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Genua F, Butt J, Ganesan H, Waterboer T, Hughes DJ. Association of Antibody Responses to Helicobacter pylori Proteins with Colorectal Adenoma and Colorectal Cancer. Pathogens 2024; 13:897. [PMID: 39452767 PMCID: PMC11510280 DOI: 10.3390/pathogens13100897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 09/30/2024] [Accepted: 10/08/2024] [Indexed: 10/26/2024] Open
Abstract
Helicobacter pylori (H. pylori) has been implicated in colorectal carcinogenesis. Here, the association of immune responses to bacterial exposure with advancing stages of colorectal neoplasia was assessed by multiplex serology. Immunoglobulin (Ig) A and G antibody responses to thirteen proteins of H. pylori were measured by a Luminex-based multiplex assay in plasma from patients with colorectal cancer (CRC, n = 25), advanced adenoma (n = 82), or small polyps (n = 85) and controls (n = 100). Multivariable logistic regression was used to assess the association of bacterial seropositivity with colorectal neoplasia. The threshold for overall seropositivity required subjects to be positive for at least 4 out of the 13 tested antigens. In a cohort subset with matched data (n = 34), H. pylori seropositivity was correlated with bacterial abundance in both neoplastic and matched normal tissue. While no association was found between H. pylori seropositivity and the presence of CRC, IgA seropositivity to CagA was associated with a decreased risk of advanced adenoma (odds ratio, OR = 0.48, 95% confidence intervals, CIs: 0.24-0.96). Regarding IgG, higher antibody responses to HpaA was associated with advanced adenoma occurrence (OR = 2.46, 95% CI: 1.00-6.01), while responses to HP0395, CagA and Catalase were associated with polyp development (OR = 2.65, 95%, CI: 1.31-5.36, OR = 1.83, 95% CI: 1.01-3.32, and OR = 2.16, CI: 1.09-4.29, respectively). Positive correlations were found between H. pylori abundance in the normal mucosa and levels of both the IgA and IgG antibody response to Catalase and VacA antigens (r = 0.48, p < 0.01; r = 0.37, p = 0.04; r = 0.51, p < 0.01; and r = 0.71, p = 0.04, respectively). Conversely, H. pylori abundance was negatively correlated with levels of IgA antibody response to HpaA and with IgG antibody response to HP0231 in the diseased tissue (r = -0.34, p = 0.04 and r = -0.41, p = 0.01, respectively). The association between levels of H. pylori antigens and colorectal neoplasia risk gradually decreased with the adenoma progression, implicating the early activation of the immune response at the polyp stage. Thus, the evaluation of antibody response to certain bacterial antigens may indicate the presence of early-stage colorectal neoplasia. Further studies are needed to clarify the role H. pylori or the immune response to its antigens may have in colorectal carcinogenesis stages.
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Affiliation(s)
- Flavia Genua
- Molecular Epidemiology of Cancer Group, School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, D04 V1W8 Dublin, Ireland; (F.G.); (H.G.)
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, D02 VN51 Dublin, Ireland
| | - Julia Butt
- Infections and Cancer Epidemiology, German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ), 69120 Heidelberg, Germany; (J.B.); (T.W.)
| | - Harsha Ganesan
- Molecular Epidemiology of Cancer Group, School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, D04 V1W8 Dublin, Ireland; (F.G.); (H.G.)
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ), 69120 Heidelberg, Germany; (J.B.); (T.W.)
| | - David J. Hughes
- Molecular Epidemiology of Cancer Group, School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, D04 V1W8 Dublin, Ireland; (F.G.); (H.G.)
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Huang J, Leung EYM, Chun SCC, Li Z, Liu X, Zhong CY, Lin JL, Hang JJ, Zhong CCW, Yuan JQ, Wong MCS. Development of a risk scoring system for predicting advanced colorectal neoplasia within subcentimetric polyps: A population-based study. J Dig Dis 2024; 25:436-443. [PMID: 39081006 DOI: 10.1111/1751-2980.13303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/24/2024] [Accepted: 07/02/2024] [Indexed: 09/26/2024]
Abstract
OBJECTIVE To determine a risk scoring system for predicting advanced colorectal neoplasia (ACN) within subcentimetric polyps in a large Asian population. METHODS A retrospective study was conducted in Hong Kong SAR, China involving participants who underwent colonoscopy between 2008 and 2015. A random sample of 20 072 subjects were included as the derivation cohort to assess ACN-associated independent factors using logistic regression modeling. Another 8603 subjects formed a validation cohort. A risk scoring system was developed and its performance was assessed using the area under the receiver operating characteristic curve (AUROC). RESULTS The risk scores were assigned based on the following criteria: (a) patients who were admitted from inpatient colonoscopy (2.2) or not (1); (b) with three or more chronic diseases (hypertension, diabetes mellitus, hyperlipidemia, heart disease, or cancer) (1.7) or not (1); (c) anemia (1.3) or without anemia (1); (d) receiving aspirin (0.5) or not (1); (e) receiving other nonsteroidal anti-inflammatory drugs (0.3) or not (1); (f) male (1.2) or female gender (1); (g) age <55 (1), 55-64 (1.4), 65-69 (2), 70 years or above (2.2). ACN was more common in those with scores of 2.192 or higher, and they were classified as high risk (HR). The prevalence of ACN in the validation cohort was 13.28% and 3.56% in the HR and low-risk groups, respectively. In both the derivation and validation cohorts, AUROC of the risk-scoring model was 0.7138. CONCLUSION Physicians are recommended to utilize this validated score for risk-stratification of patients having subcentimetric polyps.
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Affiliation(s)
- Junjie Huang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eman Y M Leung
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sam C C Chun
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zhaojun Li
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xianjing Liu
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Chao Ying Zhong
- Department of Electrical Engineering and Automation, Guangdong Ocean University, Zhanjiang, Guangdong Province, China
| | - Jian Li Lin
- Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Jun Jie Hang
- Department of Oncology, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Claire C W Zhong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jin Qiu Yuan
- Clinical Research Center, Big Data Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Martin C S Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- School of Public Health, Peking University, Beijing, China
- School of Public Health, The Chinese Academy of Medical Sciences and The Peking Union Medical Colleges, Beijing, China
- School of Public Health, Fudan University, Shanghai, China
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Yee J, Dachman A, Kim DH, Kobi M, Laghi A, McFarland E, Moreno C, Park SH, Pickhardt PJ, Plumb A, Pooler BD, Zalis M, Chang KJ. CT Colonography Reporting and Data System (C-RADS): Version 2023 Update. Radiology 2024; 310:e232007. [PMID: 38289209 DOI: 10.1148/radiol.232007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
The CT Colonography Reporting and Data System (C-RADS) has withstood the test of time and proven to be a robust classification scheme for CT colonography (CTC) findings. C-RADS version 2023 represents an update on the scheme used for colorectal and extracolonic findings at CTC. The update provides useful insights gained since the implementation of the original system in 2005. Increased experience has demonstrated confusion on how to classify the mass-like appearance of the colon consisting of soft tissue attenuation that occurs in segments with acute or chronic diverticulitis. Therefore, the update introduces a new subcategory, C2b, specifically for mass-like diverticular strictures, which are likely benign. Additionally, the update simplifies extracolonic classification by combining E1 and E2 categories into an updated extracolonic category of E1/E2 since, irrespective of whether a finding is considered a normal variant (category E1) or an otherwise clinically unimportant finding (category E2), no additional follow-up is required. This simplifies and streamlines the classification into one category, which results in the same management recommendation.
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Affiliation(s)
- Judy Yee
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Abraham Dachman
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - David H. Kim
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Mariya Kobi
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Andrea Laghi
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Elizabeth McFarland
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Courtney Moreno
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Seong Ho Park
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Perry J. Pickhardt
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Andrew Plumb
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - B Dustin Pooler
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Michael Zalis
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Kevin J Chang
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
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Genua F, Butt J, Waterboer T, Hughes DJ. Association of Antibody Responses to Fusobacterium nucleatum and Streptococcus gallolyticus Proteins with Colorectal Adenoma and Colorectal Cancer. Dig Dis Sci 2023:10.1007/s10620-023-08001-4. [PMID: 37338617 PMCID: PMC10352388 DOI: 10.1007/s10620-023-08001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Streptococcus gallolyticus subspecies gallolyticus (SGG) and Fusobacterium (F.) nucleatum have been implicated in colorectal carcinogenesis. Here, the association of immune responses to bacterial exposure with advancing stages of colorectal neoplasia was assessed by multiplex serology. METHODS Immunoglobulin (Ig) A and G antibody responses to eleven proteins each of F. nucleatum and SGG were measured in plasma of controls (n = 100) and patients with colorectal cancer (CRC, n = 25), advanced adenoma (n = 82), or small polyps (n = 85). Multivariable logistic regression was used to evaluate the association of bacterial sero-positivity with colorectal neoplasia. In a cohort subset with matched data (n = 45), F. nucleatum sero-positivity was correlated with bacterial abundance in both neoplastic and matched normal tissue. RESULTS IgG sero-positivity to Fn1426 of F. nucleatum was associated with an increased CRC risk (OR = 4.84; 95% CI 1.46-16.0), while IgA sero-positivity to any SGG protein or specifically Gallo0272 and Gallo1675 alone was associated with increased advanced adenoma occurrence (OR = 2.02, 95% CI 1.10-3.71; OR = 2.67, 95% CI 1.10-6.46; and OR = 6.17, 95% CI 1.61-23.5, respectively). Only F. nucleatum abundance in the normal mucosa positively correlated with the IgA response to the Fn1426 antigen (Correlation coefficient (r) = 0.38, p < 0.01). CONCLUSION Antibody responses to SGG and F. nucleatum were associated with occurrence of colorectal adenomas and CRC, respectively. Further studies are needed to clarify the role these microbes or the immune response to their antigens may have in colorectal carcinogenesis stages.
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Affiliation(s)
- Flavia Genua
- Cancer Biology and Therapeutics Laboratory, UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Julia Butt
- Infections and Cancer Epidemiology, German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ), 69120, Heidelberg, Germany
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ), 69120, Heidelberg, Germany
| | - David J Hughes
- Cancer Biology and Therapeutics Laboratory, UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, D04 V1W8, Ireland.
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Ding J, Ali M, Zhao F, Wang D. Laparoscopic resection of right hemicolectomy, and rectal tumour for loose bowel stool: A case report. Asian J Surg 2022:S1015-9584(22)01732-8. [PMID: 36550011 DOI: 10.1016/j.asjsur.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jianyue Ding
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China; General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China; Medical College of Yangzhou University, Yangzhou, 225001, China
| | - Muhammad Ali
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China; General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China; Medical College of Yangzhou University, Yangzhou, 225001, China
| | - Fanyu Zhao
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China; General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China; Medical College of Yangzhou University, Yangzhou, 225001, China
| | - Daorong Wang
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China; General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China; Medical College of Yangzhou University, Yangzhou, 225001, China.
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Lincoln A, Benton S, Piggott C, North BV, Rigney J, Young C, Quirke P, Sasieni P, Monahan KJ. Exploring the utility and acceptability of Faecal immunochemical testing (FIT) as a novel intervention for the improvement of colorectal Cancer (CRC) surveillance in individuals with lynch syndrome (FIT for lynch study): a single-arm, prospective, multi-centre, non-randomised study. BMC Cancer 2022; 22:1144. [PMID: 36344941 PMCID: PMC9639321 DOI: 10.1186/s12885-022-10217-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/22/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Lynch Syndrome (LS) is an inherited cancer predisposition syndrome defined by pathogenic variants in the mismatch repair (MMR) or EPCAM genes. In the United Kingdom, people with LS are advised to undergo biennial colonoscopy from as early as 25 until 75 years of age to mitigate a high lifetime colorectal cancer (CRC) risk, though the consideration of additional surveillance intervention(s) through the application of non-invasive diagnostic devices has yet to be longitudinally observed in LS patients. In this study, we will examine the role of annual faecal immunochemical testing (FIT) alongside biennial colonoscopy for CRC surveillance in people with LS. METHODS/DESIGN In this single-arm, prospective, non-randomised study, 400 LS patients will be recruited across 11 National Health Service (NHS) Trusts throughout the United Kingdom. Study inclusion requires a LS diagnosis, between 25 and 73 years old, and a routine surveillance colonoscopy scheduled during the recruitment period. Eligible patients will receive a baseline OC-Sensor™ FIT kit ahead of their colonoscopy, and annually for 3 years thereafter. A pre-paid envelope addressed to the central lab will be included within all patient mailings for the return of FIT kits and relevant study documents. A questionnaire assessing attitudes and perception of FIT will also be included at baseline. All study samples received by the central lab will be assayed on an OC-Sensor™ PLEDIA Analyser. Patients with FIT results of ≥6 μg of Haemoglobin per gram of faeces (f-Hb) at Years 1 and/or 3 will be referred for colonoscopy via an urgent colonoscopy triage pathway. 16S rRNA gene V4 amplicon sequencing will be carried out on residual faecal DNA of eligible archived FIT samples to characterise the faecal microbiome. DISCUSSION FIT may have clinical utility alongside colonoscopic surveillance in people with LS. We have designed a longitudinal study to examine the efficacy of FIT as a non-invasive modality. Potential limitations of this method will be assessed, including false negative or false positive FIT results related to specific morphological features of LS neoplasia or the presence of post-resection anastomotic inflammation. The potential for additional colonoscopies in a subset of participants may also impact on colonoscopic resources and patient acceptability. TRIAL REGISTRATION Trial Registration: ISRCTN, ISRCTN15740250 . Registered 13 July 2021.
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Affiliation(s)
- Anne Lincoln
- Comprehensive Cancer Centre, King's College London, London, UK
| | - Sally Benton
- NHS Bowel Cancer Screening South of England Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Carolyn Piggott
- NHS Bowel Cancer Screening South of England Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Bernard V North
- Comprehensive Cancer Centre, King's College London, London, UK
| | - Jane Rigney
- Comprehensive Cancer Centre, King's College London, London, UK
| | - Caroline Young
- Pathology & Data Analytics, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Philip Quirke
- Pathology & Data Analytics, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Peter Sasieni
- Comprehensive Cancer Centre, King's College London, London, UK
| | - Kevin J Monahan
- The Lynch Syndrome and Family Cancer Clinic, St Mark's Hospital and Academic Institute, Harrow, UK.
- Imperial College London, London, UK.
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7
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Vivas-Valencia C, Zhou Y, Sai A, Imperiale TF, Kong N. A two-phase approach to re-calibrating expensive computer simulation for sex-specific colorectal neoplasia development modeling. BMC Med Inform Decis Mak 2022; 22:244. [PMID: 36117168 PMCID: PMC9482725 DOI: 10.1186/s12911-022-01991-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical evidence from more recent observational studies may significantly alter our understanding of disease incidence and progression, and would require recalibration of existing computational and predictive disease models. However, it is often challenging to perform recalibration when there are a large number of model parameters to be estimated. Moreover, comparing the fitting performances of candidate parameter designs can be difficult due to significant variation in simulated outcomes under limited computational budget and long runtime, even for one simulation replication. METHODS We developed a two-phase recalibration procedure. As a proof-of-the-concept study, we verified the procedure in the context of sex-specific colorectal neoplasia development. We considered two individual-based state-transition stochastic simulation models, estimating model parameters that govern colorectal adenoma occurrence and its growth through three preclinical states: non-advanced precancerous polyp, advanced precancerous polyp, and cancerous polyp. For the calibration, we used a weighted-sum-squared error between three prevalence values reported in the literature and the corresponding simulation outcomes. In phase 1 of the calibration procedure, we first extracted the baseline parameter design from relevant studies on the same model. We then performed sampling-based searches within a proper range around the baseline design to identify the initial set of good candidate designs. In phase 2, we performed local search (e.g., the Nelder-Mead algorithm), starting from the candidate designs identified at the end of phase 1. Further, we investigated the efficiency of exploring dimensions of the parameter space sequentially based on our prior knowledge of the system dynamics. RESULTS The efficiency of our two-phase re-calibration procedure was first investigated with CMOST, a relatively inexpensive computational model. It was then further verified with the V/NCS model, which is much more expensive. Overall, our two-phase procedure showed a better goodness-of-fit than the straightforward employment of the Nelder-Mead algorithm, when only a limited number of simulation replications were allowed. In addition, in phase 2, performing local search along parameter space dimensions sequentially was more efficient than performing the search over all dimensions concurrently. CONCLUSION The proposed two-phase re-calibration procedure is efficient at estimating parameters of computationally expensive stochastic dynamic disease models.
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Affiliation(s)
- Carolina Vivas-Valencia
- Weldon School of Biomedical Engineering, Martin C. Jischke Hall of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907-2032 USA
| | - You Zhou
- Weldon School of Biomedical Engineering, Martin C. Jischke Hall of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907-2032 USA
| | | | - Thomas F. Imperiale
- Indiana University School of Medicine, Indiana University, Indianapolis, IN USA
- Richard A. Roudebush VA Medical Center, Indianapolis, IN USA
- Regenstrief Institute, Indianapolis, IN USA
| | - Nan Kong
- Weldon School of Biomedical Engineering, Martin C. Jischke Hall of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907-2032 USA
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8
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Colon Capsule Endoscopy in the Diagnosis of Colon Polyps: Who Needs a Colonoscopy? Diagnostics (Basel) 2022; 12:diagnostics12092093. [PMID: 36140494 PMCID: PMC9498104 DOI: 10.3390/diagnostics12092093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/16/2022] [Accepted: 08/23/2022] [Indexed: 12/09/2022] Open
Abstract
Colon screening programs have reduced colon cancer mortality. Population screening should be minimally invasive, safe, acceptably sensitive, cost-effective, and scalable. The range of screening modalities include guaiac or immunochemical fecal occult blood testing and CT colonography and colonoscopy. A number of carefully controlled studies concur that second-generation capsule endoscopy has excellent sensitivity for polyp detection and a high negative predictive value. Colon capsules fulfill the screening expectation of safety, high sensitivity for polyp detection, and patient acceptance, and appear to straddle the divide between occult blood testing and colonoscopy. While meeting these criteria, there remains the challenges of scaling, capsule practitioner training, resource allocation, and implementing change of practice. Like CT colonography, capsule screening presents the clinician with a decision on the threshold for colonoscopy referral. Overall, colon capsules are an invaluable tool in polyp detection and colon screening and offer a filter that determines “who needs a colonoscopy?”.
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9
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Mukhtar M, Ashfield N, Vodickova L, Vymetalkova V, Levy M, Liska V, Bruha J, Bendova P, O’Sullivan J, Doherty G, Sheahan K, Nolan B, Vodicka P, Hughes DJ. The Associations of Selenoprotein Genetic Variants with the Risks of Colorectal Adenoma and Colorectal Cancer: Case–Control Studies in Irish and Czech Populations. Nutrients 2022; 14:nu14132718. [PMID: 35807897 PMCID: PMC9268344 DOI: 10.3390/nu14132718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/27/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Selenium manifests its biological effects through its incorporation into selenoproteins, which play several roles in countering oxidative and inflammatory responses implicated in colorectal carcinogenesis. Selenoprotein genetic variants may contribute to colorectal cancer (CRC) development, as we previously observed for SNP variants in a large European prospective study and a Czech case–control cohort. Methods: We tested if significantly associated selenoprotein gene SNPs from these studies were also associated with CRC risk in case–control studies from Ireland (colorectal neoplasia, i.e., cancer and adenoma cases: 450, controls: 461) and the Czech Republic (CRC cases: 718, controls: 646). Genotyping of 23 SNPs (20 in the Irish and 13 in the Czechs) was performed by competitive specific allele-specific PCR (KASPar). Multivariable adjusted logistic regression was used to assess the associations with CRC development. Results: We found significant associations with an increased CRC risk for rs5859 (SELENOF) and rs2972994 (SELENOP) in the Irish cohort but only with rs4802034 (SELENOV) in the Czechs. Significant associations were observed for rs5859 (SELENOF), rs4659382 (SELENON), rs2972994 (SELENOP), rs34713741 (SELENOS), and the related Se metabolism gene variant rs2275129 (SEPHS1) with advanced colorectal neoplasia development. However, none of these findings retained significance after multiple testing corrections. Conclusions: Several SNPs previously associated with CRC risk were also associated with CRC or colorectal neoplasia development in either the Irish or Czech cohorts. Selenoprotein gene variation may modify CRC risk across diverse European populations, although the specific variants may differ.
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Affiliation(s)
- Maryam Mukhtar
- Cancer Biology and Therapeutics Group, School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, D04 V1W8 Dublin, Ireland; (M.M.); (N.A.)
| | - Niall Ashfield
- Cancer Biology and Therapeutics Group, School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, D04 V1W8 Dublin, Ireland; (M.M.); (N.A.)
| | - Ludmila Vodickova
- Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic; (L.V.); (V.V.); (P.V.)
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic; (V.L.); (J.B.)
- Institute of Experimental Medicine ASCR, 142 20 Prague, Czech Republic;
| | - Veronika Vymetalkova
- Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic; (L.V.); (V.V.); (P.V.)
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic; (V.L.); (J.B.)
- Institute of Experimental Medicine ASCR, 142 20 Prague, Czech Republic;
| | - Miroslav Levy
- Department of Surgery, First Faculty of Medicine, Charles University and Thomayer Hospital, 121 08 Prague, Czech Republic;
| | - Václav Liska
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic; (V.L.); (J.B.)
| | - Jan Bruha
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic; (V.L.); (J.B.)
- Institute of Experimental Medicine ASCR, 142 20 Prague, Czech Republic;
| | - Petra Bendova
- Institute of Experimental Medicine ASCR, 142 20 Prague, Czech Republic;
| | - Jacintha O’Sullivan
- Trinity Translational Medicine Institute, Department of Surgery, Trinity College Dublin and St. James’s Hospital, D08 NHY1 Dublin, Ireland;
| | - Glen Doherty
- Centre for Colorectal Disease, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland; (G.D.); (K.S.); (B.N.)
| | - Kieran Sheahan
- Centre for Colorectal Disease, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland; (G.D.); (K.S.); (B.N.)
| | - Blathnaid Nolan
- Centre for Colorectal Disease, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland; (G.D.); (K.S.); (B.N.)
| | - Pavel Vodicka
- Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic; (L.V.); (V.V.); (P.V.)
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic; (V.L.); (J.B.)
- Institute of Experimental Medicine ASCR, 142 20 Prague, Czech Republic;
| | - David J. Hughes
- Cancer Biology and Therapeutics Group, School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, D04 V1W8 Dublin, Ireland; (M.M.); (N.A.)
- Correspondence: ; Tel.: +353-1-716-6988
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10
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Wang Y, Boland CR, Goel A, Wodarz D, Komarova NL. Aspirin's effect on kinetic parameters of cells contributes to its role in reducing incidence of advanced colorectal adenomas, shown by a multiscale computational study. eLife 2022; 11:71953. [PMID: 35416770 PMCID: PMC9007589 DOI: 10.7554/elife.71953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Aspirin intake has been shown to lead to significant protection against colorectal cancer, for example with an up to twofold reduction in colorectal adenoma incidence rates at higher doses. The mechanisms contributing to protection are not yet fully understood. While aspirin is an anti-inflammatory drug and can thus influence the tumor microenvironment, in vitro and in vivo experiments have recently shown that aspirin can also have a direct effect on cellular kinetics and fitness. It reduces the rate of tumor cell division and increases the rate of cell death. The question arises whether such changes in cellular fitness are sufficient to significantly contribute to the epidemiologically observed protection. To investigate this, we constructed a class of mathematical models of in vivo evolution of advanced adenomas, parameterized it with available estimates, and calculated population level incidence. Fitting the predictions to age incidence data revealed that only a model that included colonic crypt competition can account for the observed age-incidence curve. This model was then used to predict modified incidence patterns if cellular kinetics were altered as a result of aspirin treatment. We found that changes in cellular fitness that were within the experimentally observed ranges could reduce advanced adenoma incidence by a sufficient amount to account for age incidence data in aspirin-treated patient cohorts. While the mechanisms that contribute to the protective effect of aspirin are likely complex and multi-factorial, our study demonstrates that direct aspirin-induced changes of tumor cell fitness can significantly contribute to epidemiologically observed reduced incidence patterns.
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Affiliation(s)
- Yifan Wang
- Department of Mathematics, University of California Irvine, Irvine, United States
| | - C Richard Boland
- Department of Medicine, University of California San Diego School of Medicine, San Diego, United States
| | - Ajay Goel
- Department of Molecular Diagnostics and Experimental Therapeutics, Beckman Research Institute of City of Hope Comprehensive Cancer Center, Duarte, United States
| | - Dominik Wodarz
- Department of Mathematics, University of California Irvine, Irvine, United States.,Department of Population Health and Disease Prevention, University of California Irvine, Irvine, United States
| | - Natalia L Komarova
- Department of Mathematics, University of California Irvine, Irvine, United States
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11
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Chung KH, Park MJ, Jin EH, Seo JY, Song JH, Yang SY, Kim YS, Yim JY, Lim SH, Kim JS, Chung SJ, Park JK. Risk Factors for High-Risk Adenoma on the First Lifetime Colonoscopy Using Decision Tree Method: A Cross-Sectional Study in 6,047 Asymptomatic Koreans. Front Med (Lausanne) 2021; 8:719768. [PMID: 34631743 PMCID: PMC8494773 DOI: 10.3389/fmed.2021.719768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/23/2021] [Indexed: 01/22/2023] Open
Abstract
Background/Aims: As risk of colorectal neoplasm is varied even in persons with “average-risk,” risk evaluation and tailored screening are needed. This study aimed to evaluate the risk factors of high-risk adenoma (HRA) in healthy individuals and determine the characteristics of advanced neoplasia (AN) among individual polyps. Methods: Asymptomatic adults who underwent the first lifetime screening colonoscopy at the Seoul National University Hospital Healthcare System Gangnam Center (SNUH GC) were recruited from 2004 to 2007 as SNUH GC Cohort and were followed for 10 years. Demographic and clinical characteristics were compared between the subjects with and without AN (≥10 mm in size, villous component, and/or high-grade dysplasia and/or cancer) or HRA (AN and/or 3 or more adenomas). For individual polyps, correlations between clinical or endoscopic features and histologic grades were evaluated using a decision tree method. Results: A total of 6,047 subjects were included and 5,621 polyps were found in 2,604 (43%) subjects. Advanced age, male sex, and current smoking status were statistically significant with regards to AN and HRA. A lower incidence of AN was observed in subjects taking aspirin. In the decision tree model, the location, shape, and size of the polyp, and sex of the subject were key predictors of the pathologic type. A weak but significant association was observed between the prediction of the final tree and the histological grouping (Kendall's tau-c = 0.142, p < 0001). Conclusions: Advanced neoplasia and HRA can be predicted using several individual characteristics and decision tree models.
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Affiliation(s)
- Kwang Hyun Chung
- Division of Gastroenterology, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, South Korea
| | - Min Jung Park
- Department of Internal Medicine, Healthcare System Gangnam Center, Healthcare Research Institute, Seoul National University Hospital, Seoul, South Korea.,Department of Internal Medicine, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates
| | - Eun Hyo Jin
- Department of Internal Medicine, Healthcare System Gangnam Center, Healthcare Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Ji Yeon Seo
- Department of Internal Medicine, Healthcare System Gangnam Center, Healthcare Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Ji Hyun Song
- Department of Internal Medicine, Healthcare System Gangnam Center, Healthcare Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Sun Young Yang
- Department of Internal Medicine, Healthcare System Gangnam Center, Healthcare Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Young Sun Kim
- Department of Internal Medicine, Healthcare System Gangnam Center, Healthcare Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Jeong Yoon Yim
- Department of Internal Medicine, Healthcare System Gangnam Center, Healthcare Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Seon Hee Lim
- Department of Internal Medicine, Healthcare System Gangnam Center, Healthcare Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Joo Sung Kim
- Department of Internal Medicine, Healthcare System Gangnam Center, Healthcare Research Institute, Seoul National University Hospital, Seoul, South Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Su Jin Chung
- Department of Internal Medicine, Healthcare System Gangnam Center, Healthcare Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Joo Kyung Park
- Division of Gastroenterology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
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12
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Liew WS, Tang TB, Lin CH, Lu CK. Automatic colonic polyp detection using integration of modified deep residual convolutional neural network and ensemble learning approaches. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 206:106114. [PMID: 33984661 DOI: 10.1016/j.cmpb.2021.106114] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 04/07/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND AND OBJECTIVE The increased incidence of colorectal cancer (CRC) and its mortality rate have attracted interest in the use of artificial intelligence (AI) based computer-aided diagnosis (CAD) tools to detect polyps at an early stage. Although these CAD tools have thus far achieved a good accuracy level to detect polyps, they still have room to improve further (e.g. sensitivity). Therefore, a new CAD tool is developed in this study to detect colonic polyps accurately. METHODS In this paper, we propose a novel approach to distinguish colonic polyps by integrating several techniques, including a modified deep residual network, principal component analysis and AdaBoost ensemble learning. A powerful deep residual network architecture, ResNet-50, was investigated to reduce the computational time by altering its architecture. To keep the interference to a minimum, median filter, image thresholding, contrast enhancement, and normalisation techniques were exploited on the endoscopic images to train the classification model. Three publicly available datasets, i.e., Kvasir, ETIS-LaribPolypDB, and CVC-ClinicDB, were merged to train the model, which included images with and without polyps. RESULTS The proposed approach trained with a combination of three datasets achieved Matthews Correlation Coefficient (MCC) of 0.9819 with accuracy, sensitivity, precision, and specificity of 99.10%, 98.82%, 99.37%, and 99.38%, respectively. CONCLUSIONS These results show that our method could repeatedly classify endoscopic images automatically and could be used to effectively develop computer-aided diagnostic tools for early CRC detection.
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Affiliation(s)
- Win Sheng Liew
- Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, 32610 Seri Iskandar, Perak, Malaysia
| | - Tong Boon Tang
- Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, 32610 Seri Iskandar, Perak, Malaysia
| | - Cheng-Hung Lin
- Department of Electrical Engineering and Biomedical Engineering Research Center, Yuan Ze University, Jungli 32003, Taiwan
| | - Cheng-Kai Lu
- Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, 32610 Seri Iskandar, Perak, Malaysia.
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13
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PET/CT Integrated With CT Colonography in Preoperative Obstructive Colorectal Cancer by Incomplete Optical Colonoscopy: A Prospective Study. Clin Nucl Med 2020; 45:943-947. [PMID: 32910057 DOI: 10.1097/rlu.0000000000003252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIM The aim of this study was to evaluate if integrating whole-body PET/CT with CT colonography (PET/CTC) improves the preoperative diagnosis of obstructive colorectal cancer (CRC). METHODS We prospectively included 47 consecutive patients (18 women and 29 men; mean age, 71 ± 14 years) suspected of having CRC by optical colonoscopy, which was not completed due to obstructive masses. To perform PET/CTC, a small caliber Foley catheter was inserted to distend the colon with CO2 insufflations. Polyps measuring 10 mm or larger were considered as high risk of malignancy. All findings were histologically confirmed. RESULTS Colorectal cancer was localized in the sigmoid (n = 21), rectum (n = 7), rectosigmoid junction (n = 5), ascending (n = 7), descending (n = 5), and transverse (n = 2) colon. All tumors showed FDG uptake (mean ± SD SUVmax, 20.02 ± 9.9) including one synchronic tumor (SUVmax, 10.46). Forty-seven polyps were histologically confirmed as smaller than 10 mm (n = 35) and 10 mm or larger (n = 12). All 12 polyps 10 mm or larger showed FDG uptake (SUVmax range, 3.08-19.5), but only one smaller than 10 mm could be identified by PET. Pathological lymph nodes were diagnosed in 17/47 cases after surgical removal with a sensitivity and specificity for CTC and PET/CTC of 71% and 97% and 59% and 100%, respectively. Liver metastases were confirmed in 9 patients and in 4/9 along with lung metastases (n = 2) or implants (n = 2), showing a sensitivity and specificity for CTC of 89% and 100% and both 100% for PET/CTC. CONCLUSIONS PET/CTC is a reliable technique for staging CRC and diagnosing synchronous tumors. In this series, PET/CTC was not able to identify small polyps but showed potential use for ruling out 10 mm or larger polyps at high risk of malignancy.
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14
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Miller J, Shukla S, Baigorri B, Tejero H. CT diagnosis of appendiceal intussusception in a middle-aged female. J Radiol Case Rep 2020; 14:8-14. [PMID: 33088412 DOI: 10.3941/jrcr.v14i6.3809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Appendiceal intussusception is rare with an estimated incidence of 0.01%. Although it is infrequently encountered, the few documented cases of this entity have shown it may mimic or indicate an underlying neoplasm when evaluated with colonoscopy. With the abundant use of multi-detector CT and increased utility of CT colonography, awareness of the radiologic findings of this condition has become increasingly important. Appendiceal intussusception, while potentially pathologic in its own right, may mimic or even coexist with other pathologies, both malignant and benign. We present a case of adult appendiceal intussusception without a "lead point" that was successfully diagnosed by CT imaging.
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Affiliation(s)
- Jacob Miller
- Department of Radiology, Aventura Hospital and Medical Center, Aventura, Fl, USA
| | - Savya Shukla
- Department of Radiology, Aventura Hospital and Medical Center, Aventura, Fl, USA
| | - Brian Baigorri
- Department of Radiology, Aventura Hospital and Medical Center, Aventura, Fl, USA
| | - Hilda Tejero
- Department of Radiology, Aventura Hospital and Medical Center, Aventura, Fl, USA
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15
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Tepus M, Yau TO. Non-Invasive Colorectal Cancer Screening: An Overview. Gastrointest Tumors 2020; 7:62-73. [PMID: 32903904 PMCID: PMC7445682 DOI: 10.1159/000507701] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) follows a protracted stepwise progression, from benign adenomas to malignant adenocarcinomas. If detected early, 90% of deaths are preventable. However, CRC is asymptomatic in its early-stage and arises sporadically within the population. Therefore, CRC screening is a public health priority. SUMMARY Faecal immunochemical test (FIT) is gradually replacing guaiac faecal occult blood test and is now the most commonly used screening tool for CRC screening program globally. However, FIT is still limited by the haemoglobin degradation and the intermittent bleeding patterns, so that one in four CRC cases are still diagnosed in a late stage, leading to poor prognosis. A multi-target stool DNA test (Cologuard, a combination of NDRG4 and BMP3 DNA methylation, KRAS mutations, and haemoglobin) and a plasma SEPT9 DNA methylation test (Epi proColon) are non-invasive tools also approved by the US FDA, but those screening approaches are not cost-effective, and the detection accuracies remain unsatisfactory. In addition to the approved tests, faecal-/blood-based microRNA and CRC-related gut microbiome screening markers are under development, with work ongoing to find the best combination of molecular biomarkers which maximise the screening sensitivity and specificity. KEY MESSAGE Maximising the detection accuracy with a cost-effective approach for non-invasive CRC screening is urgently needed to further reduce the incidence of CRC and associated mortality rates.
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Affiliation(s)
| | - Tung On Yau
- John van Geest Cancer Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
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Sacks J, Atlas S, Enno A, Santos L, Humphries J, Kirwan A. Giant villous adenoma of the sigmoid colon: an unusual cause of homogeneous, segmental bowel wall thickening. BJR Case Rep 2020; 6:20200016. [PMID: 33299583 PMCID: PMC7709061 DOI: 10.1259/bjrcr.20200016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 12/04/2022] Open
Abstract
Colonic adenomas are commonly encountered lesions that are a precursor of colorectal cancer. Of these, villous adenomas are a rarer, more advanced subtype that are larger in size than tubular adenomas and have a higher risk of malignant transformation. We present a patient with a giant villous adenoma of the sigmoid colon identified on CT as homogeneous segmental bowel wall thickening.
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Affiliation(s)
| | | | - Alar Enno
- Department of Pathology, Liverpool Hospital, Sydney, NSW, Australia
| | - Leonardo Santos
- Department of Pathology, Liverpool Hospital, Sydney, NSW, Australia
| | - Jeremy Humphries
- Department of Gastroenterology, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia
| | - Alexander Kirwan
- Department of Radiology, Westmead Hospital, Sydney, NSW, Australia
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GPs' perspectives on colorectal cancer screening and their potential influence on FIT-positive patients: an exploratory qualitative study from a Dutch context. BJGP Open 2019; 3:bjgpopen18X101631. [PMID: 31049411 PMCID: PMC6480863 DOI: 10.3399/bjgpopen18x101631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 01/27/2023] Open
Abstract
Background In the Dutch colorectal cancer (CRC) screening programme, individuals receive a faecal immunochemical test (FIT) to do at home. After a positive FIT result, a follow-up colonoscopy is recommended to identify CRC or advanced adenomas (AA). GPs may influence their patients’ decisions on adherence to follow-up by colonoscopy. Aim To explore GPs’ perspectives on the CRC screening programme and their potential influence on FIT-positive patients to follow up with the recommended colonoscopy. Design & setting Semi-structured interviews among GPs in Amsterdam, the Netherlands. Method GPs were approached using purposive sampling. Analysis was performed on 11 interviews using open coding and constant comparison. Results All interviewed GPs would recommend FIT-positive patients without obvious contraindications to adhere to a follow-up colonoscopy. If patients were likely to be distressed by a positive FIT result, most GPs described using reassurance strategies emphasising a low cancer probability. Most GPs stressed the probability of false-positive FIT results. Some described taking a positive screening result in CRC screening less seriously than one in breast cancer screening. Most GPs underestimated CRC and AA probabilities after a positive FIT result. When told the actual probabilities, some stated that this knowledge might change the way they would inform patients. Conclusion These results imply that some of the interviewed GPs have too low a perception of the risk associated with a positive FIT result, which might influence their patients’ decision-making. Simply informing GPs about the actual rates of CRC and AA found in the screening programme might improve this risk perception.
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Interobserver Variation of Colonic Polyp Measurement at Computed Tomography Colonography. Can Assoc Radiol J 2019; 70:44-51. [PMID: 30691562 DOI: 10.1016/j.carj.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/14/2018] [Accepted: 09/20/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The concept of "advanced polyps" is well accepted and is defined as polyps ≥10 mm and/or those having a villous component and/or demonstrating areas of dysplasia. Of these parameters, computed tomography colonography (CTC) can only document size. The accepted management of CTC-detected "advanced polyps" is to recommend excision if feasible, whereas the management of "intermediate" (6-9 mm) polyps is more controversial, and interval surveillance may be acceptable. Therefore, distinction between 6-9 mm and ≥10 mm is important. METHODS Datasets containing 26 polyps originally reported as between 8-12 mm in diameter were reviewed independently by 4 CTC-accredited radiologists. Observers tabulated the largest measurement for each polyp on axial, coronal, sagittal, and endoluminal views at lung-window settings. These measurements were also compared to those determined by the computer-aided detection (CAD) software. RESULTS The interobserver reliability intra-class correlation coefficient (ICC) for sagittal projection was 0.80 ("excellent" category of Hosmer and Lemeshow [2004]), 0.71 for axial ("acceptable"), 0.69 for coronal, and 0.41 for endoluminal ("unacceptable"). The largest of sagittal/axial/coronal measurement gave the best reliability with the smallest variance (ICC = 0.80; 95% CI 0.67-0.89). For 8 of 26 polyps, at least one radiologist's measurement placed the polyp in a different category compared to a colleague. For the majority of the polyps, the CAD significantly overestimated the readings compared to the largest of the manual measurements with an average difference of 1.6 mm (P < .0001 for sagittal/axial/coronal). This resulted in 33% of polyps falling into a different category-10% were lower and 23% were higher (P < .034). CONCLUSION It is apparent that around the cutoff point of 10 mm between "advanced" and "intermediate" polyps, interobserver performance is variable.
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Lubner MG, Menias CO, Johnson RJ, Gaballah AH, Shaaban A, Elsayes KM. Villous Gastrointestinal Tumors: Multimodality Imaging with Histopathologic Correlation. Radiographics 2018; 38:1370-1384. [PMID: 30059275 DOI: 10.1148/rg.2018170159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Villous lesions are advanced adenomas that manifest most commonly in the colon; however, they can develop throughout the gastrointestinal tract. The duodenum is the most common small-bowel site of these lesions. Although in most cases these are isolated lesions that occur sporadically, patients with certain specific colorectal cancer syndromes, including familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, may develop multiple advanced adenomas. Villous lesions are important because although they are histologically benign, they may harbor dysplasia and have potential for malignancy. These characteristics make them a primary target for colorectal cancer screening with optical and virtual colonoscopy. However, these lesions can also be symptomatic and detected at diagnostic imaging when patients present for examination. They have characteristic features at a variety of imaging examinations, including barium fluoroscopy, CT, MRI, and endoscopic US. It is important for radiologists to be aware of these lesions, their potential morphologies, and their typical appearances at multimodality imaging. Although villous tumors can be detected at imaging and confirmed with biopsy, owing to limitations in identifying dysplasia and foci of malignancy with the above modalities alone and the potential for malignancy, referral for surgical resection of these lesions ultimately is required. ©RSNA, 2018.
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Affiliation(s)
- Meghan G Lubner
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (M.G.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex (R.J.J.); Department of Radiology, University of Missouri Healthcare, Columbia, Mo (A.H.G.); Department of Radiology, Health Sciences Center, University of Utah, Salt Lake City, Utah (A.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Christine O Menias
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (M.G.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex (R.J.J.); Department of Radiology, University of Missouri Healthcare, Columbia, Mo (A.H.G.); Department of Radiology, Health Sciences Center, University of Utah, Salt Lake City, Utah (A.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Rashad J Johnson
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (M.G.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex (R.J.J.); Department of Radiology, University of Missouri Healthcare, Columbia, Mo (A.H.G.); Department of Radiology, Health Sciences Center, University of Utah, Salt Lake City, Utah (A.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Ayman H Gaballah
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (M.G.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex (R.J.J.); Department of Radiology, University of Missouri Healthcare, Columbia, Mo (A.H.G.); Department of Radiology, Health Sciences Center, University of Utah, Salt Lake City, Utah (A.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Akram Shaaban
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (M.G.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex (R.J.J.); Department of Radiology, University of Missouri Healthcare, Columbia, Mo (A.H.G.); Department of Radiology, Health Sciences Center, University of Utah, Salt Lake City, Utah (A.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Khaled M Elsayes
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (M.G.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex (R.J.J.); Department of Radiology, University of Missouri Healthcare, Columbia, Mo (A.H.G.); Department of Radiology, Health Sciences Center, University of Utah, Salt Lake City, Utah (A.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
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CT Colonography Performance for the Detection of Polyps and Cancer in Adults ≥ 65 Years Old: Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018; 211:40-51. [DOI: 10.2214/ajr.18.19515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Labianca R, Merelli B. Screening and Diagnosis for Colorectal Cancer: Present and Future. TUMORI JOURNAL 2018. [DOI: 10.1177/548.6506] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Barbara Merelli
- Unit of Medical Oncology, Ospedali Riuniti di Bergamo, Italy
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22
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Turner KO, Genta RM, Sonnenberg A. Lesions of All Types Exist in Colon Polyps of All Sizes. Am J Gastroenterol 2018; 113:303-306. [PMID: 29231190 DOI: 10.1038/ajg.2017.439] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 10/22/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Although large polyps are known to harbor more advanced neoplasia than small polyps, the extent of the relationship between size and type is not fully known. The study aim was to establish benchmarks for the prevalence of different histologic polyp types among varying size categories. METHODS The Miraca Life Sciences Database is an electronic repository of histopathologic patient records from private practices throughout the United States. We extracted the records of 483,998 unique patients who underwent colonoscopy with polypectomy between January 2008 and December 2014. A total of 550,811 polyps were stratified by their endoscopic size measurement. Polyps of each size were further stratified as hyperplastic polyp (HP), tubular adenoma (TA), tubulovillous adenoma (TVA), sessile serrated adenoma/polyp, and adenocarcinoma. RESULTS Of all 550,811 polyps, 447,343 (81%) were 1-9 mm in size, and 103,517 (19%) were 10 mm or larger. A fraction of 18,591/550,811 polyps (3.4%) harbored histologic features of advanced adenoma, such as TVA, high-grade dysplasia, or cancer. Of these, 4,725/18,591 (25%) occurred in polyps 1-9 mm and 13,868/18,591 (75%) occurred in polyps 10 mm or larger. The fractions of advanced adenoma were 0.6% (0.5-0.6%) in 1-5 mm polyps and 2.1% (2.0-2.2%) in 6-9 mm polyps, as compared to 13.4% (13.2-13.6%) in polyps 10 mm or larger. The frequency of HP significantly decreased with increasing polyp size, whereas the frequency of TA remained largely unaffected by polyp size. CONCLUSIONS While advanced histopathology was found more frequently in colorectal polyps of larger than smaller size, one quarter of all advanced histopathology existed in polyps of <10 mm.
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Affiliation(s)
- Kevin O Turner
- Miraca Life Sciences, Irving, Texas, USA.,Baylor College of Medicine, Houston, Texas, USA
| | - Robert M Genta
- Miraca Life Sciences, Irving, Texas, USA.,Baylor College of Medicine, Houston, Texas, USA
| | - Amnon Sonnenberg
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon, USA.,Gastroenterology Section, Portland VA Medical Center, Portland, Oregon, USA
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Romdhane H, Marzouk I, Mzoughi Z, Cheikh M, Dridi M, Fadhl H, Ennaifer R, Belhadj N. Value of water enema computed tomography in elderly symptomatic patients. Arab J Gastroenterol 2017; 18:235-237. [PMID: 29241725 DOI: 10.1016/j.ajg.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/14/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND STUDY AIMS Colonoscopy remains the gold standard for the examination of the colon. However, its use in the elderly is not well tolerated, and there is often a need for general anaesthesia, thus increasing the risk, especially if there are co-morbidities. Water enema computed tomography has been suggested to be a satisfactory alternative as a non-invasive, fast and effective means for the diagnosis of colorectal supra-centimetric lesions. The aim of our study was to assess the performance of water enema computed tomography as first-line examination by calculating its negative predictive value (NPV) for the diagnosis of supra-centimetric lesions in symptomatic elderly referred to colonoscopy. PATIENTS AND METHODS This was a prospective study including 57 symptomatic patients older than 65 years. All patients were explored by water enema computed tomography at first, followed by colonoscopy, and responded to a questionnaire on the tolerance to the preparation and both procedures. RESULTS The mean age of patients was 73 years. The M:F sex ratio was 1.59. The most frequent indication for colonoscopy was bowel disorders associated with abdominal pain (30%). Water enema computed tomography allowed the diagnosis of tumours (n = 2), polyps (n = 6), diverticulosis (n = 7), inflammatory wall thickening (n = 1) and extra-colic lesions (n = 28). NPV of water enema computed tomography for supra-centimetric lesions was 96.5%. Sensitivity and specificity were 87.3% and 98%, respectively. However, for sub-centimetric lesions, water enema computed tomography had a low sensitivity estimated at 6%, specificity at 89.9%, positive predictive value at 91.9% and NPV at 27.7%. CONCLUSION Water enema computed tomography has proven to be a valuable and non-invasive method indicated as a first-line examination in case of colonic symptoms in the elderly to diagnose supra-centimetric lesions.
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Affiliation(s)
- Heyfa Romdhane
- Tunis Manar University, Faculty of Medecine of Tunis, 1007 Tunis, Tunisia; Gastroenterology Departement, Mongi Slim Hospital, Sidi Daoued La Marsa, Tunisia
| | - Imen Marzouk
- Tunis Manar University, Faculty of Medecine of Tunis, 1007 Tunis, Tunisia; Radiologiy Departement, Mongi Slim Hospital, Sidi Daoued La Marsa, Tunisia
| | - Zeineb Mzoughi
- Tunis Manar University, Faculty of Medecine of Tunis, 1007 Tunis, Tunisia; General Surgery Departement, Mongi Slim Hospital, Sidi Daoued La Marsa, Tunisia.
| | - Meriem Cheikh
- Tunis Manar University, Faculty of Medecine of Tunis, 1007 Tunis, Tunisia; Gastroenterology Departement, Mongi Slim Hospital, Sidi Daoued La Marsa, Tunisia
| | - Meriem Dridi
- Tunis Manar University, Faculty of Medecine of Tunis, 1007 Tunis, Tunisia; Radiologiy Departement, Mongi Slim Hospital, Sidi Daoued La Marsa, Tunisia
| | - Houcem Fadhl
- Tunis Manar University, Faculty of Medecine of Tunis, 1007 Tunis, Tunisia; Gastroenterology Departement, Mongi Slim Hospital, Sidi Daoued La Marsa, Tunisia
| | - Rym Ennaifer
- Tunis Manar University, Faculty of Medecine of Tunis, 1007 Tunis, Tunisia; Gastroenterology Departement, Mongi Slim Hospital, Sidi Daoued La Marsa, Tunisia
| | - Najet Belhadj
- Tunis Manar University, Faculty of Medecine of Tunis, 1007 Tunis, Tunisia; Gastroenterology Departement, Mongi Slim Hospital, Sidi Daoued La Marsa, Tunisia
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Prospective Trial Evaluating the Surgical Anastomosis at One-Year Colorectal Cancer Surveillance: CT Colonography Versus Optical Colonoscopy and Implications for Patient Care. Dis Colon Rectum 2017; 60:1162-1167. [PMID: 28991080 PMCID: PMC5635837 DOI: 10.1097/dcr.0000000000000845] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to compare the accuracy of CT colonography versus optical colonoscopy for neoplastic involvement at the surgical anastomosis 1 year after curative-intent colorectal cancer resection. DESIGN, SETTING, PATIENTS, AND INTERVENTIONS Two hundred one patients (mean age, 58.6 years; 117 men, 84 women) underwent same-day contrast-enhanced CT colonography and colonoscopy approximately 1 year (mean, 12.1 months; median, 11.9 months) after colorectal cancer resection as part of a prospective, multicenter trial. All patients enrolled were without clinical evidence of disease and considered low risk for recurrence (stage I-III). MAIN OUTCOME MEASURES Suspected neoplastic lesions within 5 cm of the colonic anastomosis were recorded at CT colonography, with subsequent colonoscopy performed for the same, with segmental unblinding of colonography findings. Anastomotic region biopsy or polypectomy was performed at the endoscopist's discretion. RESULTS None of the 201 patients had intraluminal anastomotic cancer recurrence or advanced neoplasia (or metachronous cancers). CT colonography detected extramural perianastomotic recurrence in 2 patients (1.0%); neither was detected at colonoscopy. Only 2 patients (1.0%; 2/201) were called positive at CT colonography for intraluminal anastomotic nondiminutive lesions (7- to 8-mm polyps), which were confirmed at colonoscopy but nonneoplastic at histopathology. At optical colonoscopy, the anastomosis was deemed abnormal and/or biopsied in 10.0% (20/201), yielding only 1 nondiminutive benign neoplasm (7-mm tubular adenoma). LIMITATIONS The lack of luminal cancer recurrence in our lower-risk cohort precludes assessment of sensitivity for detection, rendering the study underpowered in this regard. Potential cost savings of combined CT/CT colonography over the standard CT/colonoscopy approach were not assessed. CONCLUSIONS Relevant intraluminal anastomotic pathology appears to be very uncommon 1 year after colorectal cancer resection in lower-risk cohorts. Unlike colonoscopy, diagnostic contrast-enhanced CT colonography effectively evaluates both the intra- and extraluminal aspects of the anastomosis. See Video Abstract at http://links.lww.com/DCR/A471.
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Von Renteln D, Bouin M, Barkun AN. Current standards and new developments of colorectal polyp management and resection techniques. Expert Rev Gastroenterol Hepatol 2017; 11:835-842. [PMID: 28319429 DOI: 10.1080/17474124.2017.1309279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Colonoscopy and endoscopic removal of precancerous polyps play an important role in colorectal cancer (CRC) prevention. Improved endoscopes and quality standards have led to an increasing polyp and adenoma detection rate. Optimal polyp resection techniques and management strategies are key for an effective colonoscopy practice. Areas covered: Strategies for how to improve diminutive polyp (polyps up to 5 mm in size) management are discussed because of their high prevalence. Systematic removal of diminutive polyps leads to increasing costs of colonoscopy practice, while the effect on colorectal cancer prevention might be negligible. Furthermore, polypectomy recommendations for mid-size and large polyps are provided. For all larger polyps larger, complete and safe resection is mandatory to avoid post colonoscopy cancers. The focus for managing such larger polyps is to use new techniques (i.e. cold snares) and to attempt complete removal and to reduce post-polypectomy complications. Expert commentary: The resect-and-discard strategy is a promising management strategy for diminutive polyps. However, modification of this approach might be required in order to make widespread adoption feasible. Cold snare polypectomy is a promising new approach for small polyp resection. For resection of large polyps adequate treatment recommendations with regard to endoscopic mucosal resection and complication prevention are provided.
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Affiliation(s)
- Daniel Von Renteln
- a Department of Medicine, Division of Gastroenterology , Montreal University Hospital (CHUM) , Montreal , Canada
| | - Mickael Bouin
- a Department of Medicine, Division of Gastroenterology , Montreal University Hospital (CHUM) , Montreal , Canada
| | - Alan N Barkun
- b Division of Gastroenterology , McGill University Health Center, McGill University , Montreal , Quebec , Canada
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von Renteln D, Pohl H. Polyp Resection - Controversial Practices and Unanswered Questions. Clin Transl Gastroenterol 2017; 8:e76. [PMID: 28277492 PMCID: PMC5387755 DOI: 10.1038/ctg.2017.6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/05/2017] [Indexed: 02/07/2023] Open
Abstract
Detection and complete removal of precancerous neoplastic polyps are central to effective colorectal cancer screening. The prevalence of neoplastic polyps in the screening population in the United States is likely >50%. However, most persons with neoplastic polyps are never destined to develop cancer, and do not benefit for finding and removing polyps, and may only be harmed by the procedure. Further 70-80% of polyps are diminutive (≤5 mm) and such polyps almost never contain cancer. Given the questionable benefit, the high-cost and the potential risk changing our approach to the management of diminutive polyps is currently debated. Deemphasizing diminutive polyps and shifting our efforts to detection and complete removal of larger and higher-risk polyps deserves discussion and study. This article explores three controversies, and emerging concepts related to endoscopic polyp resection. First, we discuss challenges of optical resect-and-discard strategy and possible alternatives. Second, we review recent studies that support the use of cold snare resection for ≥5 mm polyps. Thirdly, we examine current evidence for prophylactic clipping after resection of large polyps.
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Affiliation(s)
- Daniel von Renteln
- Department of Medicine, Division of Gastroenterology, Montreal University Hospital (CHUM), and Montreal University Hospital Research Center (CR-CHUM), Montréal, Quebec, Canada
| | - Heiko Pohl
- Department of Veterans Affairs Medical Center, White River Junction, Vermont, and Geisel School of Medicine and The Dartmouth Institute, Hanover, New Hampshire, USA
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Abstract
OPINION STATEMENT Colorectal cancer (CRC) is a common cancer among throughout the world with the highest rates in developed countries such as the USA. There is ample evidence demonstrating the beneficial effects of colorectal cancer screening and, largely thanks to screening initiatives and insurance coverage, epidemiologic analyses show a steady decline in both CRC incidence and mortality rates over the last several decades. However, screening rates for CRC in the US remain low and approximately 1 in 3 adults between the ages of 50 and 75 years has not undergone any form of CRC screening, highlighting the need for additional accurate, minimally invasive, and acceptable screening options. Computed tomography colonography (CTC) has emerged as a viable alternative to existing CRC screening tests and research continues to enhance our knowledge regarding the ability of CTC to play a meaningful role in optimizing CRC screening in areas where it is available. This review highlights recent publications of salient research in the field of CTC. CTC continues to evolve, with lower radiation doses and greater evidence of its ability to identify clinical relevant colonic and extracolonic abnormalities. Recent evidence has bolstered the currently recommended CTC screening interval of 5 years and has reiterated the cost-effectiveness of CTC as a CRC screening examination. Additionally, emerging evidence suggests a role for CTC as a polyp and CRC surveillance modality as well as a preoperative adjunct in patients with established CRC. Data supporting the safety and patient acceptance of CTC also has continued to accumulate and CTC has recently been endorsed as an appropriate test for CRC screening in multiple important guidelines and recommendations. CTC is poised to become an important option in the CRC screening and surveillance arena.
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Ponugoti PL, Cummings OW, Rex DK. Risk of cancer in small and diminutive colorectal polyps. Dig Liver Dis 2017; 49:34-37. [PMID: 27443490 DOI: 10.1016/j.dld.2016.06.025] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/07/2016] [Accepted: 06/20/2016] [Indexed: 12/11/2022]
Abstract
The prevalence of cancer in small and diminutive polyps is relevant to "resect and discard" and CT colonography reporting recommendations. We evaluated a prospectively collected colonoscopy polyp database to identify polyps <10mm and those with cancer or advanced histology (high-grade dysplasia or villous elements). Of 32,790 colonoscopies, 15,558 colonoscopies detected 42,630 polyps <10mm in size. A total of 4790 lesions were excluded as they were not conventional adenomas or serrated class lesions. There were 23,524 conventional adenomas <10mm of which 22,952 were tubular adenomas. There were 14,316 serrated class lesions of which 13,589 were hyperplastic polyps and the remainder were sessile serrated polyps. Of all conventional adenomas, 96 had high-grade dysplasia including 0.3% of adenomas ≤5mm in size and 0.8% of adenomas 6-9mm in size. Of all conventional adenomas, 2.1% of those ≤5mm in size and 5.6% of those 6-9mm in size were advanced. Among 36,107 polyps ≤5mm in size and 6523 polyps 6-9mm in size, there were no cancers. These results support the safety of resect and discard as well as current CT colonography reporting recommendations for small and diminutive polyps.
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Affiliation(s)
- Prasanna L Ponugoti
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Oscar W Cummings
- Division of Surgical Pathology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, United States.
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Di Serafino M, Severino R, Laviani F, Maroscia D. Three-dimensional computed tomography rendering of pedunculated colon polyp: new "clapper-bell" sign pedunculated polyp at 3D computed tomography. Radiol Case Rep 2016; 11:292-295. [PMID: 27920846 PMCID: PMC5128358 DOI: 10.1016/j.radcr.2016.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 07/07/2016] [Accepted: 07/07/2016] [Indexed: 01/04/2023] Open
Abstract
The incidental detection of a tubulovillous adenoma at a contrast-enhanced computed tomography (CECT) with nondedicated protocol, performed in emergency conditions, is an uncommon finding. We report a case of a woman presenting with a subocclusive episode. A CECT scan was performed, and a pedunculated polyp could be appreciated at 3D-reconstruction images. A particular depiction of pedunculus of the polypoid lesion, resemble a clapper-bell, could help to define the vegetating lesion at the volume-rendering reconstruction images. This case emphasizes the fundamental role of postprocessing in the clinical practice to improve the diagnostic accuracy of abdominal CT scan. In addition, a potential new radiologic sign, the "clapper-bell sign", is proposed, as literature about the appearance of a polyp at CECT, performed without a dedicated protocol for colonoscopy, is poor.
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Affiliation(s)
- Marco Di Serafino
- Department of Emergency Radiology, A.O.R. San Carlo, Via Potito Petrone, Potenza 85100, Italy
| | - Rosa Severino
- Department of Radiology, University Hospital Federico II, Via Sergio Pansini 5, Napoli, 80131, Italy
| | - Fabia Laviani
- Department of Emergency Radiology, A.O.R. San Carlo, Via Potito Petrone, Potenza 85100, Italy
| | - Domenico Maroscia
- Department of Emergency Radiology, A.O.R. San Carlo, Via Potito Petrone, Potenza 85100, Italy
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Berger BM, Schroy PC, Dinh TA. Screening for Colorectal Cancer Using a Multitarget Stool DNA Test: Modeling the Effect of the Intertest Interval on Clinical Effectiveness. Clin Colorectal Cancer 2015; 15:e65-74. [PMID: 26792032 DOI: 10.1016/j.clcc.2015.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/01/2015] [Accepted: 12/09/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND A multitarget stool DNA (mt-sDNA) test was recently approved for colorectal cancer (CRC) screening for men and women, aged ≥ 50 years, at average risk of CRC. The guidelines currently recommend a 3-year interval for mt-sDNA testing in the absence of empirical data. We used clinical effectiveness modeling to project decreases in CRC incidence and related mortality associated with mt-sDNA screening to help inform interval setting. MATERIALS AND METHODS The Archimedes model (Archimedes Inc., San Francisco, CA) was used to conduct a 5-arm, virtual, clinical screening study of a population of 200,000 virtual individuals to compare the clinical effectiveness of mt-sDNA screening at 1-, 3-, and 5-year intervals compared with colonoscopy at 10-year intervals and no screening for a 30-year period. The study endpoints were the decrease in CRC incidence and related mortality of each strategy versus no screening. Cost-effectiveness ratios (US dollars per quality-adjusted life year [QALY]) of mt-sDNA intervals were calculated versus no screening. RESULTS Compared with 10-year colonoscopy, annual mt-sDNA testing produced similar reductions in CRC incidence (65% vs. 63%) and related mortality (73% vs. 72%). mt-sDNA testing at 3-year intervals reduced the CRC incidence by 57% and CRC mortality by 67%, and mt-sDNA testing at 5-year intervals reduced the CRC incidence by 52% and CRC mortality by 62%. At an average price of $600 per test, the annual, 3-year, and 5-year mt-sDNA screening costs would be $20,178, $11,313, and $7388 per QALY, respectively, compared with no screening. CONCLUSION These data suggest that screening every 3 years using a multitarget mt-sDNA test provides reasonable performance at acceptable cost.
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Affiliation(s)
| | - Paul C Schroy
- Department of Gastroenterology, Boston University School of Medicine, Boston, MA
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Evolution of Screen-Detected Small (6-9 mm) Polyps After a 3-Year Surveillance Interval: Assessment of Growth With CT Colonography Compared With Histopathology. Am J Gastroenterol 2015; 110:1682-90. [PMID: 26482858 DOI: 10.1038/ajg.2015.340] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/01/2015] [Accepted: 09/02/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Volumetric growth assessment has been proposed for predicting advanced histology at surveillance computed tomography (CT) colonography (CTC). We examined whether is it possible to predict which small (6-9 mm) polyps are likely to become advanced adenomas at surveillance by assessing volumetric growth. METHODS In an invitational population-based CTC screening trial, 93 participants were diagnosed with one or two 6-9 mm polyps as the largest lesion(s). They were offered a 3-year surveillance CTC. Participants in whom surveillance CTC showed lesion(s) of ≥6 mm were offered colonoscopy. Volumetric measurements were performed on index and surveillance CTC, and polyps were classified into growth categories according to ±30% volumetric change (>30% growth as progression, 30% growth to 30% decrease as stable, and >30% decrease as regression). Polyp growth was related to histopathology. RESULTS Between July 2012 and May 2014, 70 patients underwent surveillance CTC after a mean surveillance interval of 3.3 years (s.d. 0.3; range 3.0-4.6 years). In all, 33 (35%) of 95 polyps progressed, 36 (38%) remained stable, and 26 (27%) regressed, including an apparent resolution in 13 (14%) polyps. In 68 (83%) of the 82 polyps at surveillance, histopathology was obtained; 15 (47%) of 32 progressing polyps were advanced adenomas, 6 (21%) of 28 stable polyps, and none of the regressing polyps. CONCLUSIONS The majority of 6-9 mm polyps will not progress to advanced neoplasia within 3 years. Those that do progress to advanced status can in particular be found among the lesions that increased in size on surveillance CTC.
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Tutein Nolthenius CJ, Boellaard TN, de Haan MC, Nio CY, Thomeer MGJ, Bipat S, Montauban van Swijndregt AD, van de Vijver MJ, Biermann K, Kuipers EJ, Dekker E, Stoker J. Computer tomography colonography participation and yield in patients under surveillance for 6-9 mm polyps in a population-based screening trial. Eur Radiol 2015; 26:2762-70. [PMID: 26560732 PMCID: PMC4927597 DOI: 10.1007/s00330-015-4081-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/05/2015] [Accepted: 10/22/2015] [Indexed: 12/21/2022]
Abstract
Purpose Surveillance CT colonography (CTC) is a viable option for 6-9 mm polyps at CTC screening for colorectal cancer. We established participation and diagnostic yield of surveillance and determined overall yield of CTC screening. Material and methods In an invitational CTC screening trial 82 of 982 participants harboured 6-9 mm polyps as the largest lesion(s) for which surveillance CTC was advised. Only participants with one or more lesion(s) ≥6 mm at surveillance CTC were offered colonoscopy (OC); 13 had undergone preliminary OC. The surveillance CTC yield was defined as the number of participants with advanced neoplasia in the 82 surveillance participants, and was added to the primary screening yield. Results Sixty-five of 82 participants were eligible for surveillance CTC of which 56 (86.2 %) participated. Advanced neoplasia was diagnosed in 15/56 participants (26.8 %) and 9/13 (69.2 %) with preliminary OC. Total surveillance yield was 24/82 (29.3 %). No carcinomas were detected. Adding surveillance results to initial screening CTC yield significantly increased the advanced neoplasia yield per 100 CTC participants (6.1 to 8.6; p < 0.001) and per 100 invitees (2.1 to 2.9; p < 0.001). Conclusion Surveillance CTC for 6-9 mm polyps has a substantial yield of advanced adenomas and significantly increased the CTC yield in population screening. Key Points • The participation rate in surveillance CT colonography (CTC) is 86 %. • Advanced adenoma prevalence in a 6-9 mm CTC surveillance population is high. • Surveillance CTC significantly increases the yield of population screening by CTC. • Surveillance CTC for 6-9 mm polyps is a safe strategy. • Surveillance CTC is unlikely to yield new important extracolonic findings.
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Affiliation(s)
- Charlotte J Tutein Nolthenius
- Department of Radiology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DD, Amsterdam, The Netherlands. .,Department of Radiology, Onze Lieve Vrouwe Gasthuis, PO Box 95500, 1090 HM, Amsterdam, The Netherlands. .,Department of Radiology, G1-215, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Thierry N Boellaard
- Department of Radiology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DD, Amsterdam, The Netherlands
| | - Margriet C de Haan
- Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - C Yung Nio
- Department of Radiology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DD, Amsterdam, The Netherlands
| | - Maarten G J Thomeer
- Department of Radiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Shandra Bipat
- Department of Radiology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DD, Amsterdam, The Netherlands
| | | | - Marc J van de Vijver
- Department of Pathology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DD, Amsterdam, The Netherlands
| | - Katharina Biermann
- Department of Pathology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DD, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DD, Amsterdam, The Netherlands
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Silva SME, Rosa VF, Santos ACND, Almeida RMD, Oliveira PGD, Sousa JBD. Influence of patient age and colorectal polyp size on histopathology findings. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 27:109-13. [PMID: 25004288 PMCID: PMC4678682 DOI: 10.1590/s0102-67202014000200006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 02/25/2014] [Indexed: 01/01/2023]
Abstract
Background Colorectal cancer is a major cause of morbidity and mortality and can arise
through the adenoma-carcinoma sequence. Colonoscopy is considered the method of
choice for population-wide cancer screening. Aim To assess the characteristics of endoscopically resected polyps in a consecutive
series of patients who underwent colonoscopy at a university hospital and compare
histopathology findings according to patient age and polyp size. Methods Retrospective, cross-sectional of 1950 colonoscopy reports from consecutively
examined patients. The sample was restricted to reports that mentioned colorectal
polyps. A chart review was carried out for collection of demographic data and
histopathology results. Data were compared for polyps sized ≤0.5 cm and
≥0.6 cm and then for polyps sized ≤1.0 cm and ≥1.1 cm.
Finally, all polyps resected from patients aged 49 years or younger were compared
with those resected from patients aged 50 years or older. Results A total of 272 colorectal polyps were resected in 224 of the 1950 colonoscopies
included in the sample (11.5%). Polyps >1 cm tended to be pedunculated
(p=0.000) and were more likely to exhibit an adenomatous component (p=0.001), a
villous component (p=0.000), and dysplasia (p=0.003). These findings held true
when the size cutoff was set at 0.5 cm. Patients aged 50 years or older were more
likely to have sessile polyps (p=0.023) and polyps located in the proximal colon
(p=0.009). There were no significant differences between groups in histopathology
or presence of dysplasia. Conclusion Polyp size is associated with presence of adenomas, a villous component, and
dysplasia, whereas patient age is more frequently associated with sessile polyps
in the proximal colon.
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Affiliation(s)
- Silvana Marques e Silva
- Coloproctology Service, University Hospital of Brasília, Brasília University, Brasília, DF, Brazil
| | - Viviane Fernandes Rosa
- Coloproctology Service, University Hospital of Brasília, Brasília University, Brasília, DF, Brazil
| | | | | | | | - João Batista de Sousa
- Coloproctology Service, University Hospital of Brasília, Brasília University, Brasília, DF, Brazil
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Abstract
Polypectomy at colonoscopy has been shown to reduce the subsequent risk of colorectal cancer. With the advent of national screening programs, the number of colonoscopies performed has increased worldwide. In addition, the recent drive for quality improvement combined with advances in colonoscopic technology has resulted in increased numbers of polyps detected, resected, and sent for histopathology leading to spiraling costs associated with the procedure. Being able to diagnose small polyps in vivo (optical diagnosis) would allow for adenomas to be resected and discarded without the need to retrieve them or send them for formal histopathology.
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Pickhardt PJ. CT colonography for population screening: ready for prime time? Dig Dis Sci 2015; 60:647-59. [PMID: 25492504 PMCID: PMC4629223 DOI: 10.1007/s10620-014-3454-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 11/17/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA,
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CT colonography for the detection of nonpolypoid adenomas: sensitivity assessed with restricted national CT colonography trial criteria. AJR Am J Roentgenol 2015; 203:W614-22. [PMID: 25415726 DOI: 10.2214/ajr.13.12356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of nonpolypoid adenomas and the sensitivity of CT colonography (CTC) in their detection by use of the restricted criteria of height-to-width ratio<50% and height elevation≤3 mm. MATERIALS AND METHODS In the National CT Colonography Trial (American College of Radiology Imaging Network protocol 6664), a cohort of 2531 participants without symptoms underwent CTC and screening colonoscopy. The CTC examinations were interpreted with both 2D and 3D techniques. Nonpolypoid adenomatous polyps identified with CTC or colonoscopy were retrospectively reviewed to determine which polyps met the restricted criteria. The prevalence of nonpolypoid adenomas and the prospective sensitivity of CTC were determined. Descriptive statistics were used to report the prevalence, size, and histologic features. The sensitivities (with 95% CIs) for nonpolypoid and polypoid lesions were compared by two-sided Z test for independent binomial proportions. RESULTS The retrospective review confirmed 21 nonpolypoid adenomas, yielding a prevalence of 0.83% (21 of 2531 participants). Eight (38.1%) were advanced adenomas, many (50% [4/8]) only because of large size (≥10 mm). The overall per polyp sensitivity of CTC (combined 2D and 3D interpretation) for detecting nonpolypoid adenomas≥5 mm (n=21) was 0.76; ≥6 mm (n=16), 0.75; and ≥10 mm (n=5), 0.80. These values were not statistically different from the sensitivity of detecting polypoid adenomas (p>0.37). CONCLUSION In this large screening population, nonpolypoid adenomas had a very low prevalence (<1%), and advanced pathologic features were uncommon in polyps<10 mm in diameter. Most nonpolypoid adenomas are technically visible at CTC. The prospective sensitivity is similar to that for polypoid adenomas when the interpretation combines both 2D and 3D review.
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He Q, Rao T, Guan YS. Virtual gastrointestinal colonoscopy in combination with large bowel endoscopy: Clinical application. World J Gastroenterol 2014; 20:13820-13832. [PMID: 25320519 PMCID: PMC4194565 DOI: 10.3748/wjg.v20.i38.13820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/11/2014] [Accepted: 07/16/2014] [Indexed: 02/06/2023] Open
Abstract
Although colorectal cancer (CRC) has no longer been the leading cancer killer worldwide for years with the exponential development in computed tomography (CT) or magnetic resonance imaging, and positron emission tomography/CT as well as virtual colonoscopy for early detection, the CRC related mortality is still high. The objective of CRC screening is to reduce the burden of CRC and thereby the morbidity and mortality rates of the disease. It is believed that this goal can be achieved by regularly screening the average-risk population, enabling the detection of cancer at early, curable stages, and polyps before they become cancerous. Large-scale screening with multimodality imaging approaches plays an important role in reaching that goal to detect polyps, Crohn’s disease, ulcerative colitis and CRC in early stage. This article reviews kinds of presentative imaging procedures for various screening options and updates detecting, staging and re-staging of CRC patients for determining the optimal therapeutic method and forecasting the risk of CRC recurrence and the overall prognosis. The combination use of virtual colonoscopy and conventional endoscopy, advantages and limitations of these modalities are also discussed.
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CT Colonography Reporting and Data System (C-RADS): benchmark values from a clinical screening program. AJR Am J Roentgenol 2014; 202:1232-7. [PMID: 24848819 DOI: 10.2214/ajr.13.11272] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The CT Colonography Reporting and Data System (C-RADS) is a well-recognized standard for reporting findings at CT colonography (CTC). However, few data on benchmark values for clinical performance have been published to date, especially for screening. The purpose of this study was to establish baseline C-RADS values for CTC screening. SUBJECTS AND METHODS From 2005 to 2011, 6769 asymptomatic adults (3110 men and 3659 women) 50-79 years old (mean [± SD] age, 56.7 ± 6.1 years) were enrolled for first-time CTC screening at a single center. CTC results were prospectively classified according to C-RADS for both colorectal and extracolonic findings. C-RADS classification rates and outcomes for positive patients were analyzed. RESULTS C-RADS classification rates for colorectal evaluation were C0 (0.7%), C1 (85.0%), C2 (8.6%), C3 (5.2%), and C4 (0.6%). Overall, 14.3% of subjects were positive (C2-C4), and positive findings were more frequent among men (17.5%) than women (11.6%; p < 0.0001). Positivity also increased with age, from 13.4% of patients 50-64 years old to 21.8% of patients 65-79 years old (p < 0.0001). Regarding extracolonic evaluation, 86.6% of patients were either negative for extracolonic findings or had unimportant extracolonic findings (E1 or E2). Likely unimportant but indeterminate extracolonic findings where further workup might be indicated (E3) were found in 11.3% of patients, whereas 2.1% had likely important extracolonic findings (E4). Overall, E3 and E4 rates were increased for older (p < 0.0001) and female (p = 0.008) cohorts. CONCLUSION C-RADS results from our initial experience with CTC screening may serve as an initial benchmark for program comparison and quality assurance measures.
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Schroy PC, Coe A, Chen CA, O'Brien MJ, Heeren TC. Prevalence of advanced colorectal neoplasia in white and black patients undergoing screening colonoscopy in a safety-net hospital. Ann Intern Med 2013; 159:13-20. [PMID: 23817700 PMCID: PMC4218749 DOI: 10.7326/0003-4819-159-1-201307020-00004] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
UNLABELLED Chinese translation BACKGROUND Black persons are more likely than white persons to be diagnosed with colorectal cancer and to die from it. The extent to which genetic or biological factors versus disparities in screening rates explain this variance remains controversial. OBJECTIVE To define the prevalence and location of presymptomatic advanced colorectal neoplasia (ACN) among white and black persons undergoing screening colonoscopy, controlling for other epidemiologic risk factors. DESIGN Cross-sectional survey between 22 March 2005 and 31 January 2012. SETTING Urban, open-access, academic, safety-net hospital in Massachusetts. PARTICIPANTS Asymptomatic, average-risk white (n = 1172) and black (n = 1681) persons aged 50 to 79 years undergoing screening colonoscopy. MEASUREMENTS Adjusted prevalence and location of ACN, defined as a tubular adenoma 10 mm or more in size, any adenoma with villous features or high-grade dysplasia, any dysplastic serrated lesion, or invasive cancer. RESULTS The prevalence of ACN was higher among white patients than black patients (6.8% vs. 5.0%; P = 0.039) but varied by sex (white vs. black men, 9.3% vs. 5.7%; white vs. black women, 3.5% vs. 4.3%; interaction P = 0.034). After controlling for many risk factors, black men were 41% less likely than white men (adjusted odds ratio [AOR], 0.59 [95% CI, 0.39 to 0.89]) to have ACN. No statistically significant difference was seen for women (AOR, 1.32 [CI, 0.73 to 2.40]). Black patients with ACN had a higher percentage of proximal disease (52% vs. 39%) after adjustment for age and sex (P = 0.055). LIMITATION Single-institution study with inadequate statistical power for subgroup analyses and recall bias. CONCLUSION Black men are less likely than white men to have ACN at screening colonoscopy in a safety-net health care setting. Disparities in access to screening and differential exposure to modifiable risk factors rather than genetic or biological factors may be largely responsible for the higher incidence of CRC among black men. Genetic or biological factors may explain the predilection for proximal disease.
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Affiliation(s)
- Paul C Schroy
- Boston University School of Medicine and Boston University School of Public Health, Boston, Massachusetts 02118, USA.
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Mo MH, Chen L, Fu Y, Wang W, Fu SW. Cell-free Circulating miRNA Biomarkers in Cancer. J Cancer 2012; 3:432-48. [PMID: 23074383 PMCID: PMC3471083 DOI: 10.7150/jca.4919] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 10/10/2012] [Indexed: 12/26/2022] Open
Abstract
Considerable attention and an enormous amount of resources have been dedicated to cancer biomarker discovery and validation. However, there are still a limited number of useful biomarkers available for clinical use. An ideal biomarker should be easily assayed with minimally invasive medical procedures but possess high sensitivity and specificity. Commonly used circulating biomarkers are proteins in serum, most of which require labor-intensive analysis hindered by low sensitivity in early tumor detection. Since the deregulation of microRNA (miRNA) is associated with cancer development and progression, profiling of circulating miRNAs has been used in a number of studies to identify novel minimally invasive miRNA biomarkers. In this review, we discuss the origin of the circulating cell-free miRNAs and their carriers in blood. We summarize the clinical use and function of potentially promising miRNA biomarkers in a variety of different cancers, along with their downstream target genes in tumor initiation and development. Additionally, we analyze some technical challenges in applying miRNA biomarkers to clinical practice.
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Affiliation(s)
- Meng-Hsuan Mo
- 1. Department of Medicine, Division of Genomic Medicine, and Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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The second ESGAR consensus statement on CT colonography. Eur Radiol 2012; 23:720-9. [PMID: 22983280 PMCID: PMC3563960 DOI: 10.1007/s00330-012-2632-x] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 03/18/2012] [Accepted: 04/01/2012] [Indexed: 12/14/2022]
Abstract
Objective To update quality standards for CT colonography based on consensus among opinion leaders within the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). Material and methods A multinational European panel of nine members of the ESGAR CT colonography Working Group (representing six EU countries) used a modified Delphi process to rate their level of agreement on a variety of statements pertaining to the acquisition, interpretation and implementation of CT colonography. Four Delphi rounds were conducted, each at 2 months interval. Results The panel elaborated 86 statements. In the final round the panelists achieved complete consensus in 71 of 86 statements (82 %). Categories including the highest proportion of statements with excellent Cronbach's internal reliability were colon distension, scan parameters, use of intravenous contrast agents, general guidelines on patient preparation, role of CAD and lesion measurement. Lower internal reliability was achieved for the use of a rectal tube, spasmolytics, decubitus positioning and number of CT data acquisitions, faecal tagging, 2D vs. 3D reading, and reporting. Conclusion The recommendations of the consensus should be useful for both the radiologist who is starting a CTC service and for those who have already implemented the technique but whose practice may need updating. Key Points • Computed tomographic colonography is the optimal radiological method of assessing the colon • This article reviews ESGAR quality standards for CT colonography • This article is aimed to provide CT-colonography guidelines for practising radiologists • The recommendations should help radiologists who are starting/updating their CTC services
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Detection of colorectal tumors with water enema-multidetector row computed tomography. ACTA ACUST UNITED AC 2012; 37:1092-100. [DOI: 10.1007/s00261-012-9844-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Kobayashi Y, Hayashino Y, Jackson JL, Takagaki N, Hinotsu S, Kawakami K. Diagnostic performance of chromoendoscopy and narrow band imaging for colonic neoplasms: a meta-analysis. Colorectal Dis 2012; 14:18-28. [PMID: 20955514 DOI: 10.1111/j.1463-1318.2010.02449.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM We conducted a meta-analysis to compare the diagnostic test performance of chromoendoscopy and narrow band imaging (NBI) for colonic neoplasms. METHOD MEDLINE, EMBASE and the Cochrane Library were searched (1966 to March 2009). Articles were included if: (i) chromoendoscopy or NBI was used, (ii) sensitivity and specificity were reported; (iii) absolute numbers of true-positive, false-positive, true-negative and false-negative results were provided or could be calculated; and (iv) pathology was used as the reference standard. Sensitivity and specificity were pooled using random effects model. Secondary analyses were conducted by limiting the studies in which magnifying endoscopy was used alone as a diagnostic modality, and polyp size and macroscopic appearance of lesions were not considered. RESULTS Of 1342 screened articles, 27 met the inclusion criteria. Pooled sensitivity for chromoendoscopy and NBI was 0.94 (95% CI, 0.92-0.95) and 0.94 (0.91-0.97), and specificity was 0.82 (0.77-0.88) and 0.86 (0.83-0.89), respectively. There were no differences in sensitivity (P = 0.99) or specificity (P = 0.54) between the two methods. In the secondary analysis, pooled sensitivity for choromoendoscopy and NBI was 0.93 (95% CI, 0.90-0.97) and 0.96 (0.93-0.99) and specificity was 0.80 (0.73-0.87) and 0.85 (0.78-0.92). respectively. Overall, the pooled false-negative rate was 0.057 (95% CI, 0.040-0.73) for chromoendoscopy and 0.057 (95% CI, 0.028-0.085) for NBI. CONCLUSION Chromoendoscopy and NBI had similar diagnostic test characteristics in the assessment of colonic neoplasms; however, the false-negative rate for both methods of 5.7% is an unacceptably high rate and currently therefore, neither method is ready for general use.
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Affiliation(s)
- Y Kobayashi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Keeling AN, Morrin MM, McKenzie C, Farrell RJ, Sheth SG, Ngo L, Bloch BN, Pedrosa I, Rofsky NM. Intravenous, contrast-enhanced MR colonography using air as endoluminal contrast agent: impact on colorectal polyp detection. Eur J Radiol 2012; 81:31-38. [PMID: 21131152 DOI: 10.1016/j.ejrad.2010.10.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 10/14/2010] [Accepted: 10/20/2010] [Indexed: 01/26/2023]
Abstract
PURPOSE To compare diagnostic accuracy and patient tolerance of MR colonography with intravenous contrast and luminal air (MRC) to conventional colonoscopy (CC). MATERIALS AND METHODS IRB approval and written informed consent were obtained. Forty-six patients, both screening and symptomatic, underwent MRC followed by CC. The MRC technique employed 3D T1W spoiled gradient echo sequences performed after the administration of gadopenetate dimeglumine, with parallel imaging. The diagnostic accuracy and tolerance of patients for MRC was compared to CC. RESULTS Twenty-four polyps were detected in eighteen patients with CC (5 polyps ≥ 10 mm, 4 polyps 6-9 mm, 15 polyps ≤ 5 mm). MRC was 66.7% (12/18) sensitive and 96.4% (27/28) specific for polyp detection on a per-patient basis. When analyzed by polyp size, sensitivity and specificity of MRC was 100% (5/5) and 100% (19/19), respectively, for lesions greater than 10mm, 100% (4/4) and 100% (20/20) for lesions 6-9 mm, and sensitivity of 20% (3/15) lesions less than 5mm. The sensitivity and specificity of MRC for detecting significant lesions (>6mm) was 100% (9/9) and 100% (15/15), respectively. Regarding tolerance of the exams, there were no significant differences between MRC and CC. Thirty-five percent (n=16) of patients preferred MRC as a future screening test compared to 33% (n=15) for CC. CONCLUSION MRC using air as an intraluminal contrast agent is a feasible and well-tolerated technique for detecting colonic polyps ≥ 6 mm in size. Further studies are warranted.
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Affiliation(s)
- Aoife N Keeling
- Department of Radiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
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Tsai FC, Strum WB. Prevalence of advanced adenomas in small and diminutive colon polyps using direct measurement of size. Dig Dis Sci 2011; 56:2384-8. [PMID: 21318587 DOI: 10.1007/s10620-011-1598-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 01/27/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS Most studies reporting polyp size use visual estimates. Determining the prevalence of advanced histology based on direct measurement of polyp size may help guide the management of polyps found at optical colonoscopy (OC) and CT colonography (CTC). METHODS We designed a large, prospective study to assess the prevalence of advanced adenomas based on direct measurement of polyp size by a certified pathologists' assistant as reported in the pathology report. Patients between 40 and 89 years of age who presented for screening colonoscopy were included in our study. Advanced adenomas were defined as ≥10 mm or ≥25% villous features, high grade dysplasia or cancer. Polyps were divided by size into three groups: diminutive (≤5 mm), small (6-9 mm) and large (≥10 mm). If more than one adenoma was present, the most advanced was used for analysis. RESULTS We evaluated 6,905 consecutive patients referred for colonoscopy between January 2005 and December 2006. Of the 4,967 who met the inclusion criteria, the mean age was 58.8 and consisted of 59% women. Overall, 930 (18.7%) had an adenoma; 248 (5%) were advanced adenomas including 8 (0.16%) cancers. Of 89 polyps≥10 mm, 76 (85%) had advanced histology; of 247 polyps 6-9 mm, 67 (27%) were advanced; of 1,025 polyps ≤5 mm, 105 (10%) were advanced. Thus, 172 of 248 (69%) patients with advanced adenomas had small or diminutive adenomas. CONCLUSIONS Our data indicate the majority (69%) of advanced adenomas are <10 mm. Even among polyps≤5 mm, there was an appreciable prevalence of advanced adenomas (10%). These findings may help guide the management of sub-centimeter colon polyps found by OC or CTC.
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Affiliation(s)
- Franklin C Tsai
- Division of Gastroenterology, Scripps Clinic and the Scripps Clinic Research Institute, Torrey Pines, 10666 North Torrey Pines Road, La Jolla, CA 92037, USA.
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Pagés Llinás M, Darnell Martín A, Ayuso Colella J. CT colonography: What radiologists need to know. RADIOLOGIA 2011. [DOI: 10.1016/j.rxeng.2011.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Pagés Llinás M, Darnell Martín A, Ayuso Colella JR. [CT colonography: what radiologists need to know]. RADIOLOGIA 2011; 53:315-25. [PMID: 21696795 DOI: 10.1016/j.rx.2011.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 12/11/2010] [Accepted: 01/20/2011] [Indexed: 02/06/2023]
Abstract
In 2008, CT colonography was approved by the American Cancer Society as a technique for screening for colorectal cancer. This approval should be considered an important step in the recognition of the technique, which although still relatively new is already changing some diagnostic algorithms. This update about CT colonography reports the quality parameters necessary for a CT colonographic study to be diagnostic and reviews the technical innovations and colonic preparation for the study. We provide a brief review of the signs and close with a discussion of the current indications for and controversies about the technique.
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Affiliation(s)
- M Pagés Llinás
- Centro de Diagnóstico por la Imagen, Hospital Clínic de Barcelona, Barcelona, España.
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49
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Wylie PN, Burling D. CT colonography: what the gastroenterologist needs to know. Frontline Gastroenterol 2011; 2:96-104. [PMID: 28839590 PMCID: PMC5517201 DOI: 10.1136/fg.2009.000380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2010] [Indexed: 02/04/2023] Open
Affiliation(s)
- Peter N Wylie
- Radiology Department, Royal Free Hospital, London, UK
| | - David Burling
- Intestinal Imaging Centre, St Mark's Hospital, Harrow, UK
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Abstract
In addition to histology, size and location, a morphologic description can be ascribed to polyps and adenomas. Traditionally, adenomas have been described as sessile and pedunculated, but it is now accepted that they can also present as flat or even depressed. Although first recognized in 1985, flat adenomas have become more common in Western published literature and in endoscopic reports. The Japanese Research Society Classification describes flat adenomas as lesions with a height that is less than one half of the diameter, while the Paris classification divides polyps into protruding and nonprotruding. The clinical significance of flat adenomas includes their potential malignancy, difficulty in detection and possible role in interval cancers. Serrated polyps represent a subset of polyps that have all the features that make flat lesions clinically important. Due to the relatively recent recognition of these lesions, as well as the technology required to detect them, the prevalence and malignant potential of these lesions in Western patients are still unknown. Finally, the best techniques and equipment for detecting flat polyps are also not established. In this article, we examine the issue of flat polyps and their significance in colorectal cancer screening with regard to prevalence, risk factors and methods for detecting flat polyps.
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Affiliation(s)
- Joseph C Anderson
- University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-1845, USA.
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