.4%: 35.3% among women and 33.3% among men. CONCLUSIONS Measured ADR was high among Alaska Native men and women aged ≥50 years in Interior Alaska and in all age groups that were screened. These findings have implications for which CRC screening methods, intervals, and age to begin screening are most appropriate for Alaska Native people, as well as the need for future research on the pathology, etiology, and natural history of CRC in this population.
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Erdem L, Akbal E, Koçak E, Tucer D, Üçbilek E, Uyanıkoğlu A, Dolapçıoğlu C, Ahısalı Erim E, Şirin G, Alkım H, Soylu A, Doğanay L, Kemal Kürbüz A, Özdil K, Alagözlü H, Erürker Öztürk T, Sezikli M, Adalı G, Çoban M, Hülagü S, Değertekin H, Atasoy A, Akyüz F, Gaffarlı İ, Saruç M, Altıntaş E, Sezgin O. A New Risk-Scoring System for Colorectal Cancer and Polyp Screening by Turkish Colorectal Cancer and Polyp Study Group. Turk J Gastroenterol 2022; 33:286-293. [PMID: 35550537 PMCID: PMC9153693 DOI: 10.5152/tjg.2022.21072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/30/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Colorectal cancer is one of the most commonly diagnosed types of cancer worldwide. An early diagnosis and detection of colon cancer and polyp can reduce mortality and morbidity from colorectal cancer. Even though there are a variety of options in screen- ing tests, the question remains on which test is the most effective for the early detection of colorectal cancer. In this prospective study, we aimed to develop a simple, useful, effective, and reliable scoring system to detect colon polyp and colorectal cancer. METHODS We enrolled 6508 subjects over the age of 18 from 16 centers, with colonoscopy screening. The age, smoking status, alcohol consumption, body mass index, polyp incidence, polyp size, number and localization, and pathologic findings were recorded. RESULTS The age, male gender, obesity, smoking, and family history were found as independent risk factors for adenomatous polyp. We have developed a new scoring system which can be used for these factors. With a score of 4 or above, we found the following: sensitivity 81%, specificity 40%, positive predictive value 25.68%, and negative predictive value 89.84%, for adenomatous polyp detection; and sensitivity 96%, specificity 39%, positive predictive value 3.35%, negative predictive value 99.29%, for colorectal cancer detection. CONCLUSION Even though the first colorectal cancer screening worldwide is generally performed for individuals over 50 years of age, we recommend that screening for colorectal cancer might begin for those under 50 years of age as well. Individuals with a score ≥ 4 must be included in the screening tests for colorectal cancer.
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Affiliation(s)
- Levent Erdem
- Department of Gastroenterology, Demiroğlu Bilim University Faculty of Medicine, İstanbul, Turkey
| | - Erdem Akbal
- Department of Gastroenterology, Demiroğlu Bilim University Faculty of Medicine, İstanbul, Turkey
| | - Erdem Koçak
- Department of Gastroenterology, Demiroğlu Bilim University Faculty of Medicine, İstanbul, Turkey
| | - Dilek Tucer
- Department of Gastroenterology, Edirne State Hospital, Edirne, Turkey
| | - Enver Üçbilek
- Department of Gastroenterology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ahmet Uyanıkoğlu
- Department of Gastroenterology, Harran University Faculty of Medicine, Şanlıurfa, Turkey
| | - Can Dolapçıoğlu
- Department of Gastroenterology, Kartal Lütfü Kırdar Education and Research Hospital, İstanbul, Turkey
| | - Emel Ahısalı Erim
- Department of Gastroenterology, Koç University Faculty of Medicine, İstanbul, Turkey
| | - Göktuğ Şirin
- Department of Gastroenterology, Kocaeli University Faculty of Medicine, İstanbul, Turkey
| | - Hüseyin Alkım
- Department of Gastroenterology, Şişli Etfal Education and Research Hospital, İstanbul, Turkey
| | - Aliye Soylu
- Department of Gastroenterology, Kahramanmaraş Provincial Directorate of Health Necip Fazıl City Hospital, Kahramanmaraş, Turkey
| | - Levent Doğanay
- Department of Gastroenterology, Ümraniye Education and Research Hospital, İstanbul, Turkey
| | - Ahmet Kemal Kürbüz
- Department of Gastroenterology, Kahramanmaraş Provincial Directorate of Health Necip Fazıl City Hospital, Kahramanmaraş, Turkey
| | - Kamil Özdil
- Department of Gastroenterology, Ümraniye Education and Research Hospital, İstanbul, Turkey
| | - Hakan Alagözlü
- Department of Gastroenterology, Medical Park Hospital, Ankara, Turkey
| | | | - Mesut Sezikli
- Department of Gastroenterology, Mehmet Akif İnan Education and Research Hospital, Şanlıurfa, İstanbul
| | - Gupse Adalı
- Department of Gastroenterology, İstanbul University Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Çoban
- Department of Gastroenterology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Saadettin Hülagü
- Department of Gastroenterology, Kocaeli University Faculty of Medicine, İstanbul, Turkey
| | - Halil Değertekin
- Department of Gastroenterology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Alp Atasoy
- Department of Gastroenterology, Mehmet Akif İnan Education and Research Hospital, Şanlıurfa, İstanbul
| | - Filiz Akyüz
- Department of Gastroenterology, İstanbul University Faculty of Medicine, İstanbul, Turkey
| | - İlham Gaffarlı
- Department of Gastroenterology, Acıbadem University Faculty of Medicine, İstanbul, Turkey
| | - Murat Saruç
- Department of Gastroenterology, Acıbadem University Faculty of Medicine, İstanbul, Turkey
| | - Engin Altıntaş
- Department of Gastroenterology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Orhan Sezgin
- Department of Gastroenterology, Acıbadem University Faculty of Medicine, İstanbul, Turkey
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Safiyeva A, Bayramov N, Avunduk M. The role of "Prominin - 1" marker in adenomatous colorectal polyps. Pol Przegl Chir 2021; 94:19-26. [PMID: 35485315 DOI: 10.5604/01.3001.0015.4874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
<b>Introduction:</b> Adenomatous polyps are pivotal to the development of colorectal cancer. The risk of colorectal carcinogenesis can be reduced through polypectomy and close surveillance of the disease. Early-stage polyps can be detected and removed endoscopically, therefore, reducing the incidence of carcinoma. The identification of CSC in colon polyps allows for assessment of their potential malignancy. Therefore, it is very relevant to study the prognostic significance of the prevalence of stem cells in colorectal polyps in early detection and prevention of cancer. </br></br> <b> Method:</b> Previously pathologically evaluated adenomatous tumors (60M, 40F) at Azerbaijan Medical University were reevaluated in Meram Medical Faculty Pathology Department. Hematoxylin-Eosin-stained slides were examined and cases with and without dysplasia were determined. New sections were taken from paraffin blocs. Prominin-1 staining was performed immunohistochemically on these sections. Stained slides were examined by an image analysis system. Prominin-1-positive cells were automatically counted with the same image analysis system. The cases that developed malignancy after polypectomy were determined. The relationship between CD133 expression of dysplasia and malignancy was statistically analyzed. </br></br> <b> Results:</b> Statistically significant prominin-1 expression was detected in cases with dysplasia and malignancy. </br></br> <b> Conclusion:</b> The investigation of prominin-1 expression in colorectal polyps may be important to determine malignancy development.
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Affiliation(s)
| | - Nuru Bayramov
- Department of Surgical Diseases, Azerbaijan Medical University, Baku, Azerbaijan
| | - Mustafa Avunduk
- Department of Pathology, Faculty of Meram Medicine, Necmettin Erbakan University, Konya, Turkey
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Nguyen LH, Cao Y, Hur J, Mehta RS, Sikavi DR, Wang Y, Ma W, Wu K, Song M, Giovannucci EL, Rimm EB, Willett WC, Garrett WS, Izard J, Huttenhower C, Chan AT. The Sulfur Microbial Diet Is Associated With Increased Risk of Early-Onset Colorectal Cancer Precursors. Gastroenterology 2021; 161:1423-1432.e4. [PMID: 34273347 PMCID: PMC8545755 DOI: 10.1053/j.gastro.2021.07.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Diet may contribute to the increasing incidence of colorectal cancer (CRC) before age 50 (early-onset CRC). Microbial metabolism of dietary sulfur produces hydrogen sulfide (H2S), a gastrointestinal carcinogen that cannot be easily measured at scale. As a result, evidence supporting its role in early neoplasia is lacking. METHODS We evaluated long-term adherence to the sulfur microbial diet, a dietary index defined a priori based on increased abundance of 43 bacterial species involved with sulfur metabolism, with risk of CRC precursors among 59,013 individuals who underwent lower endoscopy in the Nurses' Health Study II (1991-2015), a prospective cohort study with dietary assessment every 4 years through validated food frequency questionnaires and an assessment of dietary intake during adolescence in 1998. The sulfur microbial diet was characterized by intake high in processed meats, foods previously linked to CRC development, and low in mixed vegetables and legumes. Multivariable logistic regression for clustered data was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS We documented 2911 cases of early-onset adenoma. After adjusting for established risk factors, higher sulfur microbial diet scores were associated with increased risk for early-onset adenomas (ORquartile [Q]4 vs Q1, 1.31; 95% CI, 1.10-1.56, Ptrend = .02), but not serrated lesions. Compared with the lowest, women in the highest quartile of sulfur microbial diet scores had significantly increased risk of early-onset adenomas with greater malignant potential (ORQ4 vs Q1, 1.65 for villous/tubulovillous histology; 95% CI, 1.12-2.43; Ptrend = .04). Similar trends for early-onset adenoma were observed based on diet consumed during adolescence. In contrast, no clear association for adenomas was identified after age 50. CONCLUSIONS Our findings in a cohort of young women support a role for dietary interactions with gut sulfur-metabolizing bacteria in early-onset colorectal carcinogenesis, possibly beginning in adolescence.
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Affiliation(s)
- Long H Nguyen
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Yin Cao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri; Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St Louis, Missouri; Division of Gastroenterology, Washington University School of Medicine in St. Louis, St Louis, Missouri
| | - Jinhee Hur
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Raaj S Mehta
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Daniel R Sikavi
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yiqing Wang
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Wenjie Ma
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kana Wu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mingyang Song
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Wendy S Garrett
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jacques Izard
- Department of Food Science and Technology, University of Nebraska, Lincoln, Nebraska; Nebraska Food for Health Center, University of Nebraska, Lincoln, Nebraska; Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska
| | - Curtis Huttenhower
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Andrew T Chan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
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Mansilla-Vivar R, Petruzzellis C, Olivari N, Milluzzo SM, Grassano A, Cesari P, Zorzi F, Spada C. Serrated polyps: innocent or guilty? Rev Gastroenterol Peru 2021; 41:245-253. [PMID: 35613395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Serrated lesions represent a group of lesions with different genetic and biological features causing important clinical repercussions. Three types of serrated lesions are identified: hyperplastic, sessile adenomas (with and without dysplasia) and traditional serrated adenomas. Such lesions are now recognized as precancerous lesions.The carcinogenic process of serrated lesions follows a pathway including: alterations concerning activation of mitogen and protein kinase regulating the extracellular signal of other intracellular kinases (MAPK-ERK), inhibition of the apoptosis and hypermethylation of DNA and instability of microsatellites. Like for adenomatous polyps, the risk factors for serrated lesions are environmental factors, related to lifestyle and diet. The cancerogenic risk is increased by excessive alcohol consumption, obesity and poor intake of folate. When a high number of colorectal polyps with architecture serrated is diagnosed, it could be considered as serrated polyposis syndrome (SPS). According the most recent ESGE guidelines, the diagnostic criteria of the SPS, are: at least 5 polyps resected proximal to the sigmoid colon, 2 of which> 10 mm, or >20 serrated lesions of any size distributed in the entire colon. This condition presents a high risk for personal and/or familiar CRC, for this reason a regular screening colonoscopy should be performed in these patients and in their first-degree relatives.
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Affiliation(s)
- Rodrigo Mansilla-Vivar
- Digestive Endoscopy Unit, Hospital Puerto Montt. Puerto Montt, Chile; Gastrointestinal Endoscopy Research Group. IIS Hospital La Fe. Valencia, Spain
| | - Carlo Petruzzellis
- Dipartimento di Endoscopia Digestiva e Gastroenterologia, Fondazione Poliambulanza. Brescia, Italy
| | - Nicola Olivari
- Dipartimento di Endoscopia Digestiva e Gastroenterologia, Fondazione Poliambulanza. Brescia, Italy
| | | | - Alessandra Grassano
- Dipartimento di Gastroenterología, Azienda Ospedaliera Universitaria Federico II. Napoli, Italy
| | - Pietro Cesari
- Dipartimento di Endoscopia Digestiva e Gastroenterologia, Fondazione Poliambulanza. Brescia, Italy
| | - Fausto Zorzi
- Dipartimento di Patología, Fondazione Poliambulanza. Brescia, Italy
| | - Cristiano Spada
- Dipartimento di Endoscopia Digestiva e Gastroenterologia, Fondazione Poliambulanza. Brescia, Italy
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Abstract
Mortality from colorectal cancer is reduced through screening and early detection; moreover, removal of neoplastic lesions can reduce cancer incidence. While understanding of the risk factors, pathogenesis, and precursor lesions of colorectal cancer has advanced, the cause of the recent increase in cancer among young adults is largely unknown. Multiple invasive, semi- and non-invasive screening modalities have emerged over the past decade. The current emphasis on quality of colonoscopy has improved the effectiveness of screening and prevention, and the role of new technologies in detection of neoplasia, such as artificial intelligence, is rapidly emerging. The overall screening rates in the US, however, are suboptimal, and few interventions have been shown to increase screening uptake. This review provides an overview of colorectal cancer, the current status of screening efforts, and the tools available to reduce mortality from colorectal cancer.
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Affiliation(s)
- Priyanka Kanth
- Division of Gastroenterology, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - John M Inadomi
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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Abstract
CASE SUMMARY A healthy 52-year-old woman without any family history presents for a health maintenance appointment and opts for a fecal immunochemical test for colorectal cancer screening after reviewing her options. After a positive result, she is referred for colonoscopy. She is found to have 3 small (<10 mm) polyps that are completely resected via snare polypectomy and return as tubular adenomas on histologic examination. It is recommended that she return for repeat colonoscopy in 3 years, at which point she has a normal examination with excellent preparation by an experienced endoscopist and is given the option to return to her average-risk screening interval.
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Affiliation(s)
| | - Kim C Lu
- Department of Surgery, Division of Gastrointestinal and General Surgery, Oregon Health & Science University, Portland, Oregon
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12
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Cano D, Otero W, Gómez M, Marulanda H. [Comparative prevalence of adenomatous polyps in people aged 45 to 49 years and in people over 50 years of age in a Colombian population: a case-control study]. Rev Gastroenterol Peru 2021; 41:150-155. [PMID: 34978551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Colon and rectal cancer (CRC) is the third most frequent cancer and the fourth cause of cancer death in the world. In Colombia, it is the third leading cause of death from cancer. The most accepted recommendation is to do colonoscopy screening in people 50 to 75 years old. However, recently the American Cancer Association (ACS) has recommended starting screening from the age of 45. In our environment there are no studies on the prevalence of adenomatous polyps in children under 50 years of age. OBJECTIVE To compare the prevalence of adenomatous polyps during screening colonoscopy in people aged 45-49 years (cases) and compare it with that of people aged 50 to 75 years (control). MATERIALS AND METHODS Case-control studies. The data were collected prospectively during the period from January 2018 to November 2019 at the gastroenterology and digestive endoscopy center of Bogotá Colombia. RESULTS 490 patients were included, 119 cases and 371 controls, case: control ratio was 1: 3. The prevalence of polyps in cases 36.7% and in controls (42.5%) p=0.279. Adenomatous polyps were detected in 18.5% (95% CI 12.4-26.6) of the cases and 32.4% (95% CI 27.7-37.2) of the controls (p=0.004). CONCLUSION The prevalence of polyps during screening colonoscopy in people aged 45-49 years is similar to that expected in screening colonoscopies of people between 50-75 years. This finding would favor screening colonoscopy from 45 years of age.
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Affiliation(s)
- Diego Cano
- Gastrocal, Hospital Internacional de Colombia. Santander, Colombia
| | - William Otero
- Hospital Universitario Nacional de Colombia, Universidad Nacional de Colombia. Bogotá, Colombia; Centro de Gastroenterología y Endoscopia Digestiva. Bogotá, Colombia
| | - Martín Gómez
- Hospital Universitario Nacional de Colombia, Universidad Nacional de Colombia. Bogotá, Colombia; Centro de Gastroenterología y Endoscopia Digestiva. Bogotá, Colombia
| | - Hernando Marulanda
- Hospital Universitario Nacional de Colombia, Universidad Nacional de Colombia. Bogotá, Colombia; Centro de Gastroenterología y Endoscopia Digestiva. Bogotá, Colombia
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13
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Mansouri D, McSorley ST, Park JH, Orange C, Horgan PG, McMillan DC, Edwards J. The inflammatory microenvironment in screen-detected premaligant adenomatous polyps: early results from the integrated technologies for improved polyp surveillance (INCISE) project. Eur J Gastroenterol Hepatol 2021; 33:983-989. [PMID: 34034277 DOI: 10.1097/meg.0000000000002202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Around 40% of patients who attend colonoscopy following a positive stool screening test have adenomatous polyps. Identifying which patients have a higher propensity for malignant transformation is currently poorly understood. The aim of the present study was to assess whether the type and intensity of inflammatory infiltrate differ between screen-detected adenomas with high-grade dysplasia (HGD) and low-grade dysplasia (LGD). METHODS A representative sample of 207 polyps from 134 individuals were included from a database of all patients with adenomas detected through the first round of the Scottish Bowel Screening Programme in NHS Greater Glasgow and Clyde (April 2009-April 2011). Inflammatory cell phenotype infiltrate was assessed by immunohistochemistry for CD3+, CD8+, CD45+ and CD68+ in a semi-quantitative manner at 20× resolution. Immune-cell infiltrate was graded as absent, weak, moderate or strong. Patient and polyp characteristics and inflammatory infiltrate were then compared between HGD and LGD polyps. RESULTS CD3+ infiltrate was significantly higher in HGD polyps compared to LGD polyps (74 vs. 69%; P < 0.05). CD8+ infiltrate was significantly higher in HGD polyps compared to LGD polyps (36 vs. 13%; P < 0.001) whereas CD45+ infiltrate was not significantly different (69 vs. 64%; P = 0.401). There was no significant difference in CD68+ infiltrate (P = 0.540) or total inflammatory cell infiltrate (calculated from CD3+ and CD68+) (P = 0.226). CONCLUSIONS This study reports an increase in CD3+ and CD8+ infiltrate in HGD colonic adenomas when compared to LGD adenomas. It may therefore have a use in the prognostic stratification and treatment of dysplastic polyps.
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Affiliation(s)
- David Mansouri
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary
| | - Stephen T McSorley
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary
| | - James H Park
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary
| | - Clare Orange
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary
| | - Paul G Horgan
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary
| | - Donald C McMillan
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary
| | - Joanne Edwards
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary
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Santiago CN, Rifkin S, Drewes J, Mullin G, Spence E, Hylind LM, Gills JJ, Kafonek D, Cromwell DM, Luna LL, Giardello F, Sears CL. Self-reported Metabolic Risk Factor Associations with Adenomatous, Sessile Serrated, and Synchronous Adenomatous and Sessile Serrated Polyps. Cancer Prev Res (Phila) 2021; 14:697-708. [PMID: 33947705 PMCID: PMC8295232 DOI: 10.1158/1940-6207.capr-20-0664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/04/2021] [Accepted: 04/27/2021] [Indexed: 01/03/2023]
Abstract
Studies have found a positive association between metabolic risk factors, such as obesity and diabetes, and adenomatous polyps (AP). However, fewer studies have assessed the association between sessile serrated polyps (SSP) or synchronous diagnosis of APs and SSPs (synch polyps). Study participants (N = 1,370; ages 40-85) undergoing screening colonoscopy were enrolled between August 2016 and February 2020. Self-reported metabolic risk factors, including diabetes, hypertension, hyperlipidemia, and overweight/obesity, were evaluated for associations with new diagnoses of APs, SSPs, and synch polyps at the present colonoscopy. Average participant age was 60.73 ± 8.63 (SD) years; 56.7% were female and 90.9% white. In an assessment of individual metabolic risk factors, adjusted for age, sex, race, and smoking status, increased body mass index (BMI; overweight or obese vs. normal BMI of <25 kg/m2) was associated with an increased odds for new onset of colon APs (P trend < 0.001) as was a diagnosis of diabetes [adjusted conditional OR (aCOR) = 1.59 (1.10-2.29)]. No associations were seen between the metabolic risk factors and onset of SSPs. Being obese or hypertensive each increased the odds of new onset of synch polyps with aCOR values of 2.09 (1.01-4.32) and 1.79 (1.06-3.02), respectively. Self-reported risk factors may help assess polyp type risk. Because SSPs and synch polyps are rare, larger studies are needed to improve our understanding of the contribution of these factors to polyp risk. These data lead us to hypothesize that differences in observed metabolic risk factors between polyp types reflect select metabolic impact on pathways to colorectal cancer. PREVENTION RELEVANCE: Self-reported medical history provides valuable insight into polyp risk, potentially enabling the use of larger retrospective studies of colonoscopy populations to assess knowledge gaps. More aggressive colonoscopy screening, critical to colorectal cancer prevention, may be considered in populations of individuals with metabolic risk factors and modifiable lifestyle risk factors.
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Affiliation(s)
- Celina N. Santiago
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Samara Rifkin
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julia Drewes
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, MD, USA
- Bloomberg-Kimmel Institute of Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gerard Mullin
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emma Spence
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Linda M. Hylind
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joell J. Gills
- Bloomberg-Kimmel Institute of Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Kafonek
- Green Spring Station Endoscopy, Lutherville-Timonium, MD, USA
| | | | - Louis La Luna
- Digestive Disease Associates, Reading, Wyomissing, PA, USA
| | - Francis Giardello
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cynthia L. Sears
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, MD, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Bloomberg-Kimmel Institute of Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Komeda Y, Handa H, Matsui R, Hatori S, Yamamoto R, Sakurai T, Takenaka M, Hagiwara S, Nishida N, Kashida H, Watanabe T, Kudo M. Artificial intelligence-based endoscopic diagnosis of colorectal polyps using residual networks. PLoS One 2021; 16:e0253585. [PMID: 34157030 PMCID: PMC8219125 DOI: 10.1371/journal.pone.0253585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 06/09/2021] [Indexed: 01/03/2023] Open
Abstract
Convolutional neural networks (CNNs) are widely used for artificial intelligence (AI)-based image classification. Residual network (ResNet) is a new technology that facilitates the accuracy of image classification by CNN-based AI. In this study, we developed a novel AI model combined with ResNet to diagnose colorectal polyps. In total, 127,610 images consisting of 62,510 images with adenomatous polyps, 30,443 with non-adenomatous hyperplastic polyps, and 34,657 with healthy colorectal normal mucosa were subjected to deep learning after annotation. Each validation process was performed using 12,761 stored images of colorectal polyps by a 10-fold cross validation. The efficacy of the ResNet system was evaluated by sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy for adenomatous polyps at WLIs were 98.8%, 94.3%, 90.5%, 87.4%, and 92.8%, respectively. Similar results were obtained for adenomatous polyps at narrow-band imagings (NBIs) and chromoendoscopy images (CEIs) (NBIs vs. CEIs: sensitivity, 94.9% vs. 98.2%; specificity, 93.9% vs. 85.8%; PPV, 92.5% vs. 81.7%; NPV, 93.5% vs. 99.9%; and overall accuracy, 91.5% vs. 90.1%). The ResNet model is a powerful tool that can be used for AI-based accurate diagnosis of colorectal polyps.
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Affiliation(s)
- Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
- * E-mail:
| | - Hisashi Handa
- Faculty of Science and Engineering, Kindai University, Osaka, Japan
- Research Institute for Science and Technology, Kindai University, Osaka, Japan
- Cyber Informatics Research Institute, Kindai University, Osaka, Japan
| | - Ryoma Matsui
- Faculty of Science and Engineering, Kindai University, Osaka, Japan
| | - Shohei Hatori
- Faculty of Science and Engineering, Kindai University, Osaka, Japan
| | - Riku Yamamoto
- Faculty of Science and Engineering, Kindai University, Osaka, Japan
| | - Toshiharu Sakurai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Satoru Hagiwara
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hiroshi Kashida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
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Soodejani MT, Mirzaei H, Manesh MM, Tabatabaei SM, Ghaderi A. Incidence of Colorectal Cancer and Adenomatous Polyps After a Two-Step Screening in Isfahan Province, Iran in 2018. J Gastrointest Cancer 2021; 51:850-854. [PMID: 31656018 DOI: 10.1007/s12029-019-00313-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to estimate the incidence of colorectal cancers in Iran. The results of this study are based on a screening program that is being implemented in Isfahan province. MATERIAL AND METHODS In this study, about 137,000 people were screened for colorectal cancer and adenomatous polyps in 2 steps during the year 2018. RESULTS Based on the findings of this study, the incidence of adenomatous polyps was reported to be 389 (95% CI, 365-422) per 100,000 population. The incidence of adenomatous polyps was reported to be 483 (95% CI, 446-520) and 316 (95% CI, 286-346) in men and women, respectively (p < 0.001). Also, the incidence of colorectal cancer was reported to be 33 (95% CI, 23-42) per 100,000 population. The incidence of colorectal cancer in men and women was reported to be 41 (95% CI, 30-51) and 26 (95% CI, 17-34), respectively, indicating a statistically non-significant difference (p = 0.29). CONCLUSION Based on the result of this study, despite a low participation rate of the target population in the screening program, the incidence of adenomatous polyps and colorectal cancer is relatively high in the average-risk population.
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Affiliation(s)
- Moslem Taheri Soodejani
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hossein Mirzaei
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Marzieh Mahmoodi Manesh
- Department of Epidemiology and Biostatistics, School of Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Seyyed Mohammad Tabatabaei
- Medical Informatics Department, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Imam Reza Hospital Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran.
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Azimeh Ghaderi
- Department of Fighting Against Disease, Najaf Abad Health Services Center, Isfahan University of Medical Sciences, Najaf Abad, Iran
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17
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Zhao X, Dou LZ, Zhang YM, Liu Y, He S, Ke Y, Liu XD, Liu YM, Wang GQ. [Clinicopathological features of the colorectal serrated adenoma and analysis on influencing factors of malignancy]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 24:75-80. [PMID: 33461256 DOI: 10.3760/cma.j.cn.441530-20200218-00062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objective: Serrated adenoma is recognized as a precancerous lesion of colorectal cancer, and the serrated pathway is considered as an important pathway that can independently develop into colorectal cancer. However, little is known about the related risk factors of carcinogenesis of serrated adenoma. The purpose of this study was to analyze the distribution characteristics and potential malignant factors of serrated adenoma in the colon and rectum. Methods: A retrospective case-control study was conducted to collect the clinical data of patients with serrated adenoma who underwent colonoscopy and were pathologically diagnosed in the Cancer Hospital of Chinese Academy of Medical Sciences from April 2017 to July 2019, and exclude patients with two or more pathological types of lesions. The clinical characteristics of serrated adenoma were summarized, and univariate and logistic multivariate regression analysis was conducted to explore the influencing factors for serrated adenoma to develop malignant transformation. Results: Among 28 730 patients undergoing colonoscopy, 311 (1.08%) were found with 372 serrated adenomas, among which 22 (5.9%) were sessile serrated adenomas/polyps, 84 (22.6%) were traditional serrated adenomas, and 266 (71.5%) were unclassified serrated adenomas according to WHO classification. The pathological results showed that 106 (28.5%) lesions were non-dysplasia, 228 (61.3%) lesions were low grade intraepithelial neoplasia, and 38 (10.2%) lesions were high grade intraepithelial neoplasia or cancer. There were 204 (54.8%) lesions with long-axis diameter <10 mm and 168 (45.2%) lesions with length long-axis ≥ 10 mm. 238 (64.0%) lesions were found in the left side colon and rectum and 134 (36.0%) lesions in the right side colon. Gross classification under endoscopy: 16 flat type lesions (4.3%), 174 sessile lesions (46.8%), 117 semi-pedunculated lesions (31.5%), 59 pedunculated lesions (15.9%). Narrow-band imaging international colorectal endoscopic (NICE) classification: 85 (22.8%) type I lesions, 280 (75.3%) type II lesions, 4 (1.1%) type III lesions. Univariate analysis showed that lesion size, lesion location, lesion site and different WHO classifications were associated with malignant transformation of colorectal serrated adenoma (all P<0.05). For the serrated adenomas with different NICE classifications, there were statistically significant differences in the distribution of malignant lesions among groups (P=0.001). Multivariate analysis showed that the long-axis diameter of the lesion ≥10 mm (OR=6.699, 95% CI: 2.843-15.786) and the lesion locating in the left side colorectum (OR=2.657, 95% CI: 1.042-6.775) were independent risk factors for malignant transformation. Conclusions: Serrated adenomas mainly locate in the left side colon and rectum, and are prone to malignant transformation when the lesions are ≥10 mm in long-axis diameter or left-sided.
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Affiliation(s)
- X Zhao
- Department of Endoscopy, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing100021, China
| | - L Z Dou
- Department of Endoscopy, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing100021, China
| | - Y M Zhang
- Department of Endoscopy, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing100021, China
| | - Y Liu
- Department of Endoscopy, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing100021, China
| | - S He
- Department of Endoscopy, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing100021, China
| | - Y Ke
- Department of Endoscopy, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing100021, China
| | - X D Liu
- Department of Endoscopy, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing100021, China
| | - Y M Liu
- Department of Endoscopy, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing100021, China
| | - G Q Wang
- Department of Endoscopy, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing100021, China
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18
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Chang CF, Huang TY, Huang HH, Shih YL, Chang WK, Hsieh TY, Wu LS, Chen KW, Lin HH. Impact of endoscopic sedation on gastric polyp detection: A one-center retrospective observational study. Medicine (Baltimore) 2020; 99:e22556. [PMID: 33031301 PMCID: PMC10545299 DOI: 10.1097/md.0000000000022556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 05/03/2020] [Accepted: 08/29/2020] [Indexed: 11/27/2022] Open
Abstract
Sedation esophagogastroduodenoscopy (EGD) has become more prevalent in many countries. However, owing to the limitation of health insurance payment for sedation EGD in Taiwan, non-sedation EGD still accounts for the majority of cases. This study was aimed to explore the differences between the sedation and non-sedation groups in terms of endoscopic findings, such as detection rate of gastric polyp of any size, number of detected gastric polyps, and location of the gastric polyps detected.We enrolled 10,940 patients who underwent EGD between January 1, 2016 and December 31, 2016 at the Tri-Service General Hospital; among the patients, 1900 received intravenous sedation (IVS) and 9040 did not. The data reviewed included demographics, parameters of the polyp (number, size, and location), and pathology.Compared with the non-sedation group, the sedation group had a higher overall polyp detection rate (P < .001); a greater number of detected polyps (Odds ratio 1.50, P = .007); and a higher detection rate of smaller polyps, such as fundic gland polyp, and hyperplastic polyp (P < .001). Among the pathological findings, gastric neuroendocrine tumor (NET) was detected using EGD in 2 cases and manifested as small polyps (<0.05 cm), and it showed significantly better detection rates in the sedation EGD group than in the non-sedation EGD group (P = .002).Sedation EGD could enhance a patients willingness and cooperation during EGD. Furthermore, sedation EGD increased the detection rates of small gastric polyps and was more likely to enable identification of unusual findings, such as gastric NET.
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Affiliation(s)
- Chao-Feng Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Tien-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Hsin-Hung Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Yu-Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Lian-Shan Wu
- Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien County, Taiwan
| | - Kai-Wen Chen
- Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien County, Taiwan
| | - Hsuan-Hwai Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
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Constantin A, Cazacu I, Ciocârlan M, Constantinescu C, Baltog G, Balahura C, Doraş I, Filip S, Filip G, Panazan I, Piţigoi D, Pirvu V, Turcu F, Copăescu C, Săftoiu A. Short Term Outcomes of Using Fecal Immunochemical Test for a Pilot Colorectal Cancer Screening Program. A Single Center Study on 3024 Consecutive Patients. Chirurgia (Bucur) 2020; 115:448-457. [PMID: 32876018 DOI: 10.21614/chirurgia.115.4.448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 11/23/2022]
Abstract
Background: In Romania, colorectal cancer does not benefit yet from a national screening program. In order to decrease the harm and burden of colorectal cancer (CRC), opportunistic programs relying on endoscopy has been adopted by each centre according to its capacity. A colorectal cancer (CRC) screening programme based on faecal immunochemical test (FIT) was launched at Ponderas Academic Hospital (PAH) in 2019. Aim: The present study analyses the outcomes after the first 1500 tests in the PAH-FIT-CRC Screening Program. We have also aimed to compare the efficiency of the FIT testing program with the screening colonoscopies performed in our Center, withing the same time interval (2019). Methods: The test was recommended in asymptomatic patients over 45 years, and it was followed by a colonoscopy when the test results were positive. Furthermore, we performed a retrospective observational study gathering data from all the consecutive patients prospectively included in the respective databases of our hospital, comparing the efficacy of the two colorectal cancer screening methods (FIT versus colonoscopy). Results: Between 01.01.2019 and 01.01.2020, 1524 screening colonoscopies were performed, and the resulting data were compared with those obtained in the FIT group (1500 FIT tests freely distributed). In the screening colonoscopy group, the polyp detection rate was 38.98% and 22 (1.44%) adenocarcinomas were identified. In the FIT group, the FIT uptake rate was 71% with a positivity rate of 21.7%. The colonoscopy compliance rate for positive FIT patients was 29.4%, with only 2 adenocarcinomas detected. Conclusions: Following data analysis, the need for improvement of uptake rate and colonoscopy compliance rate was suggested, due to the lower acceptance of FIT tests and colonoscopies, especially among men. Moreover, special efforts should be made in order to improve quality indicators for screening colonoscopies (especially adenoma detection rate) with the purpose of decreasing interval CRC.
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Gupta S, Lieberman D, Anderson JC, Burke CA, Dominitz JA, Kaltenbach T, Robertson DJ, Shaukat A, Syngal S, Rex DK. Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2020; 91:463-485.e5. [PMID: 32044106 PMCID: PMC7389642 DOI: 10.1016/j.gie.2020.01.014] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Samir Gupta
- Veterans Affairs San Diego Healthcare System, San Diego, California; University of California-San Diego, Division of Gastroenterology La Jolla, California; Moores Cancer Center, La Jolla, California.
| | - David Lieberman
- Division of Gastroenterology, Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Joseph C Anderson
- Veterans Affairs Medical Center, White River Junction, Vermont; The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; University of Connecticut Health Center, Farmington, Connecticut
| | - Carol A Burke
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
| | - Jason A Dominitz
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington; University of Washington School of Medicine, Seattle, Washington
| | - Tonya Kaltenbach
- San Francisco Veterans Affairs Medical Center, San Francisco, California; University of California San Francisco, San Francisco, California
| | - Douglas J Robertson
- Veterans Affairs Medical Center, White River Junction, Vermont; The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Aasma Shaukat
- Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota
| | - Sapna Syngal
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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21
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Kaltenbach T, Anderson JC, Burke CA, Dominitz JA, Gupta S, Lieberman D, Robertson DJ, Shaukat A, Syngal S, Rex DK. Endoscopic Removal of Colorectal Lesions-Recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2020; 91:486-519. [PMID: 32067745 DOI: 10.1016/j.gie.2020.01.029] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Tonya Kaltenbach
- Veterans Affairs San Francisco, University California-San Francisco, San Francisco, California.
| | - Joseph C Anderson
- Veterans Affairs Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; University of Connecticut Health Center, Farmington, Connecticut
| | - Carol A Burke
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio
| | - Jason A Dominitz
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington; University of Washington School of Medicine, Seattle, Washington
| | - Samir Gupta
- Veterans Affairs San Diego Healthcare System, San Diego, California; University of California-San Diego, San Diego, California
| | | | - Douglas J Robertson
- Veterans Affairs Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Aasma Shaukat
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota
| | - Sapna Syngal
- Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts
| | - Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana
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22
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Dabbous HK, Mohamed YAER, El-Folly RF, El-Talkawy MD, Seddik HE, Johar D, Sarhan MA. Evaluation of Fecal M2PK as a Diagnostic Marker in Colorectal Cancer. J Gastrointest Cancer 2020; 50:442-450. [PMID: 29626277 DOI: 10.1007/s12029-018-0088-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Invasive colonoscopy is the gold standard for patients at risk for colorectal cancer. However, the need for non-invasive and specific markers is required. OBJECTIVE To evaluate the sensitivity of the glycolytic pyruvate kinase isoenzyme type M2 dimer (M2PK) as a diagnostic biomarker for colorectal cancer (CRC) and adenomatous colorectal polyps (CRP) screening. DESIGN Case-control. PATIENTS Twenty patients with CRC, 20 patients with CRP (lack criteria for colonic cancer by biopsy), and 20 normal subjects. OUTCOME Complete blood count (CBC), erythrocyte sedimentation rate (ESR), tumor markers: carcino embryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9), fecal occult blood test (FOBT), and fecal M2PK. Pelvic and abdominal ultrasound (US), colonoscopy, and a histopathological examination. RESULTS Only weight loss and cachexia were significantly associated with CRC than CRP or control groups. M2PK was the most sensitive and specific test in differentiating CRC from CRP and the control subjects (sensitivity = 75%, specificity = 100%). LIMITATIONS (1) The selection of cases for three well-matched groups, as to perform colonoscopy in well-prepared cases and conditions. (2) Replicates in more than 20 cases for confirmation at the expense of enrolling new patients. (3) The cost associated with tumor markers analysis. CONCLUSION Fecal M2PK can be used as a precolonoscopy screening test for CRC patients, and is superior to other tumor markers, and in indicating the progress of colorectal adenomas > 1 cm. Thus being cost-effective and easy-to-perform test, it is a feasible tool to preselect patients who require colonoscopy.
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Affiliation(s)
- Hisham K Dabbous
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Runia F El-Folly
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed D El-Talkawy
- Hepatogastroenterology and Tropical Medicine Department, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Hani E Seddik
- Hepatogastroenterology and Tropical Medicine Department, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Dina Johar
- Department of Biochemistry and Nutrition, Faculty of Women for Arts, Sciences and Education, Ain Shams University, Cairo, Egypt.
- Department of Physiology and Pathophysiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 432 Basic Medical Sciences Building, 745 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0J9, Canada.
| | - Mohammed A Sarhan
- Center of Excellence of Gastrointestinal Inflammation and Immunology Research (CEGIIR), Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- National Liver Institute, Department of Medical Microbiology and Immunology, Menofia University, Shibin El-Kom, Menofia, Egypt
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23
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Burke KE, Nayor J, Campbell EJ, Ananthakrishnan AN, Khalili H, Richter JM. Interval Colorectal Cancer in Inflammatory Bowel Disease: The Role of Guideline Adherence. Dig Dis Sci 2020; 65:111-118. [PMID: 31367882 PMCID: PMC6946853 DOI: 10.1007/s10620-019-05754-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/19/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Factors associated with interval colorectal cancer (CRC) development in the inflammatory bowel disease (IBD) population remain unclear. AIMS Among a cohort of patients with interval CRC, we aimed to evaluate IBD characteristics, colonoscopy quality indicators, and surveillance guideline adherence. METHODS We performed a retrospective review of IBD- and non-IBD-associated interval CRCs diagnosed between January 2007 and December 2014 within a large US healthcare system. We evaluated risk factors for CRC among patients with IBD. We assessed adherence to surveillance guidelines according to the American Society for Gastrointestinal Endoscopy (IBD surveillance) and the US Multi-Society Task Force on Colorectal Cancer (polyp surveillance). We compared colonoscopy quality measures between patients with and without IBD. RESULTS Among 5345 cases of colonic adenocarcinoma, we detected 15 IBD-associated cases of interval CRC and 230 non-IBD-associated cases of interval CRC. Compared to patients without IBD, IBD patients were younger (54.5 vs. 70.4 years; p < 0.0001) and experienced a shorter interval between index colonoscopy and CRC diagnosis (20.7 vs. 35.1 months; p = 0.0009). Fifty three percent (8/15) of interval CRCs in IBD patients were detected within surveillance guidelines. All IBD patients with interval CRC detected after guideline surveillance interval had high-risk features, including active inflammation, previous low-grade or indefinite dysplasia, multiple pseudopolyps on index colonoscopy, or a first-degree relative with CRC. There were no differences in colonoscopy quality measures between patients with and without IBD. CONCLUSIONS This study stresses the importance of strict short-interval surveillance for IBD patients with high-risk features, including active inflammation on index colonoscopy.
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Affiliation(s)
- Kristin E Burke
- Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Jennifer Nayor
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily J Campbell
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - James M Richter
- Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
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24
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López-Vicente J, Rodríguez-Alcalde D, Hernández L, Riu Pons F, Vega P, Herrero Rivas JM, Santiago García J, Salces Franco I, Bustamante Balén M, López-Cerón M, Pellisé M. Panchromoendoscopy Increases Detection of Polyps in Patients With Serrated Polyposis Syndrome. Clin Gastroenterol Hepatol 2019; 17:2016-2023.e6. [PMID: 30366156 DOI: 10.1016/j.cgh.2018.10.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 10/02/2018] [Accepted: 10/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Serrated polyposis syndrome (SPS), characterized by multiple and/or large proximal serrated lesions, increases the risk of colorectal cancer. Serrated lesions often are missed during colonoscopy but panchromoendoscopy can increase their detection in an average-risk population. We performed a randomized controlled study to determine the efficacy of panchromoendoscopy in detection of polyps in patients with SPS. METHODS Patients with SPS (n = 86 patients) underwent tandem high-definition (HD) colonoscopies from February 2015 through July 2016 at 7 centers in Spain. Patients were assigned randomly to groups that received 2 HD white-light endoscopy examinations (HD-WLE group; n = 43) or HD-WLE followed by 0.4% indigo carmine panchromoendoscopy (HD-CE group; n = 43). For each procedure, polyps detected were described, removed, and analyzed by histology. The primary outcome was additional polyp detection rate, defined as the number of polyps detected during the second inspection divided by the total number of polyps detected during the first and the second examination. RESULTS A total of 774 polyps were detected (362 in the HD-WLE group and 412 in the HD-CE group); 54.2% were hyperplastic, 13.8% were adenomas, and 10.9% were sessile serrated polyps. There was a significantly higher additional polyp detection rate in the HD-CE group (0.39; 95% CI, 0.35-0.44) than in the HD-WLE group (0.22; 95% CI, 0.18-0.27) (P < .001). A higher additional rate of serrated lesions proximal to the sigmoid colon were detected in the second inspection with HD-CE (0.40; 95% CI, 0.33-0.47) than with HD-WLE (0.24; 95% CI, 0.19-0.31) (P = .001). Detection of adenomas and serrated lesions greater than 10 mm did not differ significantly between groups. In a multivariate logistic regression analysis, only use of HD-CE was associated independently with increased polyp detection throughout the colon. CONCLUSIONS In a randomized controlled trial, we found that panchromoendoscopy increases detection of polyps (mostly of small serrated lesions) and should be considered the standard of care in patients with SPS. Studies are needed to determine the effects of this strategy on the incidence of advanced neoplasia during long-term follow-up evaluation. ClinicalTrials.gov no: NCT03476434.
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Affiliation(s)
| | | | - Luis Hernández
- Gastroenterology Department, Hospital Santos Reyes de Aranda de Duero, Spain
| | - Fausto Riu Pons
- Gastroenterology Department, Hospital de Mar de Barcelona, Spain
| | - Pablo Vega
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Spain
| | | | - José Santiago García
- Gastroenterology Department, Hospital Universitario Puerta de Hierro de Madrid, Spain
| | | | | | - María López-Cerón
- Gastroenterology Department, Hospital Universitario 12 de Octubre de Madrid, Spain
| | - María Pellisé
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Spain.
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25
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Turse EP, Dailey FE, Bechtold ML. Impact of moderate versus deep sedation on adenoma detection rate in index average-risk screening colonoscopies. Gastrointest Endosc 2019; 90:502-505. [PMID: 31102644 DOI: 10.1016/j.gie.2019.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/05/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The debate between moderate sedation versus deep sedation for index average-risk screening colonoscopies is well known to gastroenterologists. Ensuring the best of all metrics to perform quality colonoscopies for colon cancer prevention is paramount for both patients and physicians alike, because colon cancer remains the leading cause of cancer death and is the most-used screening tool in the United States. The aim of this study was to determine if moderate sedation versus deep sedation affects outcomes of adenoma detection rate (ADR) or polyp detection rate (PDR) in index, average-risk colonoscopies for colon cancer screening. METHODS A retrospective, single, tertiary care outpatient center study of 585 healthy average-risk patients who underwent index screening colonoscopy between June 1, 2015 to December 31, 2015 (moderate sedation only) and June 1, 2016,to December 31, 2016 (deep sedation only) was performed after Institutional Review Board approval. Demographic data and polyp details were collected to determine ADR and PDR. Patients who were not average risk were excluded from the study. RESULTS A total of 585 index average-risk screening colonoscopies were included in this study with 57.7% moderate sedation and 42.2% deep sedation. Neither ADR nor PDR was significantly different between the 2 groups (44.1% vs 38.5% [P = .18] and 71.9% vs 67.6% [P = .27], respectively). CONCLUSIONS In index average-risk screening colonoscopies, deep sedation appears to have no benefit compared with moderate sedation for ADR and PDR.
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Affiliation(s)
- Erica P Turse
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Francis E Dailey
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Matthew L Bechtold
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
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26
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Mangifesta M, Mancabelli L, Milani C, Gaiani F, de'Angelis N, de'Angelis GL, van Sinderen D, Ventura M, Turroni F. Mucosal microbiota of intestinal polyps reveals putative biomarkers of colorectal cancer. Sci Rep 2018; 8:13974. [PMID: 30228361 PMCID: PMC6143603 DOI: 10.1038/s41598-018-32413-2] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/29/2018] [Indexed: 02/07/2023] Open
Abstract
The human intestine retains a complex microbial ecosystem, which performs crucial functions that impact on host health. Several studies have indicated that intestinal dysbiosis may impact on the establishment of life-threatening intestinal diseases such as colorectal cancer. An adenomatous polyp is the result of abnormal tissue growth, which is benign but is considered to be associated with a high risk of developing colorectal cancer, based on its grade of dysplasia. Development of diagnostic tools that are based on surveying the gut microbiota and are aimed at early detection of colorectal cancer represent highly desirable target. For this purpose, we performed a pilot study in which we applied a metataxonomic analysis based on 16S rRNA gene sequencing approach to unveil the composition of microbial communities of intestinal polyps. Moreover, we performed a meta-analysis involving the reconstructed microbiota composition of adenomatous polyps and publicly available metagenomics datasets of colorectal cancer. These analyses allowed the identification of microbial taxa such as Faecalibacterium, Bacteroides and Romboutsia, which appear to be depleted in cancerogenic mucosa as well as in adenomatous polyps, thus representing novel microbial biomarkers associated with early tumor formation. Furthermore, an absolute quantification of Fusubacterium nucleatum in polyps further compounded the important role of this microorganism as a valuable putative microbial biomarker for early diagnosis of colorectal cancer.
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Affiliation(s)
- Marta Mangifesta
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Leonardo Mancabelli
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Christian Milani
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Federica Gaiani
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, Parma, Italy
| | - Nicola de'Angelis
- Department of HPB Surgery and Liver Transplantation, Henri-Mondor Hospital, Université Paris Est-UPEC, Créteil, France
| | | | - Douwe van Sinderen
- School of Microbiology & APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Marco Ventura
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
- Microbiome Research Hub, University of Parma, Parma, Italy
| | - Francesca Turroni
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy.
- Microbiome Research Hub, University of Parma, Parma, Italy.
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Abstract
Colorectal cancer is the fourth most frequently diagnosed cancer. However, due to variations in diet, it was hypothesized that risk of adenomatous or hyperplastic polyps or malignancies would be lower among Hispanics. Participants (n = 1671) underwent a colonoscopy. Results were grouped into one of four groups: normal, hyperplastic polyps only, adenomatous polyps, and malignancies. As expected, Hispanics had a lower risk of hyperplastic (p = .031, OR = 0.47) and adenomatous polyps (p = .031, OR = 0.66) than non-Hispanic Whites. Comparison between malignancies was not possible as no Hispanics had a malignancy. Contrary to expectations, risk of hyperplastic and adenomatous polyps and malignancies were no different between non-Hispanic Blacks and Whites. Among rural and mostly rural populations, Hispanics had a lower risk of hyperplastic and adenomatous polyps.
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Affiliation(s)
- Gabriela Orsak
- Department of Epidemiology and Biostatistics, School of Rural and Community Health, University of Texas Health Science Center at Tyler, 11937 US HWY 271, Tyler, TX, 75708-3154, USA.
| | - Carlton M Allen
- Center for Rural and Community Health, University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - William Sorensen
- Department of Health and Kinesiology, University of Texas at Tyler, Tyler, TX, USA
| | - Paul McGaha
- Department of Community Health, University of Texas Health Science Center at Tyler, Tyler, TX, USA
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28
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Hiller DJ, Gilliam JH, Waters GS. Extensive Small Bowel Polyposis of Unknown Origin. Am Surg 2018; 84:e204-e205. [PMID: 30219137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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29
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Kim JH, Nam KS, Kwon HJ, Choi YJ, Jung K, Kim SE, Moon W, Park MI, Park SJ. Assessment of colon polyp morphology: Is education effective? World J Gastroenterol 2017; 23:6281-6286. [PMID: 28974894 PMCID: PMC5603494 DOI: 10.3748/wjg.v23.i34.6281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/09/2017] [Accepted: 07/12/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To determine the inter-observer variability for colon polyp morphology and to identify whether education can improve agreement among observers.
METHODS For purposes of the tests, we recorded colonoscopy video clips that included scenes visualizing the polyps. A total of 15 endoscopists and 15 nurses participated in the study. Participants watched 60 video clips of the polyp morphology scenes and then estimated polyp morphology (pre-test). After education for 20 min, participants performed a second test in which the order of 60 video clips was changed (post-test). To determine if the effectiveness of education was sustained, four months later, a third, follow-up test was performed with the same participants.
RESULTS The overall Fleiss’ kappa value of the inter-observer agreement was 0.510 in the pre-test, 0.618 in the post-test, and 0.580 in the follow-up test. The overall diagnostic accuracy of the estimation for polyp morphology in the pre-, post-, and follow-up tests was 0.662, 0.797, and 0.761, respectively. After education, the inter-observer agreement and diagnostic accuracy of all participants improved. However, after four months, the inter-observer agreement and diagnostic accuracy of expert groups were markedly decreased, and those of beginner and nurse groups remained similar to pre-test levels.
CONCLUSION The education program used in this study can improve inter-observer agreement and diagnostic accuracy in assessing the morphology of colon polyps; it is especially effective when first learning endoscopy.
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Affiliation(s)
- Jae Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Kosin University College of Medicine, Busan 602-702, South Korea
| | - Kyoung Sik Nam
- Division of Gastroenterology, Department of Internal Medicine, Kosin University College of Medicine, Busan 602-702, South Korea
| | - Hye Jung Kwon
- Division of Gastroenterology, Department of Internal Medicine, Kosin University College of Medicine, Busan 602-702, South Korea
| | - Youn Jung Choi
- Division of Gastroenterology, Department of Internal Medicine, Kosin University College of Medicine, Busan 602-702, South Korea
| | - Kyoungwon Jung
- Division of Gastroenterology, Department of Internal Medicine, Kosin University College of Medicine, Busan 602-702, South Korea
| | - Sung Eun Kim
- Division of Gastroenterology, Department of Internal Medicine, Kosin University College of Medicine, Busan 602-702, South Korea
| | - Won Moon
- Division of Gastroenterology, Department of Internal Medicine, Kosin University College of Medicine, Busan 602-702, South Korea
| | - Moo In Park
- Division of Gastroenterology, Department of Internal Medicine, Kosin University College of Medicine, Busan 602-702, South Korea
| | - Seun Ja Park
- Division of Gastroenterology, Department of Internal Medicine, Kosin University College of Medicine, Busan 602-702, South Korea
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30
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Chen QF, Zhou XD, Sun YJ, Fang DH, Zhao Q, Huang JH, Jin Y, Wu JS. Sex-influenced association of non-alcoholic fatty liver disease with colorectal adenomatous and hyperplastic polyps. World J Gastroenterol 2017; 23:5206-5215. [PMID: 28811715 PMCID: PMC5537187 DOI: 10.3748/wjg.v23.i28.5206] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 05/24/2017] [Accepted: 07/04/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the relationship between non-alcoholic fatty liver disease (NAFLD) and colorectal adenomatous and hyperplastic polyps.
METHODS A retrospective cross-sectional study was conducted on 3686 individuals undergoing health checkups (2430 males and 1256 females). All subjects underwent laboratory testing, abdominal ultrasonography, colonoscopy, and an interview to ascertain the baseline characteristics and general state of health. Multinomial logistic regression analysis was performed to examine the association between NAFLD and the prevalence of colorectal adenomatous and hyperplastic polyps. Furthermore, the relationship was analyzed in different sex groups. Subgroup analysis was performed based on number, size, and location of colorectal polyps.
RESULTS The prevalence of colorectal polyps was 38.8% in males (16.2% for adenomatous polyps and 9.8% for hyperplastic polyps) and 19.3% in females (8.4% for adenomatous polyps and 3.9% for hyperplastic polyps). When adjusting for confounding variables, NAFLD was significantly associated with the prevalence of adenomatous polyps (OR = 1.28, 95%CI: 1.05-1.51, P < 0.05) and hyperplastic polyps (OR = 1.35, 95%CI: 1.01-1.82, P < 0.05). However, upon analyzing adenomatous and hyperplastic polyps in different sex groups, the significant association remained in males (OR = 1.53, 95%CI: 1.18-2.00, P < 0.05; OR = 1.42, 95%CI: 1.04-1.95, P < 0.05) but not in females (OR = 0.44, 95%CI: 0.18-1.04, P > 0.05; OR = 1.18, 95%CI: 0.50-2.78, P > 0.05).
CONCLUSION NAFLD is specifically associated with an increased risk of colorectal adenomatous and hyperplastic polyps in men. However, NAFLD may not be a significant factor in the prevalence of colorectal polyps in women.
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Gkolfakis P, Tziatzios G, Dimitriadis GD, Triantafyllou K. New endoscopes and add-on devices to improve colonoscopy performance. World J Gastroenterol 2017; 23:3784-3796. [PMID: 28638218 PMCID: PMC5467064 DOI: 10.3748/wjg.v23.i21.3784] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/24/2017] [Accepted: 05/09/2017] [Indexed: 02/06/2023] Open
Abstract
Colonoscopy is the gold standard for colorectal cancer prevention; however, it is still an imperfect modality. Precancerous lesions can be lost during screening examinations, thus increasing the risk of interval cancer. A variety of factors either patient-, or endoscopist dependent or even the procedure itself may contribute to loss of lesions. Sophisticated modalities including advanced technology endoscopes and add-on devices have been developed in an effort to eliminate colonoscopy's drawbacks and maximize its ability to detect potentially culprit polyps. Novel colonoscopes aim to widen the field of view. They incorporate more than one cameras enabling simultaneous image transmission. In that way the field of view can expand up to 330°. On the other hand a plethora of add-on devices attachable on the standard colonoscope promise to detect lesions in the proximal aspect of colonic folds either by offering a retrograde view of the lumen or by straightening the haustral folds during withdrawal. In this minireview we discuss how these recent advances affect colonoscopy performance by improving its quality indicators (cecal intubation rate, adenoma detection rate) and other metrics (polyp detection rate, adenomas per colonoscopy, polyp/adenoma miss rate) associated with examination's outcomes.
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Lawless ME, Toweill DL, Jewell KD, Jain D, Lamps L, Krasinskas AM, Swanson PE, Upton MP, Yeh MM. Massive Gastric Juvenile Polyposis: A Clinicopathologic Study Using SMAD4 Immunohistochemistry. Am J Clin Pathol 2017; 147:390. [PMID: 28340255 DOI: 10.1093/ajcp/aqx015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Juvenile polyps involving the stomach are uncommon. Massive gastric juvenile polyposis is even rarer. METHODS We describe the clinicopathologic features of nine cases of massive gastric juvenile polyposis. RESULTS All patients had anemia; four had hypoalbuminemia. The polyps were composed predominantly of dilated crypts lined by columnar epithelium and abundant edematous stroma with mixed inflammatory infiltrates. One patient had a poorly differentiated adenocarcinoma, arising in juvenile polyp-associated intraepithelial neoplasia. A second patient had a well-differentiated intramucosal adenocarcinoma arising in a juvenile polyp with high-grade dysplasia. Three of our cases had polyposis restricted to the stomach. Six (66.6%) had loss of SMAD4 immunoreactivity, making them subject to severe bleeding and hypoproteinemia, as well as developing severe dysplasia or adenocarcinoma. CONCLUSIONS SMAD4 immunohistochemstry is a helpful ancillary diagnostic test in cases of suspected juvenile polyposis syndrome involving the stomach.
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Affiliation(s)
- Margaret E Lawless
- From the Department of Pathology, University of Washington School of Medicine, Seattle
| | - Daniel L Toweill
- From the Department of Pathology, University of Washington School of Medicine, Seattle
| | - Kim D Jewell
- From the Department of Pathology, University of Washington School of Medicine, Seattle
| | - Dhanpat Jain
- Department of Pathology, Yale University School of Medicine, New Haven, CT
| | - Laura Lamps
- Department of Pathology, University of Arkansas, Little Rock, AR
| | | | - Paul E Swanson
- From the Department of Pathology, University of Washington School of Medicine, Seattle
| | - Melissa P Upton
- From the Department of Pathology, University of Washington School of Medicine, Seattle
| | - Matthew M Yeh
- From the Department of Pathology, University of Washington School of Medicine, Seattle
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Ioffe IV, Trotsenko SN, Lesnoy VV. [THE PROGNOSTIC FACTORS ANALYSIS FOR THE REPEATED DEVELOPMENT OF GASTRIC POLYPS AFTER ENDOSCOPIC POLYPECTOMY]. Klin Khir 2017:22-24. [PMID: 30272934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There were analyzed the results of treatment of 1450 patients, to whom in surgical departments of Lugansk Regional Clinical Hospital the elective endoscopic polypectomy for solitary and multiple gastric polyps, premalignant changes, was conducted. The unfavorable prognosis signs, trustworthily impacting the gastric polyps reoccurring, were considered: quantity of gastric polyps, their dimensions, localization and presence of mucosal erosions. Reoccurrence of majority of the polyps in gastric antrum may be due to microcirculatory disorders, present in their mucosa.
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Uratani R, Toiyama Y, Kitajima T, Kawamura M, Hiro J, Kobayashi M, Tanaka K, Inoue Y, Mohri Y, Mori T, Kato T, Goel A, Kusunoki M. Diagnostic Potential of Cell-Free and Exosomal MicroRNAs in the Identification of Patients with High-Risk Colorectal Adenomas. PLoS One 2016; 11:e0160722. [PMID: 27760147 PMCID: PMC5070810 DOI: 10.1371/journal.pone.0160722] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/22/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although there is a growing interest in developing circulating microRNA (miRNA) as noninvasive diagnostic biomarkers for the detection of high-risk colorectal adenomas and early-stage CRCs, but the comparative diagnostic significance of serum vs. exosomal miRNAs remains unexplored. METHODS Based upon published literature, we performed an initial discovery step by investigating the expression of a miRNA panel in 20 normal colonic mucosa, 27 adenomas, and 19 CRC tissues. We performed subsequent validation by quantifying expression of candidate miRNAs in total serum and in exosomes from 26 adenoma patients and 47 healthy controls, and evaluated their clinical significance and potential diagnostic value in colorectal adenomas. RESULTS We observed that the expression of four miRNAs, miR-21, miR-29a, miR-92a, and miR-135b, was significantly higher in colorectal adenomas vs. normal colonic mucosa. During validation, expression of miR-21, miR-29a and miR-92a in serum was significantly higher in adenomas vs. healthy controls, significantly correlated with adenoma size and total adenoma number within the colorectum, and significantly discriminated patients with advanced adenomas. In contrast, although exosomal miR-21 and miR-29a levels in adenoma patients were significantly higher than those of healthy volunteers, only exosomal miR-21 significantly correlated with adenoma size and total adenoma number, and could discriminate patients with high-risk adenomas. CONCLUSION Compared to exosomal miRNAs, serum levels of miR-21, miR-29a and miR-92a are superior diagnostic biomarkers in patients with high-risk adenomatous polyps.
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Affiliation(s)
- Ryo Uratani
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Graduate School of Medicine, Mie University, Mie 514–8507, Japan
| | - Yuji Toiyama
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Graduate School of Medicine, Mie University, Mie 514–8507, Japan
- * E-mail: (YT); (AG)
| | - Takahito Kitajima
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Graduate School of Medicine, Mie University, Mie 514–8507, Japan
| | - Mikio Kawamura
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Graduate School of Medicine, Mie University, Mie 514–8507, Japan
| | - Junichiro Hiro
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Graduate School of Medicine, Mie University, Mie 514–8507, Japan
| | - Minako Kobayashi
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Graduate School of Medicine, Mie University, Mie 514–8507, Japan
| | - Koji Tanaka
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Graduate School of Medicine, Mie University, Mie 514–8507, Japan
| | - Yasuhiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Graduate School of Medicine, Mie University, Mie 514–8507, Japan
| | - Yasuhiko Mohri
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Graduate School of Medicine, Mie University, Mie 514–8507, Japan
| | - Takao Mori
- Moriei Hospital, Kuwana city, Mie 511–0038, Japan
| | - Toshio Kato
- Tohyama Hospital, Tsu city, Mie 514–0043, Japan
| | - Ajay Goel
- Center for Gastrointestinal Research & Center for Epigenetics, Cancer Prevention and Cancer Genomics, Baylor Research Institute and Charles A Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, 75246–2017, United States of America
- * E-mail: (YT); (AG)
| | - Masato Kusunoki
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Graduate School of Medicine, Mie University, Mie 514–8507, Japan
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Bergholt MS, Lin K, Wang J, Zheng W, Xu H, Huang Q, Ren JL, Ho KY, Teh M, Srivastava S, Wong B, Yeoh KG, Huang Z. Simultaneous fingerprint and high-wavenumber fiber-optic Raman spectroscopy enhances real-time in vivo diagnosis of adenomatous polyps during colonoscopy. J Biophotonics 2016; 9:333-42. [PMID: 25850576 DOI: 10.1002/jbio.201400141] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 03/12/2015] [Accepted: 03/20/2015] [Indexed: 05/06/2023]
Abstract
Colorectal cancer can be prevented if detected early (e.g., precancerous polyps-adenoma). Endoscopic differential diagnosis of hyperplastic polyps (that have little or no risk of malignant transformation) and adenomas (that have prominent malignant latency) remains an unambiguous clinical challenge. Raman spectroscopy is an optical vibrational technique capable of probing biomolecular changes of tissue associated with neoplastic transformation. This work aims to apply a fiber-optic simultaneous fingerprint (FP) and high wavenumber (HW) Raman spectroscopy technique for real-time in vivo assessment of adenomatous polyps during clinical colonoscopy. We have developed a fiber-optic Raman endoscopic technique capable of simultaneously acquiring both the FP (i.e., 800-1800 cm(-1)) and HW (i.e., 2800-3600 cm(-1)) Raman spectra from colorectal tissue subsurface (<200 µm) for real-time assessment of colorectal carcinogenesis. In vivo FP/HW Raman spectra were acquired from 50 patients with 17 colorectal polyps during clinical colonoscopy. Prominent Raman spectral differences (p < 0.001) were found between hyperplastic (n = 118 spectra), adenoma (n = 184 spectra) that could be attributed to changes in inter- and intra-cellular proteins, lipids, DNA and water structures and conformations. Simultaneous FP/HW Raman endoscopy provides a diagnostic sensitivity of 90.9% and specificity of 83.3% for differentiating adenoma from hyperplastic polyps, which is superior to either the FP or HW Raman technique alone. This study shows that simultaneous FP/HW Raman spectroscopy technique has the potential to be a clinically powerful tool for improving early diagnosis of adenomatous polyps in vivo during colonoscopic examination.
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Affiliation(s)
- Mads Sylvest Bergholt
- Optical Bioimaging Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117576, Singapore
| | - Kan Lin
- Optical Bioimaging Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117576, Singapore
| | - Jianfeng Wang
- Optical Bioimaging Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117576, Singapore
| | - Wei Zheng
- Optical Bioimaging Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117576, Singapore
| | - Hongzhi Xu
- Institute of Digestive Disease, Department of Gastroenterology, Zhongshan Hospital affiliated to Xiamen University, Xiamen, 361004, China
| | - Qingwen Huang
- Institute of Digestive Disease, Department of Gastroenterology, Zhongshan Hospital affiliated to Xiamen University, Xiamen, 361004, China
| | - Jian-Lin Ren
- Institute of Digestive Disease, Department of Gastroenterology, Zhongshan Hospital affiliated to Xiamen University, Xiamen, 361004, China
| | - Khek Yu Ho
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119260, Singapore
| | - Ming Teh
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119074, Singapore
| | - Supriya Srivastava
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119074, Singapore
| | - Benjamin Wong
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119074, Singapore
| | - Khay Guan Yeoh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119260, Singapore
| | - Zhiwei Huang
- Optical Bioimaging Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117576, Singapore.
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Bond AD, Burkitt MD, Sawbridge D, Corfe BM, Probert CS. Correlation between Faecal Tumour M2 Pyruvate Kinase and Colonoscopy for the Detection of Adenomatous Neoplasia in a Secondary Care Cohort. J Gastrointestin Liver Dis 2016; 25:71-7. [PMID: 27014756 DOI: 10.15403/jgld.2014.1121.251.m2p] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS Colorectal cancer screening programmes that target detection and excision of adenomatous colonic polyps have been shown to reduce colorectal cancer related mortality. Many screening programmes include an initial faecal occult blood test (FOBt) prior to colonoscopy. To refine the selection of patients for colonoscopy other faecal-based diagnostic tools have been proposed, including tumour M2-pyruvate kinase (tM2-PK). To determine whether tM2-PK quantification may have a role in diverse settings we have assessed the assay in a cohort of patients derived from both the England bowel cancer screening programme (BCSP) and symptomatic individuals presenting to secondary care. METHOD Patients undergoing colonoscopy provided faecal samples prior to bowel preparation. Faecal tM2-PK concentrations were measured by ELISA. Sensitivity, specificity, positive predictive value, negative predictive value and ROC analyses were calculated. RESULTS Ninety-six patients returned faecal samples: 50 of these with adenomas and 7 with cancer. Median age was 68. Median faecal tM2-PK concentration was 3.8 U/mL for individuals without neoplastic findings at colonoscopy, 7.7 U/mL in those with adenomas and 24.4 U/mL in subjects with colorectal cancer (both, p=0.01). ROC analysis demonstrated an AUROC of 0.66 (sensitivity 72.4%, specificity 48.7%, positive predictive value 67.7%, negative predictive value 36.7%). Amongst BCSP patients with a prior positive FOBt faecal tM2-PK was more abundant (median 6.4 U/mL, p=0.03) and its diagnostic accuracy was greater (AUROC 0.82). CONCLUSION Our findings confirm that faecal tM2-PK ELISA may have utility as an adjunct to FOBt in a screening context, but do not support its use in symptomatic patients.
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Affiliation(s)
- Ashley D Bond
- Unit of Gastroenterology Research, Dept of Molecular and Cellular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
| | - Michael D Burkitt
- Unit of Gastroenterology Research, Dept of Molecular and Cellular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - David Sawbridge
- Unit of Gastroenterology Research, Dept of Molecular and Cellular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Bernard M Corfe
- Molecular Gastroenterology Research Group, Department of Oncology; Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - Chris S Probert
- Unit of Gastroenterology Research, Dept of Molecular and Cellular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Lim CH, Cho YS. Nonampullary duodenal adenoma: Current understanding of its diagnosis, pathogenesis, and clinical management. World J Gastroenterol 2016; 22:853-861. [PMID: 26811631 PMCID: PMC4716083 DOI: 10.3748/wjg.v22.i2.853] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 08/10/2015] [Accepted: 10/26/2015] [Indexed: 02/06/2023] Open
Abstract
Nonampullary duodenal adenomas are relatively common in familial adenomatous polyposis (FAP), but nonampullary sporadic duodenal adenomas (SDAs) are rare. Emerging evidence shows that duodenal adenomas, regardless of their anatomic location and whether they are sporadic or FAP-related, share morphologic and molecular features with colorectal adenomas. The available data suggest that duodenal adenomas develop to duodenal adenocarcinomas via similar mechanisms. The optimal approach for management of duodenal adenomas remains to be determined. The techniques for endoscopic resection of duodenal adenoma include snare polypectomy, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and argon plasma coagulation ablation. EMR may facilitate removal of large duodenal polyps. Although several studies have reported cases of successful ESD for duodenal adenomas, the procedure is technically difficult to perform safely because of the anatomical properties of the duodenum. Although current clinical practice recommends endoscopic resection of all large duodenal adenomas in patients with FAP, endoscopic treatment is usually insufficient to guarantee a polyp-free duodenum. Surgery is indicated for FAP patients with severe polyposis or nonampullary SDAs or FAP-related polyps not amenable to endoscopic resection. Further studies are needed to develop newer endoscopic techniques to guide diagnostic and therapeutic decisions for future management of nonampullary duodenal adenomas.
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Abstract
There is strong evidence that modifiable lifestyle factors such as obesity play a key role in colorectal carcinogenesis. Epidemiologic data have consistently reported a positive association between obesity and colorectal cancer. The relative risk associated with general obesity (as assessed by BMI) is higher in men than in women and for cancer of the colon than for cancer of the rectum. Abdominal obesity (as assessed by waist circumference (WC) or waist-to-hip ratio) is associated with an increased risk of colorectal cancer in both sexes, with stronger associations for cancer of the colon than for cancer of the rectum. Plausible biological mechanisms include insulin resistance, hyperinsulinemia, chronic inflammation, altered levels of growth factors, adipocytokines and steroid hormones. In addition to its effect on colorectal cancer incidence, obesity may play a role in colorectal cancer recurrence, treatment outcomes and survival. Understanding the effects of childhood and adolescent obesity and weight change over the life course in relation to future risk of colorectal cancer is incomplete but essential for targeted preventive recommendations. This chapter summarizes the current evidence on the relationship between obesity and colorectal cancer and colorectal adenoma, a common precursor lesion.
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Affiliation(s)
- Carmen Jochem
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
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Wallace K, Brandt HM, Bearden JD, Blankenship BF, Caldwell R, Dunn J, Hegedus P, Hoffman BJ, Marsh CH, Marsh WH, Melvin CL, Seabrook ME, Sterba RE, Stinson ML, Thibault A, Berger FG, Alberg AJ. Race and Prevalence of Large Bowel Polyps Among the Low-Income and Uninsured in South Carolina. Dig Dis Sci 2016; 61:265-72. [PMID: 26386856 PMCID: PMC5125220 DOI: 10.1007/s10620-015-3862-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/28/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Compared to whites, blacks have higher colorectal cancer incidence and mortality rates and are at greater risk for early-onset disease. The reasons for this racial disparity are poorly understood, but one contributing factor could be differences in access to high-quality screening and medical care. AIMS The present study was carried out to assess whether a racial difference in prevalence of large bowel polyps persists within a poor and uninsured population (n = 233, 124 blacks, 91 whites, 18 other) undergoing screening colonoscopy. METHODS Eligible patients were uninsured, asymptomatic, had no personal history of colorectal neoplasia, and were between the ages 45-64 years (blacks) or 50-64 years (whites, other). We examined the prevalence of any adenoma (conventional, serrated) and then difference in adenoma/polyp type by race and age categories. RESULTS Prevalence for ≥1 adenoma was 37 % (95 % CI 31-43 %) for all races combined and 36 % in blacks <50 years, 38 % in blacks ≥50 years, and 35 % in whites. When stratified by race, blacks had a higher prevalence of large conventional proximal neoplasia (8 %) compared to whites (2 %) (p value = 0.06) but a lower prevalence of any serrated-like (blacks 18 %, whites 32 %; p value = 0.02) and sessile serrated adenomas/polyps (blacks 2 %, whites 8 % Chi-square p value; p = 0.05). CONCLUSIONS Within this uninsured population, the overall prevalence of adenomas was high and nearly equal by race, but the racial differences observed between serrated and conventional polyp types emphasize the importance of taking polyp type into account in future research on this topic.
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Affiliation(s)
- Kristin Wallace
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
- Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA.
| | - Heather M Brandt
- Center for Colon Cancer Research, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - James D Bearden
- Gibbs Cancer Center and Research Institute, Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | - Bridgette F Blankenship
- Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA
| | - Renay Caldwell
- Center for Colon Cancer Research, University of South Carolina, Columbia, SC, USA
| | - James Dunn
- Gibbs Cancer Center and Research Institute, Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | - Patricia Hegedus
- Gibbs Cancer Center and Research Institute, Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | - Brenda J Hoffman
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
- Department of Gastroenterology, Center for Digestive Disease, MUSC, Charleston, SC, USA
| | - Courtney H Marsh
- Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA
| | - William H Marsh
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Cathy L Melvin
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA
| | - March E Seabrook
- Center for Colon Cancer Research, University of South Carolina, Columbia, SC, USA
| | - Ronald E Sterba
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Mary Lou Stinson
- Center for Colon Cancer Research, University of South Carolina, Columbia, SC, USA
| | - Annie Thibault
- Center for Colon Cancer Research, University of South Carolina, Columbia, SC, USA
| | - Franklin G Berger
- Center for Colon Cancer Research, University of South Carolina, Columbia, SC, USA
| | - Anthony J Alberg
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA
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Abstract
Colorectal carcinoma (CRC), as the third most common new cancer diagnosis, poses a significant health risk to the population. Interval CRCs are those that appear after a negative screening test or examination. The development of interval CRCs has been shown to be multifactorial: location of exam-academic institution versus community hospital, experience of the endoscopist, quality of the procedure, age of the patient, flat versus polypoid neoplasia, genetics, hereditary gastrointestinal neoplasia, and most significantly missed or incompletely excised lesions. The rate of interval CRCs has decreased in the last decade, which has been ascribed to an increased understanding of interval disease and technological advances in the screening of high risk individuals. In this article, we aim to review the literature with regard to the multifactorial nature of interval CRCs and provide the most recent developments regarding this important gastrointestinal entity.
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Sokolova EA, Boyarskikh UA, Shirshova AN, Kel AE, Filipenko ML. [THE BIOMARKERS FOR TIMELY DIAGNOSTICS OF COLORECTAL CANCER]. Klin Lab Diagn 2015; 60:15-23. [PMID: 27032247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The colorectal cancer (CC) is one of the most widespread type of cancer all over the world. It is confirmed that the screening procedures intended for timely detection of CC and adenomatous polyps, significantly decrease mortality. The colonoscopy and analysis offeces for occult blood are widely applied as screening procedures. However, they have a number of shortcomings. The studies of the last decade revealed number of genetic and epigenetic markers potentially permitting revealing patients with CC at early stages of development of disease. The article analyzes CC-specific microRNA and their possible interactions with different transcriptional factors. These factors, being integrated into the structure of so called network s with direct signal propagation, ensure special stability of all regulatory system. The derangement of functioning of these networks quite often results in pathological alterations.
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Yamamoto M, Fukuoka H, Iguchi G, Matsumoto R, Takahashi M, Nishizawa H, Suda K, Bando H, Takahashi Y. The prevalence and associated factors of colorectal neoplasms in acromegaly: a single center based study. Pituitary 2015; 18:343-51. [PMID: 24947684 DOI: 10.1007/s11102-014-0580-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Colorectal neoplasms are well known to be a complication in cases of acromegaly; however, data on the prevalence of colorectal neoplasms in Asian patients with acromegaly are limited. Further, the factors associated with colorectal neoplasms in cases of acromegaly are controversial. Therefore, we aimed to clarify the prevalence of and factors associated with colorectal neoplasms in Japanese patients with acromegaly in a single center. METHODS We analyzed consecutive 57 patients who had undergone full-length colonoscopy at the time of diagnosis at Kobe University Hospital between 1986 and 2012. RESULTS Of the 57 patients, 22 (38.6%), 18 (31.6%) and 3 (5.3%) patients were diagnosed with hyperplastic polyps, adenomas, and adenocarcinomas, respectively and the prevalence was significantly higher than in a historical control group, Chinese patients with irritable bowel syndrome (The odds ratio was 4.0, 8.7, and 17.5, respectively). The prevalence of adenocarcinomas was also significantly higher in these patients than in the general Japanese population (odds ratio 14.5). Patients with acromegaly who had colorectal neoplasms had longer disease duration than those without colorectal neoplasms. Of note, the area under the growth hormone (GH) concentration-time curve (GH AUC) during the oral glucose tolerance test was significantly higher in patients with adenocarcinomas than in those with no colonic lesion or those with hyperplastic polyps. CONCLUSION Japanese patients with acromegaly exhibited an increased risk of colorectal neoplasms, especially colorectal adenocarcinomas. An increased GH AUC was associated with an increased risk for colon adenocarcinomas in patients with acromegaly.
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Affiliation(s)
- Masaaki Yamamoto
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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Ciarloni L, Hosseinian S, Monnier-Benoit S, Imaizumi N, Dorta G, Ruegg C. Discovery of a 29-gene panel in peripheral blood mononuclear cells for the detection of colorectal cancer and adenomas using high throughput real-time PCR. PLoS One 2015; 10:e0123904. [PMID: 25876024 PMCID: PMC4395254 DOI: 10.1371/journal.pone.0123904] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/27/2015] [Indexed: 12/15/2022] Open
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer-related death in developed countries. Early detection of CRC leads to decreased CRC mortality. A blood-based CRC screening test is highly desirable due to limited invasiveness and high acceptance rate among patients compared to currently used fecal occult blood testing and colonoscopy. Here we describe the discovery and validation of a 29-gene panel in peripheral blood mononuclear cells (PBMC) for the detection of CRC and adenomatous polyps (AP). Blood samples were prospectively collected from a multicenter, case-control clinical study. First, we profiled 93 samples with 667 candidate and 3 reference genes by high throughput real-time PCR (OpenArray system). After analysis, 160 genes were retained and tested again on 51 additional samples. Low expressed and unstable genes were discarded resulting in a final dataset of 144 samples profiled with 140 genes. To define which genes, alone or in combinations had the highest potential to discriminate AP and/or CRC from controls, data were analyzed by a combination of univariate and multivariate methods. A list of 29 potentially discriminant genes was compiled and evaluated for its predictive accuracy by penalized logistic regression and bootstrap. This method discriminated AP >1cm and CRC from controls with a sensitivity of 59% and 75%, respectively, with 91% specificity. The behavior of the 29-gene panel was validated with a LightCycler 480 real-time PCR platform, commonly adopted by clinical laboratories. In this work we identified a 29-gene panel expressed in PBMC that can be used for developing a novel minimally-invasive test for accurate detection of AP and CRC using a standard real-time PCR platform.
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Affiliation(s)
- Laura Ciarloni
- Diagnoplex SA, Epalinges, Switzerland
- Novigenix SA, Epalinges, Switzerland
| | - Sahar Hosseinian
- Diagnoplex SA, Epalinges, Switzerland
- Novigenix SA, Epalinges, Switzerland
| | | | - Natsuko Imaizumi
- Diagnoplex SA, Epalinges, Switzerland
- National Center for Competence in Research (NCCR), Molecular Oncology, Swiss Institute for Experimental Cancer Research (ISREC)-Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Gian Dorta
- Department of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Curzio Ruegg
- Novigenix SA, Epalinges, Switzerland
- National Center for Competence in Research (NCCR), Molecular Oncology, Swiss Institute for Experimental Cancer Research (ISREC)-Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Department of Medicine, Faculty of Science, University of Fribourg, Fribourg, Switzerland
- * E-mail:
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Klare P, Ascher S, Wagenpfeil S, Rapp D, Bajbouj M, Neu B, Schmid RM, von Delius S. Trainee colonoscopists fulfil quality standards for the detection of adenomatous polyps. BMC Med Educ 2015; 15:26. [PMID: 25882580 PMCID: PMC4347549 DOI: 10.1186/s12909-015-0312-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 02/18/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND The detection of adenomatous lesions is a major indicator for quality and competence in colonoscopy. Little is known about adenoma detection rates (ADR) of endoscopy trainees. The aim of our study was to investigate the performance of trainee colonoscopists in detecting adenomas and to depict the shape of adenoma detection learning curves during apprenticeship. METHODS We retrospectively investigated a prospectively maintained database of a single tertiary referral center to reveal colonoscopies performed by trainee endoscopists during 2001 and 2013. Colonoscopy reports were chronologically retrieved and separately analyzed for each trainee. Using cumulative curves, courses of trainee's Adenoma detection rates (ADR) during apprenticeship were displayed. Additionally, procedural data including cecal intubation rate and occurrence of complications were assessed. RESULTS We retrospectively analyzed 4354 colonoscopies conducted by 10 trainee endoscopists (TE). A median number of 371 investigations were performed by each apprentice. Group ADR was 23%. No significant difference between aggregated ADRs at the beginning (23%) and at the end (22%) of apprenticeship could be determined (p = 0.70). However, individual learning curves showed considerable different slopes. Personal ADR values ranged between 17% and 31%. Overall cecum intubation rate was 99.0 %. Complication rates were low and fulfilled quality requirements recommended in guidelines. CONCLUSION From the beginning of education, trainee colonoscopists are capable to provide high-quality investigations considering the detection of adenomas as a benchmark quality indicator. Nevertheless, performance differs markedly between investigators. Therefore, individual detection rates should be reviewed regularly to reveal further need for training.
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Affiliation(s)
- Peter Klare
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität, Ismaninger Str. 22, 81675 München, Germany
| | - Stefan Ascher
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität, Ismaninger Str. 22, 81675 München, Germany
| | - Stefan Wagenpfeil
- Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik, Medizinische Fakultät der Universität des Saarlands, Kirrberger Straße 100, 66424 Homburg/Saar, Germany
| | - Daniel Rapp
- Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik, Medizinische Fakultät der Universität des Saarlands, Kirrberger Straße 100, 66424 Homburg/Saar, Germany
| | - Monther Bajbouj
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität, Ismaninger Str. 22, 81675 München, Germany
| | - Bruno Neu
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität, Ismaninger Str. 22, 81675 München, Germany
| | - Roland M Schmid
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität, Ismaninger Str. 22, 81675 München, Germany
| | - Stefan von Delius
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität, Ismaninger Str. 22, 81675 München, Germany
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Tandon K, Imam M, Ismail BES, Castro F. Body mass index and colon cancer screening: The road ahead. World J Gastroenterol 2015; 21:1371-1376. [PMID: 25663756 PMCID: PMC4316079 DOI: 10.3748/wjg.v21.i5.1371] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/06/2014] [Accepted: 01/08/2015] [Indexed: 02/07/2023] Open
Abstract
Screening for colorectal cancer (CRC) has been associated with a decreased incidence and mortality from CRC. However, patient adherence to screening is less than desirable and resources are limited even in developed countries. Better identification of individuals at a higher risk could result in improved screening efforts. Over the past few years, formulas have been developed to predict the likelihood of developing advanced colonic neoplasia in susceptible individuals but have yet to be utilized in mass screening practices. These models use a number of clinical factors that have been associated with colonic neoplasia including the body mass index (BMI). Advances in our understanding of the mechanisms by which obesity contributes to colonic neoplasia as well as clinical studies on this subject have proven the association between BMI and colonic neoplasia. However, there are still controversies on this subject as some studies have arrived at different conclusions on the influence of BMI by gender. Future studies should aim at resolving these discrepancies in order to improve the efficiency of screening strategies.
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Włodarczyk B, Pazurek M, Talar-Wojnarowska R, Małecka-Panas E. [Application of double balloon enteroscopy in diagnosis of small bowel diseases]. Wiad Lek 2015; 68:20-25. [PMID: 26094329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Double balloon enteroscopy (DBE) is one of the newest among endoscopic techniques used in diagnosis of the digestive tract diseases--particularly in small bowel's lesions. MATERIALS AND METHODS The retrospective analysis of patients' data from 2008 to 2012 in the Department of Digestive Tract Diseases, UM was made. Case histories were analised and evaluated for sex, age, clinical symptoms, results of additional examinations and indications. The course of the examination, its result, complications and role in final diagnosis were also checked. RESULTS During the analysed period DBE was attempted 71 times DBE among 42 patients (17 women and 25 men; the age was 44.5 years ± 17.5 years). The most frequent indication for DBE was occult gastrointestinal bleeding--34 patients (80.9%). Among the other patients, the clinical image suggested Crohn's disease (4 cases--9.5%), suspicion of small bowel's neoplasm (2 patients--4.8%), familiar adenomatous polyposis with a need to make polypectomy (1 case--2.4%) and state after bariatric surgery to extract moved gastric balloon (1 patient--2.4%). Small bowel's lesions were detected in 21 patients (50%)--8 polyps, 8--aphthaes and inflammatory changes, 3--vascular lesions, 2--smoothing villi. In four cases the polypectomy was made. The anaesthetic complications appeared with two patients (4,8%). Complications being a result of performed DBE was observed in one case (2.4%). CONCLUSIONS Double balloon enteroscopy is safe endoscopic procedure and it plays a key role in diagnosis of patients with gastrointestinal bleeding.
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Mori Y, Sato N, Matayoshi N, Tamura T, Minagawa N, Shibao K, Higure A, Nakamoto M, Taguchi M, Yamaguchi K. Rare combination of familial adenomatous polyposis and gallbladder polyps. World J Gastroenterol 2014; 20:17661-17665. [PMID: 25516682 PMCID: PMC4265629 DOI: 10.3748/wjg.v20.i46.17661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023] Open
Abstract
Familial adenomatous polyposis is associated with a high incidence of malignancies in the upper gastrointestinal tract (particularly ampullary adenocarcinomas). However, few reports have described a correlation between familial adenomatous polyposis and gallbladder neoplasms. We present a case of a 60-year-old woman with familial adenomatous polyposis who presented with an elevated mass in the neck of the gallbladder (measuring 16 mm × 8 mm in diameter) and multiple small cholecystic polyps. She had undergone a total colectomy for ascending colon cancer associated with familial adenomatous polyposis 22 years previously. The patient underwent laparoscopic cholecystectomy under a preoperative diagnosis of multifocal gallbladder polyps. Pathologic examination of the resected gallbladder revealed more than 70 adenomatous lesions, a feature consistent with adenoma of the gallbladder. This case suggests a requirement for long-term surveillance of the biliary system in addition to the gastrointestinal tract in patients with familial adenomatous polyposis.
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Drew JE, Farquharson AJ, Mayer CD, Vase HF, Coates PJ, Steele RJ, Carey FA. Predictive gene signatures: molecular markers distinguishing colon adenomatous polyp and carcinoma. PLoS One 2014; 9:e113071. [PMID: 25423035 PMCID: PMC4244109 DOI: 10.1371/journal.pone.0113071] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/23/2014] [Indexed: 12/15/2022] Open
Abstract
Cancers exhibit abnormal molecular signatures associated with disease initiation and progression. Molecular signatures could improve cancer screening, detection, drug development and selection of appropriate drug therapies for individual patients. Typically only very small amounts of tissue are available from patients for analysis and biopsy samples exhibit broad heterogeneity that cannot be captured using a single marker. This report details application of an in-house custom designed GenomeLab System multiplex gene expression assay, the hCellMarkerPlex, to assess predictive gene signatures of normal, adenomatous polyp and carcinoma colon tissue using archived tissue bank material. The hCellMarkerPlex incorporates twenty-one gene markers: epithelial (EZR, KRT18, NOX1, SLC9A2), proliferation (PCNA, CCND1, MS4A12), differentiation (B4GANLT2, CDX1, CDX2), apoptotic (CASP3, NOX1, NTN1), fibroblast (FSP1, COL1A1), structural (ACTG2, CNN1, DES), gene transcription (HDAC1), stem cell (LGR5), endothelial (VWF) and mucin production (MUC2). Gene signatures distinguished normal, adenomatous polyp and carcinoma. Individual gene targets significantly contributing to molecular tissue types, classifier genes, were further characterised using real-time PCR, in-situ hybridisation and immunohistochemistry revealing aberrant epithelial expression of MS4A12, LGR5 CDX2, NOX1 and SLC9A2 prior to development of carcinoma. Identified gene signatures identify aberrant epithelial expression of genes prior to cancer development using in-house custom designed gene expression multiplex assays. This approach may be used to assist in objective classification of disease initiation, staging, progression and therapeutic responses using biopsy material.
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Affiliation(s)
- Janice E. Drew
- Metabolic Health, Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, AB21 9SB, Scotland
- * E-mail:
| | - Andrew J. Farquharson
- Metabolic Health, Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, AB21 9SB, Scotland
| | - Claus Dieter Mayer
- Biomathematics and Statistics Scotland, University of Aberdeen, Aberdeen, AB21 9SB, Scotland
| | - Hollie F. Vase
- Metabolic Health, Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, AB21 9SB, Scotland
| | - Philip J. Coates
- Ninewells Hospital and Medical School, Dundee, DD1 9SU, Scotland
| | - Robert J. Steele
- Ninewells Hospital and Medical School, Dundee, DD1 9SU, Scotland
| | - Francis A. Carey
- Ninewells Hospital and Medical School, Dundee, DD1 9SU, Scotland
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Mori H, Kobara H, Tsushimi T, Fujihara S, Nishiyama N, Matsunaga T, Ayaki M, Yachida T, Masaki T. Two rare gastric hamartomatous inverted polyp cases suggest the pathogenesis of growth. World J Gastroenterol 2014; 20:5918-5923. [PMID: 24914354 PMCID: PMC4024803 DOI: 10.3748/wjg.v20.i19.5918] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 12/27/2013] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
Gastric hamartomatous inverted polyps (GHIP) are difficult to diagnose accurately because of inversion into the submucosal layer. GHIP are diagnosed using the pathological characteristics of the tumor, including the fibroblast cells, smooth muscle, nerve components, glandular hyperplasia, and cystic gland dilatation. Although Peutz-Jeghers syndrome, juvenile polyposis, and Cowden disease are hereditary, it is rare to encounter 2 cases of monostotic and asymptomatic gastric hamartomas. The pathogeneses of hamartomatous inverted polyps and inverted hyperplastic polyps remain controversial because of the paucity of reported cases. There are 3 hypotheses regarding the pathogenesis of complete gastric inverted polyps. Based on our experience with 2 successive, rare GHIP cases, we affirm the hypothesis that after a hamartomatous change occurs in the submucosal layer, some of these components are exposed to the gastric mucosa and, consequently, form a hypertrophic lesion. In Case 1, our hypothesis explains why a tiny hypertrophic change was first detected on the top of the submucosal tumor using a detailed narrow band imaging-magnified endoscopy. There was no confirmation that the milky white mucous and calcification structures were exuding directly from the biopsy site like Case 1, and in Case 2 the presence of this mucous was indirectly confirmed during an endoscopic submucosal dissection (ESD). Regarding the pathogenesis of GHIP, a submucosal hamartomatous change may occur prior to the growth of hypertrophic portions. An en bloc resection using ESD is recommended for treatment.
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Saito M, Miyazaki M, Tanino M, Tanaka S, Miyashita K, Izumiyama K, Mori A, Irie T, Tanaka M, Morioka M, Tsukamoto E. 18F-FDG PET/CT imaging for a gastrointestinal mantle cell lymphoma with multiple lymphomatous polyposis. World J Gastroenterol 2014; 20:5141-5146. [PMID: 24803832 PMCID: PMC4009554 DOI: 10.3748/wjg.v20.i17.5141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 01/10/2014] [Accepted: 03/10/2014] [Indexed: 02/06/2023] Open
Abstract
Multiple lymphomatous polyposis (MLP) is an uncommon type of gastrointestinal lymphoma characterized by the presence of multiple polyps along the gastrointestinal tract. Most of this entity is in fact considered the counterpart of gastrointestinal tract involvement for mantle cell lymphoma (MCL). To our knowledge, there have been no reports on [fluorine-18]-fluorodeoxy-glucose (18F-FDG)-positron emission tomography (PET)/computed tomography (CT) imaging for gastrointestinal MCL with MLP. We present the results of 18F-FDG PET/CT imaging in a patient with gastrointestinal tract involvement of MCL showing continuous MLP from the stomach to the rectum and intestinal intussusception. FDG-PET/CT findings were false negative in typical MLP spreading widely over the gastrointestinal tract, but uptake was noted in large lesions with deep infiltration considered atypical as MLP. On FDG-PET/CT imaging, the Ki-67 proliferative index, which is a cell proliferation marker, showed neither correlation with the presence of uptake nor the maximum standardized uptake value.
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