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Chang A, Prabhala S, Daneshkhah A, Lin J, Subramanian H, Roy HK, Backman V. Early screening of colorectal cancer using feature engineering with artificial intelligence-enhanced analysis of nanoscale chromatin modifications. Sci Rep 2024; 14:7808. [PMID: 38565871 PMCID: PMC10987630 DOI: 10.1038/s41598-024-58016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Colonoscopy is accurate but inefficient for colorectal cancer (CRC) prevention due to the low (~ 7 to 8%) prevalence of target lesions, advanced adenomas. We leveraged rectal mucosa to identify patients who harbor CRC field carcinogenesis by evaluating chromatin 3D architecture. Supranucleosomal disordered chromatin chains (~ 5 to 20 nm, ~1 kbp) fold into chromatin packing domains (~ 100 to 200 nm, ~ 100 to 1000 kbp). In turn, the fractal-like conformation of DNA within chromatin domains and the folding of the genome into packing domains has been shown to influence multiple facets of gene transcription, including the transcriptional plasticity of cancer cells. We deployed an optical spectroscopic nanosensing technique, chromatin-sensitive partial wave spectroscopic microscopy (csPWS), to evaluate the packing density scaling D of the chromatin chain conformation within packing domains from rectal mucosa in 256 patients with varying degrees of progression to colorectal cancer. We found average packing scaling D of chromatin domains was elevated in tumor cells, histologically normal-appearing cells 4 cm proximal to the tumor, and histologically normal-appearing rectal mucosa compared to cells from control patients (p < 0.001). Nuclear D had a robust correlation with the model of 5-year risk of CRC with r2 = 0.94. Furthermore, rectal D was evaluated as a screening biomarker for patients with advanced adenomas presenting an AUC of 0.85 and 85% sensitivity and specificity. artificial intelligence-enhanced csPWS improved diagnostic performance with AUC = 0.90. Considering the low sensitivity of existing CRC tests, including liquid biopsies, to early-stage cancers our work highlights the potential of chromatin biomarkers of field carcinogenesis in detecting early, significant precancerous colon lesions.
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Affiliation(s)
- Andrew Chang
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Sravya Prabhala
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Ali Daneshkhah
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | | | - Hariharan Subramanian
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
- NanoCytomics, Evanston, IL, USA
| | | | - Vadim Backman
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.
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Chang A, Prabhala S, Daneshkhah A, Lin J, Subramanian H, Roy HK, Backman V. Early screening of colorectal cancer using feature engineering with artificial intelligence-enhanced analysis of nanoscale chromatin modifications. RESEARCH SQUARE 2023:rs.3.rs-3500134. [PMID: 37961494 PMCID: PMC10635400 DOI: 10.21203/rs.3.rs-3500134/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Colonoscopy is accurate but inefficient for colorectal cancer (CRC) prevention due to the low (~ 7-8%) prevalence of target lesions, advanced adenomas. We leveraged rectal mucosa to identify patients who harbor CRC field carcinogenesis by evaluating chromatin 3D architecture. Supranucleosomal disordered chromatin chains (~ 5-20 nm, ~ 1 kbp) fold into chromatin packing domains (~ 100-200 nm, ~ 100-1,000 kbp). In turn, the fractal-like conformation of DNA within chromatin domains and the folding of the genome into packing domains has been shown to influence multiple facets of gene transcription, including the transcriptional plasticity of cancer cells. We deployed an optical spectroscopic nanosensing technique, chromatin-sensitive partial wave spectroscopic microscopy (csPWS), to evaluate the packing density scaling D of the chromatin chain conformation within packing domains from rectal mucosa in 256 patients with varying degrees of progression to colorectal cancer. We found average packing scaling D of chromatin domains was elevated in tumor cells, histologically normal-appearing cells 4 cm proximal to the tumor, and histologically normal-appearing rectal mucosa compared to cells from control patients (p < 0.001). Nuclear D had a robust correlation with the model of 5-year risk of CRC with r2 = 0.94. Furthermore, rectal D was evaluated as a screening biomarker for patients with advanced adenomas presenting an AUC of 0.85 and 85% sensitivity and specificity. Artificial Intelligence (AI)-enhanced csPWS improved diagnostic performance with AUC = 0.90. Considering the low sensitivity of existing CRC tests, including liquid biopsies, to early-stage cancers our work highlights the potential of chromatin biomarkers of field carcinogenesis in detecting early, significant precancerous colon lesions.
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Chang A, Prabhala S, Daneshkhah A, Lin J, Subramanian H, Roy HK, Backman V. Early screening of colorectal cancer using feature engineering with artificial intelligence-enhanced analysis of nanoscale chromatin modifications. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.30.23297790. [PMID: 37961299 PMCID: PMC10635240 DOI: 10.1101/2023.10.30.23297790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Colonoscopy is accurate but inefficient for colorectal cancer (CRC) prevention due to the low (~7-8%) prevalence of target lesions, advanced adenomas. We leveraged rectal mucosa to identify patients who harbor CRC field carcinogenesis by evaluating chromatin 3D architecture. Supranucleosomal disordered chromatin chains (~5-20 nm, ~1 kbp) fold into chromatin packing domains (~100-200 nm, ~100-1,000 kbp). In turn, the fractal-like conformation of DNA within chromatin domains and the folding of the genome into packing domains has been shown to influence multiple facets of gene transcription, including the transcriptional plasticity of cancer cells. We deployed an optical spectroscopic nanosensing technique, chromatin-sensitive partial wave spectroscopic microscopy (csPWS), to evaluate the packing density scaling D of the chromatin chain conformation within packing domains from rectal mucosa in 256 patients with varying degrees of progression to colorectal cancer. We found average packing scaling D of chromatin domains was elevated in tumor cells, histologically normal-appearing cells 4 cm proximal to the tumor, and histologically normal-appearing rectal mucosa compared to cells from control patients (p<0.001). Nuclear D had a robust correlation with the model of 5-year risk of CRC with r2=0.94. Furthermore, rectal D was evaluated as a screening biomarker for patients with advanced adenomas presenting an AUC of 0.85 and 85% sensitivity and specificity. Artificial Intelligence (AI)-enhanced csPWS improved diagnostic performance with AUC=0.90. Considering the low sensitivity of existing CRC tests, including liquid biopsies, to early-stage cancers our work highlights the potential of chromatin biomarkers of field carcinogenesis in detecting early, significant precancerous colon lesions.
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Affiliation(s)
- Andrew Chang
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Sravya Prabhala
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Ali Daneshkhah
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | | | - Hariharan Subramanian
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
- NanoCytomics, Evanston, IL, USA
| | | | - Vadim Backman
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
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Diedrich L, Brinkmann M, Dreier M, Rossol S, Schramm W, Krauth C. Is there a place for sigmoidoscopy in colorectal cancer screening? A systematic review and critical appraisal of cost-effectiveness models. PLoS One 2023; 18:e0290353. [PMID: 37594967 PMCID: PMC10438011 DOI: 10.1371/journal.pone.0290353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/05/2023] [Indexed: 08/20/2023] Open
Abstract
INTRODUCTION Screening for colorectal cancer (CRC) is effective in reducing both incidence and mortality. Colonoscopy and stool tests are most frequently used for this purpose. Sigmoidoscopy is an alternative screening measure with a strong evidence base. Due to its distinct characteristics, it might be preferred by subgroups. The aim of this systematic review is to analyze the cost-effectiveness of sigmoidoscopy for CRC screening compared to other screening methods and to identify influencing parameters. METHODS A systematic literature search for the time frame 01/2010-01/2023 was conducted using the databases MEDLINE, Embase, EconLit, Web of Science, NHS EED, as well as the Cost-Effectiveness Registry. Full economic analyses examining sigmoidoscopy as a screening measure for the general population at average risk for CRC were included. Incremental cost-effectiveness ratios were calculated. All included studies were critically assessed based on a questionnaire for modelling studies. RESULTS Twenty-five studies are included in the review. Compared to no screening, sigmoidoscopy is a cost-effective screening strategy for CRC. When modelled as a single measure strategy, sigmoidoscopy is mostly dominated by colonoscopy or modern stool tests. When combined with annual stool testing, sigmoidoscopy in 5-year intervals is more effective and less costly than the respective strategies alone. The results of the studies are influenced by varying assumptions on adherence, costs, and test characteristics. CONCLUSION The combination of sigmoidoscopy and stool testing represents a cost-effective screening strategy that has not received much attention in current guidelines. Further research is needed that goes beyond a narrow focus on screening technology and models different, preference-based participation behavior in subgroups.
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Affiliation(s)
- Leonie Diedrich
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Melanie Brinkmann
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Maren Dreier
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Siegbert Rossol
- Department of Internal Medicine, Krankenhaus Nordwest, Frankfurt/M, Germany
| | - Wendelin Schramm
- GECKO Institute for Medicine, Informatics and Economics, Heilbronn University, Heilbronn, Germany
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
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Abstract
Colorectal cancer (CRC) is characterized by genetic-environmental interplay leading to diffuse changes in the entire colonic mucosa (field carcinogenesis or field of injury) and to a pro-neoplastic genetic/epigenetic/physiological milieu. The clinical consequences are increased risk of synchronous and metachronous neoplasia. Factors such as genetics, race, ethnicity, age, and socioeconomic status are thought to influence neoplasia development. Here, we explore the potential improvement to CRC screening through exploiting field carcinogenesis, with particular focus on racial disparities and chemoprevention strategies. Also, we discuss future directions for field carcinogenesis/risk stratification using molecular and novel biophotonic techniques for personalized CRC screening.
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Adhikari P, Shukla PK, Ghimire HM, Hasan M, Sahay P, Almabadi H, Tripathi V, Skalli O, Rao R, Pradhan P. TEM study of chronic alcoholism effects on early carcinogenesis by probing the nanoscale structural alterations of cell nuclei. Phys Biol 2021; 18:026001. [PMID: 33207323 DOI: 10.1088/1478-3975/abcbdd] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nanoscale structural alteration in the nuclei of cells with the progression of carcinogenesis is due to the rearrangements of the basic building blocks in the cell such as DNA, RNA, lipids, etc. Although epigenetic modifications underlie the development of cancer, exposure to carcinogenic chemicals such as alcohol also enhances the development of cancer. We report the effects of chronic alcoholism on early-carcinogenesis based on changes in the degree of nanoscale structural alterations (L d) in nuclei. For this, transmission electron microscopy (TEM) imaging of the nuclei of colonic cells is performed for the following four mouse models: control mice; chronic alcoholic mice treated with ethanol (i.e., EtOH mice); mice treated with colonic carcinogen azoxymethane (AOM) and dextran sulfate sodium (DSS) that induced colitis (i.e., AOM + DSS mice); and chronic alcoholic or EtOH treated mice, together with AOM and DSS treatment (i.e., AOM + DSS + EtOH mice). The disordered optical lattices are constructed from their respective TEM images of thin colonic cell nuclei and the L d values are calculated using the inverse participation ratio (IPR) technique from the spatially localized eigenfunctions of these lattices. Results show no significant difference in the average L d value of the colon cell nuclei of alcohol treated mice relative to its control [i.e., L d(C) ∼ L d(EtOH)]; however, an increase in the L d value of alcohol treated precancerous cells [i.e., L d(AOM + DSS + EtOH) > L d(AOM + DSS)], indicating that alcohol accelerates the early carcinogenic process.
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Affiliation(s)
- Prakash Adhikari
- Department of Physics and Astronomy, Mississippi State University, Mississippi State, MS 39762, United States of America. These authors contributed equally to the work
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Coghlan E, Laferrere L, Zenon E, Marini JM, Rainero G, San Roman A, Posadas Martinez ML, Nadales A. Timed screening colonoscopy: a randomized trial of two colonoscopic withdrawal techniques. Surg Endosc 2019; 34:1200-1205. [PMID: 31144121 DOI: 10.1007/s00464-019-06873-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 05/21/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Eduardo Coghlan
- Department of Gastroenterology, Hospital Universitario Austral, Buenos Aires, Argentina.
| | - Luis Laferrere
- Department of Gastroenterology, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Elisa Zenon
- Department of Gastroenterology, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Juan Manuel Marini
- Department of Gastroenterology, Hospital Universitario Austral, Buenos Aires, Argentina
| | - German Rainero
- Department of Gastroenterology, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Alberto San Roman
- Department of Pathology, Hospital Universitario Austral, Buenos Aires, Argentina
| | | | - Angel Nadales
- Department of Gastroenterology, Hospital Universitario Austral, Buenos Aires, Argentina
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The Association between Distal Findings and Proximal Colorectal Neoplasia: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2017; 112:1234-1245. [PMID: 28555635 DOI: 10.1038/ajg.2017.130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/01/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Whether screening participants with distal hyperplastic polyps (HPs) detected by flexible sigmoidoscopy (FS) should be followed by subsequent colonoscopy is controversial. We evaluated the association between distal HPs and proximal neoplasia (PN)/advanced proximal neoplasia (APN) in asymptomatic, average-risk patients. METHODS We searched Ovid Medline, EMBASE, and the Cochrane Library from inception to 30 June 2016 and included all screening studies that examined the relationship between different distal findings and PN/APN. Data were independently extracted by two reviewers with disagreements resolved by a third reviewer. We pooled absolute risks and odds ratios (ORs) with a random effects meta-analysis. Seven subgroup analyses were performed according to study characteristics. Heterogeneity was characterized with the I2 statistics. RESULTS We analyzed 28 studies (104,961 subjects). When compared with normal distal findings, distal HP was not associated with PN (OR=1.16, 95% confidence interval (CI)=0.89-1.51, P=0.14, I2=40%) or APN (OR=1.09, 95% CI=0.87-1.36, P=0.39, I2=5%), while subjects with distal non-advanced or advanced adenoma had higher odds of PN/APN. Higher odds of PN/APN were observed for more severe distal lesions. Weaker association between distal and proximal findings was noticed in studies with higher quality, larger sample size, population-based design, and more stringent endoscopy quality-control measures. The Egger's regression tests showed all P>0.05. CONCLUSIONS Distal HP is not associated with PN/APN in asymptomatic screening population when compared with normal distal findings. Hence, the presence of distal HP alone detected by FS does not automatically indicate colonoscopy referral for all screening participants, as other risk factors of PN/APN should be considered.
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Roy HK, Turzhitsky V, Wali R, Radosevich AJ, Jovanovic B, Della'Zanna G, Umar A, Rubin DT, Goldberg MJ, Bianchi L, De La Cruz M, Bogojevic A, Helenowski IB, Rodriguez L, Chatterton R, Skripkauskas S, Page K, Weber CR, Huang X, Richmond E, Bergan RC, Backman V. Spectral biomarkers for chemoprevention of colonic neoplasia: a placebo-controlled double-blinded trial with aspirin. Gut 2017; 66:285-292. [PMID: 26503631 PMCID: PMC5108693 DOI: 10.1136/gutjnl-2015-309996] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE A major impediment to translating chemoprevention to clinical practice has been lack of intermediate biomarkers. We previously reported that rectal interrogation with low-coherence enhanced backscattering spectroscopy (LEBS) detected microarchitectural manifestations of field carcinogenesis. We now wanted to ascertain if reversion of two LEBS markers spectral slope (SPEC) and fractal dimension (FRAC) could serve as a marker for chemopreventive efficacy. DESIGN We conducted a multicentre, prospective, randomised, double-blind placebo-controlled, clinical trial in subjects with a history of colonic neoplasia who manifested altered SPEC/FRAC in histologically normal colonic mucosa. Subjects (n=79) were randomised to 325 mg aspirin or placebo. The primary endpoint changed in FRAC and SPEC spectral markers after 3 months. Mucosal levels of prostaglandin E2 (PGE2) and UDP-glucuronosyltransferase (UGT)1A6 genotypes were planned secondary endpoints. RESULTS At 3 months, the aspirin group manifested alterations in SPEC (48.9%, p=0.055) and FRAC (55.4%, p=0.200) with the direction towards non-neoplastic status. As a measure of aspirin's pharmacological efficacy, we assessed changes in rectal PGE2 levels and noted that it correlated with SPEC and FRAC alterations (R=-0.55, p=0.01 and R=0.57, p=0.009, respectively) whereas there was no significant correlation in placebo specimens. While UGT1A6 subgroup analysis did not achieve statistical significance, the changes in SPEC and FRAC to a less neoplastic direction occurred only in the variant consonant with epidemiological evidence of chemoprevention. CONCLUSIONS We provide the first proof of concept, albeit somewhat underpowered, that spectral markers reversion mirrors antineoplastic efficacy providing a potential modality for titration of agent type/dose to optimise chemopreventive strategies in clinical practice. TRIAL NUMBER NCT00468910.
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Affiliation(s)
- Hemant K Roy
- Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Vladimir Turzhitsky
- Department of Biomedical Engineering, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Ramesh Wali
- Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Andrew J Radosevich
- Department of Biomedical Engineering, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Borko Jovanovic
- Department of Preventive Medicine, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Gary Della'Zanna
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA
| | - Asad Umar
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA
| | - David T Rubin
- Department of Medicine, The University of Chicago Medical Center, Chicago, Illinois, USA
| | - Michael J Goldberg
- Department of Medicine, NorthShore University Health Systems, Evanston, Illinois, USA
| | - Laura Bianchi
- Department of Medicine, NorthShore University Health Systems, Evanston, Illinois, USA
| | - Mart De La Cruz
- Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Andrej Bogojevic
- Department of Medicine, NorthShore University Health Systems, Evanston, Illinois, USA
| | - Irene B Helenowski
- Department of Preventive Medicine, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Luz Rodriguez
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA
| | - Robert Chatterton
- Department of Obstetrics and Gynecology, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Silvia Skripkauskas
- Department of Medicine, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Katherine Page
- Department of Medicine, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Christopher R Weber
- Department of Pathology, The University of Chicago Medical Center, Chicago, Illinois, USA
| | - Xiaoke Huang
- Department of Medicine, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Ellen Richmond
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA
| | - Raymond C Bergan
- Department of Medicine, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Vadim Backman
- Department of Biomedical Engineering, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
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Abstract
PURPOSE OF REVIEW Despite the large investment of resources from screening, the fact that colorectal cancer remains the second leading cause of cancer deaths among Americans underscores the need for alternative strategies. Thus, a major clinical and research imperative is personalize clinical care, while focusing on risk stratification for screening, surveillance, chemoprevention, and therapeutic intervention. RECENT FINDINGS A complicating factor that colorectal cancer is biologically heterogeneous for at least four consensus molecular subtypes presents clear challenges for developing robust molecular biomarkers. SUMMARY The purpose of the review is to discuss the genetics and molecular biology of colonic neoplasia, high and low penetrance, and racial disparities in colonic neoplasia. Finally, we put forth the emerging concept of greater genomic landscape and the idea of chromatin protection therapy as a novel adjuvant to chemotherapy.
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Ruco A, Stock D, Hilsden RJ, McGregor SE, Paszat LF, Saskin R, Rabeneck L. Evaluation of a risk index for advanced proximal neoplasia of the colon. Gastrointest Endosc 2016; 81:1427-32. [PMID: 25771065 DOI: 10.1016/j.gie.2014.12.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/07/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND A clinical risk index that uses distal colorectal findings at flexible sigmoidoscopy (FS) in conjunction with easily determined risk factors for advanced proximal neoplasia (APN) may be useful for tailoring or prioritizing screening with colonoscopy. OBJECTIVE To conduct an external evaluation of a previously published risk index in a large, well-characterized cohort. DESIGN Cross-sectional. SETTING Teaching hospital and colorectal cancer screening center. PATIENTS A total of 5139 asymptomatic persons aged 50 to 74 (54.9% women) with a mean age (±SD) of 58.3 (±6.2) years. INTERVENTIONS Between 2003 and 2011, all participants underwent a complete screening colonoscopy and removal of all polyps. MAIN OUTCOME MEASUREMENTS Participants were classified as low, intermediate, or high risk for APN, based on their composite risk index scores. The concordance or c-statistic was used to measure discriminating ability of the risk index. RESULTS A total of 167 persons (3.2%) had APN. The prevalence of those with APN among low-, intermediate-, and high-risk categories was 2.1%, 2.9%, and 6.5%, respectively. High-risk individuals were 3.2 times more likely to have APN compared with those in the low-risk category. The index did not discriminate well between those in the low- and intermediate-risk categories. The c-statistic for the overall index was 0.62 (95% confidence interval, 0.58-0.66). LIMITATIONS Distal colorectal findings were derived from colonoscopies and not FS itself. CONCLUSION The risk index discriminated between those at low risk and those at high risk, but it had limited ability to discriminate between low- and intermediate-risk categories for prevalent APN. Information on other risk factors may be needed to tailor, or prioritize, access to screening colonoscopy.
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Affiliation(s)
- Arlinda Ruco
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - David Stock
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | - S Elizabeth McGregor
- Population, Public & Aboriginal Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Lawrence F Paszat
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Refik Saskin
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Linda Rabeneck
- Institute for Clinical Evaluative Sciences, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Prevention and Cancer Control, Cancer Care Ontario, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
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12
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Association of distal hyperplastic polyps and proximal neoplastic lesions: a prospective study of 5613 subjects. Gastrointest Endosc 2016; 83:555-62. [PMID: 26253019 DOI: 10.1016/j.gie.2015.06.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 06/18/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Current evidence of whether distal hyperplastic polyps (HPs) are markers of proximal neoplasia (PN) is mixed. We evaluated the association between distal neoplasia and synchronous PN in asymptomatic subjects. METHODS We recruited 5819 Chinese asymptomatic screening participants 50 to 70 years of age who underwent colonoscopy in Hong Kong from 2008 to 2014, of whom 206 subjects with distal advanced neoplasia or cancer were excluded. The association between distal pathology (tubular adenomas [TAs], HPs, no polyps) and proximal pathology (PN, proximal advanced neoplasia [PAN]) was assessed by multivariate regression models, overall and stratified by the Asia Pacific Colorectal Screening scoring system (scores of 4-7, high risk; scores of 0-3, lower risk). RESULTS The prevalence of PN in the no distal polyps group, distal HPs group, and distal TAs group was 14.8%, 19.3%, and 29.4%, respectively. The corresponding prevalence of PAN was 1.8%, 3.2%, and 3.5%. Participants with distal HPs did not have significantly higher odds of PN (adjusted odds ratio [AOR] 1.24; 95% confidence interval [CI], 0.97-1.59; P = .089), and their association with PAN was marginally significant (AOR 1.77; 95% CI, 1.00-3.13; P = .052), except in lower risk subjects for whom the odds of PAN were marginally higher in the distal HPs group than the no distal polyps group (AOR 1.97; 95% CI, 1.01-3.85; P = .048). Overall, the distal polyps group had significantly lower odds of PN than the distal TAs group (AOR 0.55; 95% CI, 0.40-0.76; P < .001). The increased risk of PN and PAN among those with distal HPs was modest. CONCLUSIONS A direct association between distal HPs and PN is lacking, and this implies a need for a multivariate assessment of the risk of PAN. Recommending colonoscopy for every patient with distal HPs detected by screening sigmoidoscopy is not supported by this study.
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Ruco A, Stock D, Hilsden RJ, McGregor SE, Paszat LF, Saskin R, Rabeneck L. Evaluation of a clinical risk index for advanced colorectal neoplasia among a North American population of screening age. BMC Gastroenterol 2015; 15:162. [PMID: 26585867 PMCID: PMC4653881 DOI: 10.1186/s12876-015-0395-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/12/2015] [Indexed: 12/14/2022] Open
Abstract
Background A clinical risk index employing age, sex, family history of colorectal cancer (CRC), smoking history and body mass index (BMI) may be useful for prioritizing screening with colonoscopy. The aim of this study was to conduct an external evaluation of a previously published risk index for advanced neoplasia (AN) in a large, well-characterized cohort. Methods Five thousand one hundred thirty-seven asymptomatic persons aged 50 to 74 (54.9 % women) with a mean age (SD) of 58.3 (6.2) years were recruited for the study from a teaching hospital and colorectal cancer screening centre between 2003 and 2011. All participants underwent a complete screening colonoscopy and removal of all polyps. AN was defined as cancer or a tubular adenoma, traditional serrated adenoma (TSA), or sessile serrated adenoma (SSA) with villous characteristics (≥25% villous component), and/or high-grade dysplasia and/or diameter ≥10 mm. Risk scores for each participant were summed to derive an overall score (0–8). The c-statistic was used to measure discriminating ability of the risk index. Results The prevalence of AN in the study cohort was 6.8 %. The likelihood of detecting AN increased from 3.6 to 13.1 % for those with a risk score of 1 to 6 respectively. The c-statistic for the multivariable logistic model in our cohort was 0.64 (95 % CI = 0.61–067) indicating modest overlap between risk scores. Conclusions The risk index for AN using age, sex, family history, smoking history and BMI was found to be of limited discriminating ability upon external validation. The index requires further refinement to better predict AN in average risk persons of screening age.
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Affiliation(s)
- Arlinda Ruco
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - David Stock
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Robert J Hilsden
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
| | - S Elizabeth McGregor
- Alberta Health Services - Population, Public & Aboriginal Health, Calgary, AB, Canada.
| | - Lawrence F Paszat
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Refik Saskin
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
| | - Linda Rabeneck
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. .,Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, M5G 2L7, ON, Canada. .,Department of Medicine, University of Toronto, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Radosevich AJ, Mutyal NN, Eshein A, Nguyen TQ, Gould B, Rogers JD, Goldberg MJ, Bianchi LK, Yen EF, Konda V, Rex DK, Van Dam J, Backman V, Roy HK. Rectal Optical Markers for In Vivo Risk Stratification of Premalignant Colorectal Lesions. Clin Cancer Res 2015; 21:4347-4355. [PMID: 25991816 PMCID: PMC4592390 DOI: 10.1158/1078-0432.ccr-15-0136] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 05/04/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE Colorectal cancer remains the second leading cause of cancer deaths in the United States despite being eminently preventable by colonoscopy via removal of premalignant adenomas. In order to more effectively reduce colorectal cancer mortality, improved screening paradigms are needed. Our group pioneered the use of low-coherence enhanced backscattering (LEBS) spectroscopy to detect the presence of adenomas throughout the colon via optical interrogation of the rectal mucosa. In a previous ex vivo biopsy study of 219 patients, LEBS demonstrated excellent diagnostic potential with 89.5% accuracy for advanced adenomas. The objective of the current cross-sectional study is to assess the viability of rectal LEBS in vivo. EXPERIMENTAL DESIGN Measurements from 619 patients were taken using a minimally invasive 3.4-mm diameter LEBS probe introduced into the rectum via anoscope or direct insertion, requiring approximately 1 minute from probe insertion to withdrawal. The diagnostic LEBS marker was formed as a logistic regression of the optical reduced scattering coefficient [Formula: see text] and mass density distribution factor D. RESULTS The rectal LEBS marker was significantly altered in patients harboring advanced adenomas and multiple non-advanced adenomas throughout the colon. Blinded and cross-validated test performance characteristics showed 88% sensitivity to advanced adenomas, 71% sensitivity to multiple non-advanced adenomas, and 72% specificity in the validation set. CONCLUSIONS We demonstrate the viability of in vivo LEBS measurement of histologically normal rectal mucosa to predict the presence of clinically relevant adenomas throughout the colon. The current work represents the next step in the development of rectal LEBS as a tool for colorectal cancer risk stratification.
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Affiliation(s)
| | - Nikhil N. Mutyal
- Biomedical Engineering Department, Northwestern University, Evanston, Il
| | - Adam Eshein
- Biomedical Engineering Department, Northwestern University, Evanston, Il
| | - The-Quyen Nguyen
- Biomedical Engineering Department, Northwestern University, Evanston, Il
| | - Bradley Gould
- Biomedical Engineering Department, Northwestern University, Evanston, Il
| | - Jeremy D. Rogers
- Biomedical Engineering Department, University of Wisconsin, Madison, Wisconsin
| | - Michael J Goldberg
- Department of Medicine, NorthShore University HealthSystems, Evanston, Il
| | - Laura K Bianchi
- Department of Medicine, NorthShore University HealthSystems, Evanston, Il
| | - Eugene F. Yen
- Department of Medicine, NorthShore University HealthSystems, Evanston, Il
| | - Vani Konda
- Center for Endoscopic Research and Therapeutics, University of Chicago Medicine, Chicago, IL
| | - Douglas K. Rex
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jacques Van Dam
- Advanced Digestive Health Center, University of Southern California Medical Center, Los Angeles, CA
| | - Vadim Backman
- Biomedical Engineering Department, Northwestern University, Evanston, Il
| | - Hemant K. Roy
- Department of Medicine, Boston University, Boston, Massachusetts
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15
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High-resolution microendoscopy in differentiating neoplastic from non-neoplastic colorectal polyps. Best Pract Res Clin Gastroenterol 2015; 29:663-73. [PMID: 26381310 PMCID: PMC4578798 DOI: 10.1016/j.bpg.2015.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 04/16/2015] [Accepted: 05/20/2015] [Indexed: 01/31/2023]
Abstract
Colorectal cancer is one of the leading causes of death worldwide. The progression from adenoma to cancer is a well known phenomenon. Current clinical practice favors colonoscopy as the preferred modality for colorectal cancer screening. Many novel endoscopic technologies are emerging for the purposes of performing "optical biopsy" to allow real-time histologic diagnosis of polyps. High resolution microendoscopy is a low-cost endoscopic technology that has demonstrated high sensitivity and specificity in differentiating neoplastic and non-neoplastic polyps. With the ability to make real-time conclusions based on the endoscopic appearance of polyps, it is becoming increasingly possible to decrease the rate of unnecessary polypectomies and utilize a "resect and discard" strategy to decrease costs of pathology evaluation. Future directions for this technology include surveillance of premalignant conditions such as inflammatory bowel disease. Moreover, the low cost and relative ease of use of this technology lends itself to widespread applicability.
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Abstract
GOALS Our study reexamines the prevalence of interval colorectal cancer (I-CRC) by manually reviewing CRC cases at a single institution. BACKGROUND In 2% to 8% of patients with CRC, diagnosis occurs during the interval 6 to 36 months after a cancer-free colonoscopy. Rates are often determined by linking the date of colonoscopy with cancer registry information. STUDY We examined all colonoscopies from 1993 to 2011. These examinations were linked with Pennsylvania Cancer Registry data. Matched charts were manually reviewed. We determined whether the CRC was "prevalent" or, for patients with a previous colonoscopy, whether they were interval or noninterval based on time from last colonoscopy. For interval cases, we identified "administrative errors" that could falsely increase the number of reported I-CRC. RESULTS Over the study period, 43,661 colonoscopies were performed, with 1147 (2.6%) positive for CRC after excluding cases (n=52) in which patients had IBD, previous surgery, or nonadenocarcinoma malignancy. Prevalent CRCs totaled 1062 (92.6%). Noninterval CRCs (diagnosed over 36 mo from index colonoscopy) were present in 40 (3.5%). There remained 45 (3.9%) potential I-CRC cases. However, after manual review, 21 cases were found to be administrative errors. Therefore, the accurate proportion of colonoscopies that found an I-CRC was 2.1% (95% confidence interval, 1.5%-3.2%). CONCLUSIONS The prevalence of I-CRC at our institution before adjustment was comparable with previously reported rates. This proportion was 47% lower after adjusting for administrative errors placing our figure at the lower end of reported I-CRC incidence. Reported rates of I-CRC may be falsely elevated due to errors unique to merging administrative databases.
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17
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Advanced proximal neoplasia of the colon in average-risk adults. Gastrointest Endosc 2014; 80:660-667. [PMID: 24679656 DOI: 10.1016/j.gie.2014.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/03/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Estimating risk for advanced proximal neoplasia (APN) based on distal colon findings can help identify asymptomatic persons who should undergo examination of the proximal colon after flexible sigmoidoscopy (FS) screening. OBJECTIVE We aimed to determine the risk of APN by most advanced distal finding among an average-risk screening population. DESIGN Prospective, cross-sectional study. SETTING Teaching hospital and colorectal cancer screening center. PATIENTS A total of 4651 asymptomatic persons at average risk for colorectal cancer aged 50 to 74 years (54.4% women [n = 2529] with a mean [± standard deviation] age of 58.4 ± 6.2 years). INTERVENTIONS All participants underwent a complete colonoscopy, including endoscopic removal of all polyps. MAIN OUTCOME MEASUREMENTS We explored associations between several risk factors and APN. Logistic regression was used to identify independent predictors of APN. RESULTS A total of 142 persons (3.1%) had APN, of whom 85 (1.8%) had isolated APN (with no distal findings). APN was associated with older age, a BMI >27 kg/m(2), smoking, distal advanced adenoma and/or cancer, and distal non-advanced tubular adenoma. Those with a distal advanced neoplasm were more than twice as likely to have APN compared with those without distal lesions. LIMITATIONS Distal findings used to estimate risk of APN were derived from colonoscopy rather than FS itself. CONCLUSION In persons at average risk for colorectal cancer, the prevalence of isolated APN was low (1.8%). Use of distal findings to predict APN may not be the most effective strategy. However, incorporating factors such as age (>65 years), sex, BMI (>27 kg/m(2)), and smoking status, in addition to distal findings, should be considered for tailoring colonoscopy recommendations. Further evaluation of risk stratification approaches in other asymptomatic screening populations is warranted.
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Tárraga López PJ, Albero JS, Rodríguez-Montes JA. Primary and secondary prevention of colorectal cancer. CLINICAL MEDICINE INSIGHTS. GASTROENTEROLOGY 2014; 7:33-46. [PMID: 25093007 PMCID: PMC4116379 DOI: 10.4137/cgast.s14039] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 02/25/2014] [Accepted: 03/02/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Cancer is a worldwide problem as it will affect one in three men and one in four women during their lifetime. Colorectal cancer (CRC) is the third most frequent cancer in men, after lung and prostate cancer, and is the second most frequent cancer in women after breast cancer. It is also the third cause of death in men and women separately, and is the second most frequent cause of death by cancer if both genders are considered together. CRC represents approximately 10% of deaths by cancer. Modifiable risk factors of CRC include smoking, physical inactivity, being overweight and obesity, eating processed meat, and drinking alcohol excessively. CRC screening programs are possible only in economically developed countries. However, attention should be paid in the future to geographical areas with ageing populations and a western lifestyle.19,20 Sigmoidoscopy screening done with people aged 55–64 years has been demonstrated to reduce the incidence of CRC by 33% and mortality by CRC by 43%. OBJECTIVE To assess the effect on the incidence and mortality of CRC diet and lifestyle and to determine the effect of secondary prevention through early diagnosis of CRC. METHODOLOGY: A comprehensive search of Medline and Pubmed articles related to primary and secondary prevention of CRC and subsequently, a meta-analysis of the same blocks are performed. RESULTS 225 articles related to primary or secondary prevention of CRC were retrieved. Of these 145 were considered valid on meta-analysis: 12 on epidemiology, 56 on diet and lifestyle, and over 77 different screenings for early detection of CRC. Cancer is a worldwide problem as it will affect one in three men and one in four women during their lifetime. There is no doubt whatsoever which environmental factors, probably diet, may account for these cancer rates. Excessive alcohol consumption and cholesterol-rich diet are associated with a high risk of colon cancer. A diet poor in folic acid and vitamin B6 is also associated with a higher risk of developing colon cancer with an overexpression of p53. Eating pulses at least three times a week lowers the risk of developing colon cancer by 33%, after eating less meat, while eating brown rice at least once a week cuts the risk of CRC by 40%. These associations suggest a dose–response effect. Frequently eating cooked green vegetables, nuts, dried fruit, pulses, and brown rice has been associated with a lower risk of colorectal polyps. High calcium intake offers a protector effect against distal colon and rectal tumors as compared with the proximal colon. Higher intake of dairy products and calcium reduces the risk of colon cancer. Taking an aspirin (ASA) regularly after being diagnosed with colon cancer is associated with less risk of dying from this cancer, especially among people who have tumors with COX-2 overexpression.16 Nonetheless, these data do not contradict the data obtained on a possible genetic predisposition, even in sporadic or non-hereditary CRC. CRC is susceptible to screening because it is a serious health problem given its high incidence and its associated high morbidity/mortality. CONCLUSIONS (1) Cancer is a worldwide problem. (2) A modification of diet and lifestyle could reduce morbidity and mortality. (3) Early detection through screening improves prognosis and reduces mortality.
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Affiliation(s)
- Pedro J Tárraga López
- Integrated Management, Hospital Universitario de Albacete, Albacete, Spain. ; University of Castille-La Mancha, Albacete, Spain
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19
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Świątkowski M, Meder A, Sobczyński L, Koza J, Szamocka M, Brudny J, Korenkiewicz J. Serrated polyps detected during screening colonoscopies. Contemp Oncol (Pozn) 2014; 18:54-9. [PMID: 24876822 PMCID: PMC4037994 DOI: 10.5114/wo.2014.40435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/21/2013] [Accepted: 07/16/2013] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY It is estimated that between 15% and 35% of sporadic colorectal cancers (CRC) developing from adenomas come from serrated polyps. Currently, the most effective method used to prevent CRC is the removal of adenomas, including serrated polyps, during colonoscopy. The aim of this paper is to analyze the changes characterized as serrated polyps and detected during screening colonoscopies performed as part of the Screening Program for Early Colorectal Cancer Detection (SPED). MATERIAL AND METHODS In our center, as part of the nationwide SPED between 2000 and 2009, 1,442 screening colonoscopies were performed. RESULTS Serrated polyps were found in 11.9% of all patients and in 45.8% of patients who had polyps removed by endoscopy. In screening colonoscopy of the large intestine, the following polyps were found most frequently: hyperplastic, < 1 cm, without a stalk, multiple, located in the distal part of the large intestine, in men and in patients with a first-degree relative with a history of abdominal cancer. Detecting and removing polyps was facilitated by the fact that the cecum was intubated and the bowel preparation had been performed either very well or well. The detection rate of serrated polyps was not influenced by patients' place of residence or their age. CONCLUSIONS Serrated polyps constitute a frequent, and very frequent among removed polyps, abnormality detected during screening colonoscopy.
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Affiliation(s)
- Maciej Świątkowski
- Chair and Department of Gastroenterology, Vascular and Internal Diseases, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland
| | - Agnieszka Meder
- Chair and Department of Gastroenterology, Vascular and Internal Diseases, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland
| | - Lesław Sobczyński
- Chair and Department of Gastroenterology, Vascular and Internal Diseases, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland
| | - Jarosław Koza
- Chair and Department of Gastroenterology, Vascular and Internal Diseases, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland
| | - Małgorzata Szamocka
- Chair and Department of Gastroenterology, Vascular and Internal Diseases, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland
| | - Janina Brudny
- Chair and Department of Gastroenterology, Vascular and Internal Diseases, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland
| | - Jadwiga Korenkiewicz
- Division of Pathomorphology, Dr Jan Biziel University Hospital No. 2 in Bydgoszcz, Poland
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20
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Imperiale TF. Sigmoidoscopy Screening: Understanding the Trade-off Between Detection of Advanced Neoplasia and Diagnostic Efficiency. ACTA ACUST UNITED AC 2013; 105:846-8. [DOI: 10.1093/jnci/djt132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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21
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Screening for Colorectal Cancer: When, how, and by Whom? CURRENT COLORECTAL CANCER REPORTS 2013. [DOI: 10.1007/s11888-012-0150-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Joo SK, Kim JW, Lee KL, Kim BG, Jeong JB, Lee JK, Koh SJ, Kim YH. The Incidence and Clinical Characteristics of Proximal Colonic Polyps When the Polyps Are Noted on Rectosigmoid Colon by Colonoscopy. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2013; 62:42-8. [DOI: 10.4166/kjg.2013.62.1.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sae Kyung Joo
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Won Kim
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kook Lae Lee
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Byeong Gwan Kim
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Bong Jeong
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Kyung Lee
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Seong-Joon Koh
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hoon Kim
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Lee BI, Hong SP, Kim SE, Kim SH, Kim HS, Hong SN, Yang DH, Shin SJ, Lee SH, Kim YH, Park DI, Kim HJ, Yang SK, Kim HJ, Jeon HJ. [Korean guidelines for colorectal cancer screening and polyp detection]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 59:65-84. [PMID: 22387833 DOI: 10.4166/kjg.2012.59.2.65] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Colorectal cancer is the second most common cancer in males and the fourth most common in females in Korea. Since the most of colorectal cancer occur through the prolonged transformation of adenomas into carcinomas, early detection and removal of colorectal adenomas are one of the most effective methods to prevent colorectal cancer. Considering the increasing incidence of colorectal cancer and polyps in Korea, it is very important to establish Korean guideline for colorectal cancer screening and polyp detection. Korean Multi-Society Take Force developed the guidelines with evidence-based methods. Parts of the statements drawn by systematic reviews and meta-analyses. Herein we discussed the epidemiology of colorectal cancers and adenomas in Korea, optimal screening methods for colorectal cancer, and detection for adenomas including fecal occult blood tests, radiologic tests, and endoscopic examinations.
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Affiliation(s)
- Bo In Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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24
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Dutta P, Bhansali A, Vaiphei K, Dutta U, Ravi Kumar P, Masoodi S, Mukherjee KK, Varma A, Kochhar R. Colonic neoplasia in acromegaly: increased proliferation or deceased apoptosis? Pituitary 2012; 15:166-73. [PMID: 21451936 DOI: 10.1007/s11102-011-0300-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients with acromegaly have higher prevalence of colorectal neoplasms. The pathogenetic mechanism is still unclear and may be related to sustained increase in serum GH-IGF1. We aimed to evaluate the proliferative and apoptotic markers in samples of colonic mucosa obtained during screening colonoscopic biopsy from patients with acromegaly and study their relationship to serum IGF-1 and GH levels. The study subjects included 32 patients with acromegaly (4 female), 10 healthy controls (irritable bowel syndrome) and 10 positive controls (non-acromegalic colonic adenocarcinoma). Patients with acromegaly were divided into two groups, active disease (AD) and disease in remission (AR). Two biopsies each were obtained during colonoscopy from the right colon, transverse colon and rectosigmoid region. All the polyps were biopsied and subjected to histopathological examination. Immunohistochemistry for proliferation marker (Ki-67) and apoptotic markers (caspase-3 and TdT-Mediated dUTP Nick-End Labeling (TUNEL) was carried out in the histopathological samples. Indices of proliferation were significantly different in patients with acromegaly as compared to healthy controls. The mean Ki-67 positivity was 45.1 ± 17.7% in AD and 45.6 ± 23.1% in AR, as compared to 10 ± 5% in healthy controls. While none of the healthy controls had Ki-67 positivity beyond the lower third of crypts, among patients with acromegaly 12/32 (37.5%) had mid-third positivity (P = 0.000) and 15/32 (46.8%) had full length of crypt positively (P = 0.00). Immunostaining for caspase-3 was negative in patients with acromegaly and healthy controls. TUNEL was strongly positive in patients with colonic adenocarcinoma but not in healthy controls and patients with acromegaly. IGF-1 levels were higher in those with Ki-67 positivity in the superficial mucosa. Patients with acromegaly have increased proliferation of colonic epithelial cells. Elevated levels of serum IGF1 are associated with increase proliferation in the superficial crypt cells.
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Affiliation(s)
- Pinaki Dutta
- Departments of Endocinology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Damania D, Roy HK, Subramanian H, Weinberg DS, Rex DK, Goldberg MJ, Muldoon J, Cherkezyan L, Zhu Y, Bianchi LK, Shah D, Pradhan P, Borkar M, Lynch H, Backman V. Nanocytology of rectal colonocytes to assess risk of colon cancer based on field cancerization. Cancer Res 2012; 72:2720-7. [PMID: 22491589 DOI: 10.1158/0008-5472.can-11-3807] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Developing a minimally invasive and cost-effective prescreening strategy for colon cancer is critical because of the impossibility of conducting colonoscopy on the entire at-risk population. The concept of field carcinogenesis, in which normal-appearing tissue away from a tumor has molecular and, consequently, nano-architectural abnormalities, offers one attractive approach to identify high-risk patients. In this study, we investigated whether the novel imaging technique partial wave spectroscopic (PWS) microscopy could risk-stratify patients harboring precancerous lesions of the colon, using an optically measured biomarker (L(d)) obtained from microscopically normal but nanoscopically altered cells. Rectal epithelial cells were examined from 146 patients, including 72 control patients, 14 patients with diminutive adenomas, 20 patients with nondiminutive/nonadvanced adenomas, 15 patients with advanced adenomas/high-grade dysplasia, 12 patients with genetic mutation leading to Lynch syndrome, and 13 patients with cancer. We found that the L(d) obtained from rectal colonocytes was well correlated with colon tumorigenicity in our patient cohort and in an independent validation set of 39 additional patients. Therefore, our findings suggest that PWS-measured L(d) is an accurate marker of field carcinogenesis. This approach provides a potential prescreening strategy for risk stratification before colonoscopy.
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Affiliation(s)
- Dhwanil Damania
- Biomedical Engineering Department, Northwestern University, Evanston, Illinois, USA
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26
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Gomes AJ, Ruderman S, DelaCruz M, Wali RK, Roy HK, Backman V. In vivo measurement of the shape of the tissue-refractive-index correlation function and its application to detection of colorectal field carcinogenesis. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:047005. [PMID: 22559696 PMCID: PMC3382344 DOI: 10.1117/1.jbo.17.4.047005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Polarization-gated spectroscopy is an established method to depth-selectively interrogate the structural properties of biological tissue. We employ this method in vivo in the azoxymethane (AOM)-treated rat model to monitor the morphological changes that occur in the field of a tumor during early carcinogenesis. The results demonstrate a statistically significant change in the shape of the refractive-index correlation function for AOM-treated rats versus saline-treated controls. Since refractive index is linearly proportional to mass density, these refractive-index changes can be directly linked to alterations in the spatial distribution patterns of macromolecular density. Furthermore, we found that alterations in the shape of the refractive-index correlation function shape were an indicator of both present and future risk of tumor development. These results suggest that noninvasive measurement of the shape of the refractive-index correlation function could be a promising marker of early cancer development.
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Affiliation(s)
- Andrew J. Gomes
- Northwestern University, Department of Biomedical Engineering, Evanston, Illinois 60218
| | - Sarah Ruderman
- Northwestern University, Department of Biomedical Engineering, Evanston, Illinois 60218
| | - Mart DelaCruz
- NorthShore University Health System, Department of Internal Medicine, Evanston, Illinois 60218
| | - Ramesh K. Wali
- NorthShore University Health System, Department of Internal Medicine, Evanston, Illinois 60218
| | - Hemant K. Roy
- NorthShore University Health System, Department of Internal Medicine, Evanston, Illinois 60218
| | - Vadim Backman
- Northwestern University, Department of Biomedical Engineering, Evanston, Illinois 60218
- Address all correspondence to: Vadim Backman, Northwestern University, Department of Biomedical Engineering, 2145 Sheridan Road, BME-E310, Evanston, Illinois 60218. Tel: +847 4913536; Fax: +847 4914928; E-mail:
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27
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Lee BI, Hong SP, Kim SE, Kim SH, Kim HS, Hong SN, Yang DH, Shin SJ, Lee SH, Park DI, Kim YH, Kim HJ, Yang SK, Kim HJ, Jeon HJ. Korean guidelines for colorectal cancer screening and polyp detection. Clin Endosc 2012; 45:25-43. [PMID: 22741131 PMCID: PMC3363119 DOI: 10.5946/ce.2012.45.1.25] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Revised: 01/17/2012] [Accepted: 01/17/2012] [Indexed: 12/15/2022] Open
Abstract
Now colorectal cancer is the second most common cancer in males and the fourth most common cancer in females in Korea. Since most of colorectal cancers occur after the prolonged transformation of adenomas into carcinomas, early detection and removal of colorectal adenomas are one of the most effective methods to prevent colorectal cancer. Considering the increasing incidence of colorectal cancer and polyps in Korea, it is very important to establish Korean guideline for colorectal cancer screening and polyp detection. The guideline was developed by the Korean Multi-Society Take Force and we tried to establish the guideline by evidence-based methods. Parts of the statements were draw by systematic reviews and meta-analyses. Herein we discussed epidemiology of colorectal cancers and adenomas in Korea and optimal methods for screening of colorectal cancer and detection of adenomas including fecal occult blood tests, radiologic tests, and endoscopic examinations.
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Affiliation(s)
- Bo-In Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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The relationship between distal and proximal colonic neoplasia: a meta-analysis. J Gen Intern Med 2012; 27:361-70. [PMID: 22065335 PMCID: PMC3286557 DOI: 10.1007/s11606-011-1919-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 09/29/2011] [Accepted: 10/03/2011] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate the association between proximal colonic neoplasia and distal lesions as a function of the lesion type. The extent to which health, demographic, and study characteristics moderate this association was also examined. DATA SOURCES Google Scholar, Web of Science, Scopus, and PubMed. STUDY ELIGIBILITY CRITERIA Studies allowing the calculation of OR of proximal neoplasia (PN) and proximal advanced neoplasia (PAN) for distal hyperplastic polyps (HP), nonadvanced adenomas (NAA), adenomas (AD), and advanced neoplasia (AN); also, studies for which the proportions of subjects with isolated (i.e., not accompanied by distal lesions) PN (IPN) and PAN (IPAN) over the total number of subjects with PN or PAN could be calculated. STUDY APPRAISAL AND SYNTHESIS METHODS Thirty-two studies were included for calculating OR between proximal neoplasia and distal lesions and 40 studies for proportions of IPN and IPAN. Subgroup analyses were conducted for presence of symptoms, prevalence of PN and PAN, age, proportion of males, geographic region, study design, and demarcation point. RESULTS The association between distal lesions and proximal neoplasia increased with the severity of the distal lesions. Odds of PN were higher in subjects with HP compared to subjects with a normal distal colon. Odds of PN and PAN were higher in subjects with NAA, AD, and AN than in subjects with a normal distal colon. PAN were more strongly associated with distal lesions in asymptomatic populations, in young populations, and in populations with a low prevalence of PAN. In approximately 60% of the subjects with PN and PAN, these neoplasia were isolated. LIMITATIONS The present results may be affected by publication bias and dichotomization in the subgroup analyses. Limitations related to the individual studies include self-selection, lesion misclassification and misses, and technological advances leading to changes in the detection of lesions during the time span of the included studies. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS All types of distal lesions are predictive of PN. All types of distal neoplasia are predictive of PAN. The association between distal lesions and proximal neoplasia increases with the severity of the distal lesion. The association between distal lesions and proximal advanced neoplasia is stronger in low-risk groups as compared to high-risk groups.
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Lee BI, Hong SP, Kim SE, Kim SH, Kim HS, Hong SN, Yang DH, Shin SJ, Lee SH, Kim YH, Park DI, Kim HJ, Yang SK, Kim HJ, Jeon HJ. Korean Guidelines for Colorectal Cancer Screening and Polyp Detection. Intest Res 2012. [DOI: 10.5217/ir.2012.10.1.67] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Affiliation(s)
- Bo In Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung Pil Hong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seong-Eun Kim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Soo Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Noh Hong
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Jae Shin
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Suck-Ho Lee
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Young-Ho Kim
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Il Park
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyo Jong Kim
- Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, Korea
| | - Hae Jeong Jeon
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
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Kim SE, Hong SP, Kim HS, Lee BI, Kim SH, Hong SN, Yang DH, Lee SH, Shin SJ, Park DI, Kim YH, Yang SK, Kim HJ. A Korean National Survey for Colorectal Cancer Screening and Polyp Diagnosis Methods Using Web-based Survey. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 60:26-35. [DOI: 10.4166/kjg.2012.60.1.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Seong-Eun Kim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung Pil Hong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun-Soo Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Seoul, Korea
| | - Bo In Lee
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Noh Hong
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Ulsan University College of Medicine, Seoul, Korea
| | - Suck Ho Lee
- Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Seoul, Korea
| | - Sung Jae Shin
- Department of Gastroenterology, Ajou University School of Medicine, Seoul, Korea
| | - Dong Il Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Ho Kim
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Ulsan University College of Medicine, Seoul, Korea
| | - Hyo Jong Kim
- Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, Korea
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Khalid-de Bakker CAJ, Jonkers DMAE, Sanduleanu S, de Bruïne AP, Meijer GA, Janssen JBMJ, van Engeland M, Stockbrügger RW, Masclee AAM. Test performance of immunologic fecal occult blood testing and sigmoidoscopy compared with primary colonoscopy screening for colorectal advanced adenomas. Cancer Prev Res (Phila) 2011; 4:1563-71. [PMID: 21750209 DOI: 10.1158/1940-6207.capr-11-0076] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Given the current increase in colorectal cancer screening, information on performance of screening tests is needed, especially in groups with a presumed lower test performance. We compared test performance of immunologic fecal occult blood testing (FIT) and pseudosigmoidoscopy with colonoscopy for detection of advanced adenomas in an average risk screening population. In addition, we explored the influence of gender, age, and location on test performance. FIT was collected prior to colonoscopy with a 50 ng/mL cutoff point. FIT results and complete colonoscopy findings were available from 329 subjects (mean age: 54.6 ± 3.7 years, 58.4% women). Advanced adenomas were detected in 38 (11.6%) of 329 subjects. Sensitivity for advanced adenomas of FIT and sigmoidoscopy were 15.8% (95% CI: 6.0-31.3) and 73.7% (95% CI: 56.9-86.6), respectively. No sensitivity improvement was obtained using the combination of sigmoidoscopy and FIT. Mean fecal hemoglobin in FIT positives was significantly lower for participants with only proximal adenomas versus those with distal ones (P = 0.008), for women versus men (P = 0.023), and for younger (<55 years) versus older (≥55 years) subjects (P = 0.029). Sensitivities of FIT were 0.0% (95% CI: 0.0-30.9) in subjects with only proximal versus 21.4% (95% CI: 8.3-41.0) in those with distal nonadvanced adenomas; 5.3% (95% CI: 0.0-26.0) in women versus 26.3% (95% CI: 9.2-51.2) in men; 9.5% (95% CI: 1.2-30.4) in younger versus 23.5% (95% CI: 6.8-49.9) in older subjects. Sigmoidoscopy had a significantly higher sensitivity for advanced adenomas than FIT. A single FIT showed very low sensitivity, especially in subjects with only proximal nonadvanced adenomas, in women, and in younger subjects. This points to the existence of "low" FIT performance in subgroups and the need for more tailored screening strategies.
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Affiliation(s)
- Carolina A J Khalid-de Bakker
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center, the Netherlands
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Levitzky BE, Brown CC, Heeren TC, Schroy PC. Performance of a risk index for advanced proximal colorectal neoplasia among a racially/ethnically diverse patient population (risk index for advanced proximal neoplasia). Am J Gastroenterol 2011; 106:1099-106. [PMID: 21326221 DOI: 10.1038/ajg.2011.20] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Tailoring the use of screening colonoscopy based on the risk of advanced proximal neoplasia (APN) has been advocated as a strategy for reducing demand and optimizing effectiveness. A 7-point index based on age, sex, and distal findings at sigmoidoscopy has been proposed that stratifies individuals into low, intermediate, and high-risk categories. The aim of this cross-sectional analysis was to determine the validity of this index, which was originally derived and validated among mostly whites, for black and Hispanic patients. METHODS Data, including age, sex, colonoscopic findings, and pathology, were collected retrospectively from 1,481 white, 1,329 black, and 689 Hispanic asymptomatic, average-risk patients undergoing screening colonoscopy between 2000 and 2005. Cumulative scores ranging from 0 to 7 were derived for each subject and categorized as low, intermediate, or high risk. Rates of APN were assessed for each risk category after stratification by race/ethnicity. Index performance was assessed using the C-statistic and compared across the three racial groups. RESULTS Rates of APN among patients categorized as low, intermediate, or high risk increased from 1.0 to 2.8 to 3.7% for whites, 1.0 to 2.2 to 4.2% for blacks, and 0.6 to 1.9 to 3.7% for Hispanics. The index performed similarly for all three groups, but showed limited ability to discriminate low from intermediate-risk patients, with C-statistic values of 0.62 for whites, 0.63 for blacks, and 0.68 for Hispanics. CONCLUSIONS A risk index based on age, sex, and distal endoscopic findings has limited ability to discriminate low from intermediate-risk white, black, and Hispanic patients for APN.
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Affiliation(s)
- Benjamin E Levitzky
- Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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Backman V, Roy HK. Light-scattering technologies for field carcinogenesis detection: a modality for endoscopic prescreening. Gastroenterology 2011; 140:35-41. [PMID: 21078318 PMCID: PMC3319699 DOI: 10.1053/j.gastro.2010.11.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Colonoscopy has revolutionized colorectal cancer (CRC) screening resulting in a decrease in both CRC mortality and incidence. Despite this, CRC still ranks as the second leading cause of cancer deaths among Americans underscoring the need to both increase availability and accuracy of colonoscopy. The latter considerations provide the impetus for much of the current research into adjunctive imaging technologies. Recent advances in improving detection of dysplasia that have translated into clinical practice include high-definition scopes, narrow-band imaging, and chromo-endoscopy. Another major direction of research into improving endoscopy is determining histology of lesions in situ (“optical biopsy”) with confocal endomicroscopy, fluorescence and elastic scattering spectroscopy. All these techniques are of great promise in improving delivery of endoscopy but, to date, have not addressed the potentially more important hurdle associated with logistic challenges of providing accurate CRC screening for the entire at-risk population.
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Affiliation(s)
- Vadim Backman
- Biomedical Engineering Department, Northwestern University, Evanston, Illinois 60208, USA.
| | - Hemant K. Roy
- Section of Gastroenterology, NorthShore University HealthSystems, Evanston IL
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Heitman SJ, Hilsden RJ, Au F, Dowden S, Manns BJ. Colorectal cancer screening for average-risk North Americans: an economic evaluation. PLoS Med 2010; 7:e1000370. [PMID: 21124887 PMCID: PMC2990704 DOI: 10.1371/journal.pmed.1000370] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 10/14/2010] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) fulfills the World Health Organization criteria for mass screening, but screening uptake is low in most countries. CRC screening is resource intensive, and it is unclear if an optimal strategy exists. The objective of this study was to perform an economic evaluation of CRC screening in average risk North American individuals considering all relevant screening modalities and current CRC treatment costs. METHODS AND FINDINGS An incremental cost-utility analysis using a Markov model was performed comparing guaiac-based fecal occult blood test (FOBT) or fecal immunochemical test (FIT) annually, fecal DNA every 3 years, flexible sigmoidoscopy or computed tomographic colonography every 5 years, and colonoscopy every 10 years. All strategies were also compared to a no screening natural history arm. Given that different FIT assays and collection methods have been previously tested, three distinct FIT testing strategies were considered, on the basis of studies that have reported "low," "mid," and "high" test performance characteristics for detecting adenomas and CRC. Adenoma and CRC prevalence rates were based on a recent systematic review whereas screening adherence, test performance, and CRC treatment costs were based on publicly available data. The outcome measures included lifetime costs, number of cancers, cancer-related deaths, quality-adjusted life-years gained, and incremental cost-utility ratios. Sensitivity and scenario analyses were performed. Annual FIT, assuming mid-range testing characteristics, was more effective and less costly compared to all strategies (including no screening) except FIT-high. Among the lifetimes of 100,000 average-risk patients, the number of cancers could be reduced from 4,857 to 1,393 [corrected] and the number of CRC deaths from 1,782 [corrected] to 457, while saving CAN$68 per person. Although screening patients with FIT became more expensive than a strategy of no screening when the test performance of FIT was reduced, or the cost of managing CRC was lowered (e.g., for jurisdictions that do not fund expensive biologic chemotherapeutic regimens), CRC screening with FIT remained economically attractive. CONCLUSIONS CRC screening with FIT reduces the risk of CRC and CRC-related deaths, and lowers health care costs in comparison to no screening and to other existing screening strategies. Health policy decision makers should consider prioritizing funding for CRC screening using FIT.
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Affiliation(s)
- Steven J. Heitman
- The Department of Medicine, University of Calgary, Alberta, Canada
- The Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Robert J. Hilsden
- The Department of Medicine, University of Calgary, Alberta, Canada
- The Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Flora Au
- The Department of Medicine, University of Calgary, Alberta, Canada
| | - Scot Dowden
- The Department of Medicine, University of Calgary, Alberta, Canada
- Alberta Health Services - Cancer Care, Alberta, Canada
| | - Braden J. Manns
- The Department of Medicine, University of Calgary, Alberta, Canada
- The Department of Community Health Sciences, University of Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Alberta, Canada
- * E-mail:
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Al-Enezi SA, Alsurayei SA, Ismail AE, Aly NYA, Ismail WA, Abou-Bakr AA. Adenomatous colorectal polyps in patients referred for colonoscopy in a regional hospital in Kuwait. Saudi J Gastroenterol 2010; 16:188-93. [PMID: 20616414 PMCID: PMC3003207 DOI: 10.4103/1319-3767.65194] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/AIM Adenomatous colorectal polyps (ACPs) are known to be the precursor lesions for colorectal cancer. The aim of the study was to determine the prevalence, endoscopic and pathological features of ACPs in patients referred for colonoscopy. PATIENTS AND METHODS The endoscopic and histological reports of adult patients who underwent complete colonoscopy in the gastroenterology unit of a regional Kuwaiti hospital between January 2008 and December 2008 were retrospectively studied. The specimens of polyps were reviewed by an experienced pathologist who was blinded to the clinical or endoscopic information. Non-neoplastic polyps were not included in the analysis. RESULTS Of 530 eligible patients (mean age, 45 years; male-female ratio, 2:1), 54 (10%) had 103 ACPs. Of the patients with ACPs (mean age, 57 years), 43 (80%) were males and 36 (67%) were Kuwaitis. Histopathological examination of the most significant polyp in each patient revealed that 40 (74%) polyps were tubular adenomas (TAs); 11 (20%), tubulovillous (TV) adenomas; and 3 (6%), villous adenomas. High-grade dysplasia was noticed in 4 (10%) adenomas. Fifteen (2.8%) of the 530 patients had advanced ACPs. Logistic regression analysis of some variables and their association with ACPs found that age (P < 0.001; OR, 1.9; CI, 1.5-2.3), history of adenoma (P=0.001; OR, 6.4; CI, .2.1-19.4) and being Kuwaitis (P=0.029; OR, 2.1; CI, 1.1-4.1) to be independently associated with ACPs. CONCLUSION The most common histological type of ACPs was tubular adenoma. Advancing age, being Kuwaiti nationals and prior removal of ACPs were significantly associated with the occurrence of ACPs.
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Affiliation(s)
- Saleh A. Al-Enezi
- Department of Medicine, Farwaniya Hospital, Ministry of Health, Kuwait,Address for correspondence: Dr. Saleh A. Al-Enezi, Department of Medicine, Farwaniya Hospital, Ministry of Health, PO Box 18373, Postal Code 81004, Kuwait. E-mail:
| | | | - Ali E. Ismail
- Department of Medicine, Farwaniya Hospital, Ministry of Health, Kuwait,Department of Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nasser Yehia A. Aly
- Department of Infection Control, Farwaniya Hospital, Ministry of Health, Kuwait,Department of Tropical Medicine and Hygiene, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Waleed A. Ismail
- Department of Medicine, Farwaniya Hospital, Ministry of Health, Kuwait,Department of Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amany A. Abou-Bakr
- Department of Pathology, Farwaniya Hospital, Ministry of Health, Kuwait,Department of Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
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Roy HK, Gomes AJ, Ruderman S, Bianchi LK, Goldberg MJ, Stoyneva V, Rogers JD, Turzhitsky V, Kim Y, Yen E, Jameel M, Bogojevic A, Backman V. Optical measurement of rectal microvasculature as an adjunct to flexible sigmoidosocopy: gender-specific implications. Cancer Prev Res (Phila) 2010; 3:844-51. [PMID: 20570881 DOI: 10.1158/1940-6207.capr-09-0254] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Flexible sigmoidoscopy is a robust, clinically validated, and widely available colorectal cancer screening technique that is currently sanctioned by major guideline organizations. Given that endoscopic visualization is generally limited to the distal third of the colon and women tend to have a proclivity for proximal lesions, the flexible sigmoidoscopy performance is markedly inferior in women than in men. Our group has shown that by using a novel light-scattering approach, we were able to detect an early increase in blood supply (EIBS) in the distal colonic mucosa, which served as a marker of field carcinogenesis and, hence, proximal neoplasia. Therefore, we sought to ascertain whether rectal EIBS would improve flexible sigmoidoscopy, especially in women. A polarization-gated spectroscopy fiber-optic probe was used to assess EIBS in the endoscopically normal rectum (n = 366). When compared with gender-matched neoplasia-free controls, females with advanced proximal neoplasia (n = 10) had a robust (60%; P = 0.002) increase in rectal mucosal oxyhemoglobin content whereas the effect size in males was less marked (33%; P = 0.052). In women, addition of rectal oxyhemoglobin tripled the sensitivity for advanced neoplasia over flexible sigmoidoscopy alone. Indeed, the performance characteristics seemed to be excellent (sensitivity, 100%; specificity, 76.8%; positive predictive value, 32.6%; and negative predictive value, 100%). A variety of nonneoplastic factors were assessed and did not confound the relationship between rectal EIBS and advanced neoplasia. Therefore, using rectal EIBS in combination with flexible sigmoidoscopy mitigated the gender gap and may allow flexible sigmoidoscopy to be considered as a viable colorectal cancer screening test in women.
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Affiliation(s)
- Hemant K Roy
- Department of Medicine, Northshore University Health System, Evanston, IL 60201, USA.
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Stec R, Pławski A, Synowiec A, Mączewski M, Szczylik C. Colorectal cancer in the course of familial adenomatous polyposis syndrome ("de novo" pathogenic mutation of APC gene): case report, review of the literature and genetic commentary. Arch Med Sci 2010; 6:283-7. [PMID: 22371760 PMCID: PMC3281354 DOI: 10.5114/aoms.2010.13911] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 08/01/2008] [Accepted: 08/26/2008] [Indexed: 11/17/2022] Open
Abstract
Colorectal cancer (CRC) is one of the most common malignant tumours in Poland. Annually approximately 11 000 new cases of CRC are diagnosed, while the number of deaths caused by CRC approaches 8 000. Five-year survival does not exceed 20%. Familial adenomatous polyposis (FAP) is responsible for about 1% of new cases of CRC. The risk of CRC in FAP syndrome is 100%, and the average age of CRC development is 39 years. Early colectomy is the most effective method of CRC prevention. We report an atypical case of CRC in a patient with FAP caused by 2797-2800delAACA mutation of the APC gene.
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Affiliation(s)
- Rafał Stec
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland
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Ye YF, Zhang SQ, Li DH, Wang LQ, Zhou RM, Liu RH, Sun JL. Computed tomography colonography: advantages and main points. Shijie Huaren Xiaohua Zazhi 2010; 18:679-684. [DOI: 10.11569/wcjd.v18.i7.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the advantages of computed tomography (CT) colonography and to summarize the main points for CT colonography.
METHODS: Multislice CT colonography was performed in 46 patients with suspected colonic diseases, of which some patients underwent CT colonography in both the supine and prone positions. Different post-processing techniques such as multiplanar reformation (MPR), CT virtual colonoscopy, shaded surface display, Raysum and virtual pathology were employed to evaluate the mucosal and peripheral appearance of the colon.
RESULTS: Eleven patients showed negative results. Eleven patients were diagnosed as colon polyps, of which one had familial colonic polyposis. Sixteen patients were diagnosed as malignant lesions, of which 2 showed local thickening of the colon wall and 14 showed mass lesions. Five patients were diagnosed as inflammatory diseases.
CONCLUSION: The location, size, density and adjacent invasion of colon lesions can be evaluated objectively by CT colonography. The main points for CT colonography include sufficient cleansing of the colon lumen, adequate air injection, and combination of multiple post-processing techniques.
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Heitman SJ, Ronksley PE, Hilsden RJ, Manns BJ, Rostom A, Hemmelgarn BR. Prevalence of adenomas and colorectal cancer in average risk individuals: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2009; 7:1272-8. [PMID: 19523536 DOI: 10.1016/j.cgh.2009.05.032] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 05/14/2009] [Accepted: 05/29/2009] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS There is an extensive yet inconsistent body of literature reporting on the prevalence of adenomatous polyps (adenomas) and colorectal cancer among average risk individuals. The objectives of our study were to determine the pooled prevalence of adenomas and colorectal cancer, as well as nonadvanced and advanced adenomas, among average risk North Americans. METHODS Articles were obtained by searching electronic databases (MEDLINE: 1950 through March 2008 and EMBASE: 1980 through March 2008), bibliographies, major journals, and conference proceedings, with no language restrictions. Two reviewers independently selected cross-sectional studies reporting adenoma and colorectal cancer prevalence rates in average risk individuals and assessed studies for inclusion and quality, and extracted the data for analysis. Pooled adenoma and colorectal cancer prevalence rates were estimated using fixed and random effects models. Stratification and metaregression was used to assess heterogeneity. RESULTS Based on 18 included studies, the pooled prevalence of adenomas, colorectal cancer, nonadvanced adenomas, and advanced adenomas was 30.2%, 0.3%, 17.7%, and 5.7%, respectively. Heterogeneity was observed in the pooled prevalence rates for overall adenomas, advanced adenomas, and colorectal cancer and was explained by the mean age (> or = 65 years vs < 65 years) with older cohorts reporting higher prevalence rates. None of the study quality indicators was found to be significant predictors of heterogeneity. CONCLUSIONS The high prevalence of advanced adenomas and colorectal cancer, especially among older screen-eligible individuals, provides impetus for expanding colorectal cancer screening programs. Furthermore, the pooled prevalence estimates can be used as quality indicators for established programs.
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Affiliation(s)
- Steven J Heitman
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Denis B, Gendre I, Aman F, Ribstein F, Maurin P, Perrin P. Colorectal cancer screening with the addition of flexible sigmoidoscopy to guaiac-based faecal occult blood testing: A French population-based controlled study (Wintzenheim trial). Eur J Cancer 2009; 45:3282-90. [DOI: 10.1016/j.ejca.2009.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 06/08/2009] [Accepted: 06/12/2009] [Indexed: 12/24/2022]
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Subramanian H, Roy HK, Pradhan P, Goldberg MJ, Muldoon J, Brand RE, Sturgis C, Hensing T, Ray D, Bogojevic A, Mohammed J, Chang JS, Backman V. Nanoscale cellular changes in field carcinogenesis detected by partial wave spectroscopy. Cancer Res 2009; 69:5357-63. [PMID: 19549915 DOI: 10.1158/0008-5472.can-08-3895] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Understanding alteration of cell morphology in disease has been hampered by the diffraction-limited resolution of optical microscopy (>200 nm). We recently developed an optical microscopy technique, partial wave spectroscopy (PWS), which is capable of quantifying statistical properties of cell structure at the nanoscale. Here we use PWS to show for the first time the increase in the disorder strength of the nanoscale architecture not only in tumor cells but also in the microscopically normal-appearing cells outside of the tumor. Although genetic and epigenetic alterations have been previously observed in the field of carcinogenesis, these cells were considered morphologically normal. Our data show organ-wide alteration in cell nanoarchitecture. This seems to be a general event in carcinogenesis, which is supported by our data in three types of cancer: colon, pancreatic, and lung. These results have important implications in that PWS can be used as a new method to identify patients harboring malignant or premalignant tumors by interrogating easily accessible tissue sites distant from the location of the lesion.
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Erarslan E, Turkay C, Isik A, Uz B, Kaya A, Bavbek N. Prevalence of proximal neoplasms among asymptomatic patients according to distal colorectal findings. Dig Dis Sci 2009; 54:1312-6. [PMID: 19184422 DOI: 10.1007/s10620-009-0728-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2007] [Accepted: 06/20/2007] [Indexed: 12/09/2022]
Abstract
Colorectal cancer has been described in association with hyperplastic polyposis. Only half of proximal colon cancers are associated with distal adenomas. To compare the prevalence of proximal and advanced neoplasia between patients with distal hyperplastic polyps only; with distal adenomas with or without hyperplastic polyps; and with no distal polyps, we retrospectively analyzed data of 1,064 adults who underwent colonoscopy. Of these patients, 3% had neoplasia. Proximal neoplasia occurred in 0.8% of 945 patients with no distal polyps, compared to none of 19 with distal hyperplastic polyps (P > 0.05) and 6% with distal adenomas (P > 0.05). Proximal advanced neoplasia occurred in 0.6% patients with no distal polyps, compared with none with distal hyperplastic polyps (P > 0.05) and 6% with distal adenomas (P > 0.05). In conclusion, patients with distal hyperplastic polyps, unlike those with distal adenomas, do not exhibit an increased risk for proximal neoplasia or proximal advanced neoplasia compared to those with no distal polyps.
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Affiliation(s)
- Elife Erarslan
- Department of Gastroenterology, Fatih University Medical School, Ankara, Turkey.
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Roy HK, Turzhitsky V, Kim Y, Goldberg MJ, Watson P, Rogers JD, Gomes AJ, Kromine A, Brand RE, Jameel M, Bogovejic A, Pradhan P, Backman V. Association between rectal optical signatures and colonic neoplasia: potential applications for screening. Cancer Res 2009; 69:4476-83. [PMID: 19417131 DOI: 10.1158/0008-5472.can-08-4780] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Field carcinogenesis detection represents a promising means for colorectal cancer (CRC) screening, although current techniques (e.g., flexible sigmoidoscopy) lack the requisite sensitivity. The novel optical technology low-coherence enhanced backscattering (LEBS) spectroscopy, allows identification of microscale architectural consequences of the field carcinogenesis in preclinical CRC models with unprecedented accuracy. To investigate the potential clinical translatability of this approach, we obtained biopsies from the normal-appearing rectal mucosa from patients undergoing colonoscopy (n = 219). LEBS signals were recorded through a bench-top instrument. Four parameters characterizing LEBS signal were linearly combined into a single marker. We found that LEBS signal parameters generally mirrored neoplasia progression from patients with no neoplasia, to 5 to 9 mm adenoma and to advanced adenomas. The composite LEBS marker calculated from the LEBS signal paralleled this risk status (ANOVA P < 0.001). Moreover, this was independent of CRC risk factors, benign colonic findings, or clinically unimportant lesions (diminutive adenomas, hyperplastic polyps). For advanced adenomas, the LEBS marker had a sensitivity of 100%, specificity of 80%, and area under the receiver operator characteristic curve of 0.895. Leave-one-out cross-validation and an independent data set (n = 51) supported the robustness of these findings. In conclusion, we provide the first demonstration that LEBS-detectable alterations in the endoscopically normal rectum were associated with the presence of neoplasia located elsewhere in the colon. This study provides the proof of concept that rectal LEBS analysis may potentially provide a minimally intrusive CRC screening technique. Further studies with an endoscopically compatible fiber optic probe are under way for multicenter clinical validation.
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Affiliation(s)
- Hemant K Roy
- Department of Medicine, Evanston-Northwestern Healthcare, Northwestern University, Evanston, IL 60201, USA.
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Patient factors predictive of inadequate bowel preparation using polyethylene glycol: a prospective study in Korea. J Clin Gastroenterol 2009; 43:448-52. [PMID: 18978506 DOI: 10.1097/mcg.0b013e3181662442] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Inadequate bowel preparation is important because it can result in missed lesions, cancelled procedures, increased procedural time, and a potential increase in complication rates. This prospective study was designed to look at the quality of colon preparation using polyethylene glycol solution and evaluate potential associations between specific patient characteristics and inadequate bowel preparation. METHODS A total of 362 patients who were compliant with preparation instructions were enrolled. All colonoscopic examinations were performed by an experienced endoscopist and the quality of the preparation was graded by the endoscopist (excellent to poor). Patient demographic and medical history information was gathered before the procedure. Possible predictors of inadequate colonic preparation were analyzed using univariate statistics and multivariate logistic regression models. RESULTS An inadequate bowel preparation was reported in 28.2% of observed colonoscopies. In multivariate regression analysis, age greater than 60 years [odds ratio (OR) 2.8, 95% confidence interval (CI) 1.04-7.4], a history of diabetes (OR 8.6, 95% CI 6.3-19.4), a history of appendectomy (OR 4.6, 95% CI 2.0-10.5), a history of colorectal resection (OR 7.5, 95% CI 3.4-17.6), and a history of hysterectomy (OR 3.4, 95% CI 1.1-10.4) were independent predictors of an inadequate colon preparation. CONCLUSIONS This prospective study identified several factors that may predict inadequate polyethylene glycol preparation independent of compliance with preparation instructions and procedure starting time. This result may help to identify patients at an increased risk for inadequate bowel preparation for whom alternative preparation protocols would be beneficial.
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Gomes AJ, Roy HK, Turzhitsky V, Kim Y, Rogers JD, Ruderman S, Stoyneva V, Goldberg MJ, Bianchi LK, Yen E, Kromine A, Jameel M, Backman V. Rectal mucosal microvascular blood supply increase is associated with colonic neoplasia. Clin Cancer Res 2009; 15:3110-7. [PMID: 19383816 DOI: 10.1158/1078-0432.ccr-08-2880] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Endoscopic examination has proven effective in both detecting and preventing colorectal cancer; however, only about a quarter of eligible patients undergo screening. Even if the compliance rate increased, limited endoscopic capacity and cost would be prohibitive. There is a need for an accurate method to target colonoscopy to those most at risk of harboring colonic neoplasia. Exploiting field carcinogenesis seems to be a promising avenue. Our group recently reported that an early increase in blood supply (EIBS) is a reliable marker of field carcinogenesis in experimental models. We now investigate whether in situ detection of EIBS in the rectum can predict neoplasia elsewhere in the colon. EXPERIMENTAL DESIGN We developed a novel polarization-gated spectroscopy fiber-optic probe that allows depth-selective interrogation of microvascular blood content. Using the probe, we examined the blood content in vivo from the rectal mucosa of 216 patients undergoing screening colonoscopy. RESULTS Microvascular blood content was increased by approximately 50% in the endoscopically normal rectal mucosa of patients harboring advanced adenomas when compared with neoplasia-free patients irrespective of lesion location. Demographic factors and nonneoplastic lesions did not confound this observation. Logistic regression using mucosal oxyhemoglobin concentration and patient age resulted in a sensitivity of 83%, a specificity of 82%, and an area under the receiver operating characteristic curve of 0.88 for the detection of advanced adenomas. CONCLUSIONS Increased microvascular blood supply in the normal rectal mucosa is associated with the presence of clinically significant neoplasia elsewhere in the colon, supporting the development of rectal EIBS as a colon cancer risk-stratification tool.
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Affiliation(s)
- Andrew J Gomes
- Biomedical Engineering Department, Northwestern University, IL, USA.
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Park HW, Byeon JS, Yang SK, Kim HS, Kim WH, Kim TI, Park DI, Kim YH, Kim HJ, Lee MS, Chung IK, Jung SA, Jeen YT, Choi JH, Choi H, Choi KY, Han DS, Song JS. Colorectal Neoplasm in Asymptomatic Average-risk Koreans: The KASID Prospective Multicenter Colonoscopy Survey. Gut Liver 2009; 3:35-40. [PMID: 20479899 DOI: 10.5009/gnl.2009.3.1.35] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 09/11/2008] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/AIMS The incidence of colorectal cancer is increasing in Korea, but the epidemiology of colorectal neoplasm is not clearly defined. We aimed to elucidate the prevalence of colorectal neoplasm in average-risk Koreans and explore the underlying risk factors. METHODS A large-scale, multicenter, prospective study was conducted. Of the 19,460 subjects who underwent colonoscopy at 11 university hospitals, we analyzed 3,951 consecutive asymptomatic adults with no risk factors for colorectal cancer. RESULTS The subjects were aged 52.1+/-11.6 years (mean+/-SD) and 60.1% of them were men. The prevalences of colorectal neoplasm and advanced neoplasm were 33.3% and 2.2%, respectively. The prevalence of a neoplasm increased with age (trend: p<0.001) and was higher in males (p<0.001). The prevalence of a proximal neoplasm was higher in subjects with a distal neoplasm than in those without a distal neoplasm (11.9% vs. 5.4%, p<0.001). However, 150 (52.1%) of the 288 subjects with a proximal neoplasm had no distal neoplasm. CONCLUSIONS The overall prevalence of colorectal neoplasm in asymptomatic average-risk Koreans is comparable with that in Western countries. Being male and older are associated with a higher risk of colorectal neoplasm. Over half of proximal neoplasms are not associated with any distal sentinel lesions.
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Affiliation(s)
- Hye-Won Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Peravali R, Kandiah K, Surah A, Murria P, Taniere P, Radley S. Retrospective analysis of pre- and peri-operative imaging in confirmed proximal colonic cancers--possible implications for screening flexible sigmoidoscopy. Colorectal Dis 2009; 11:146-9. [PMID: 18462247 DOI: 10.1111/j.1463-1318.2008.01548.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Faecal occult blood testing is being introduced for population screening in the United Kingdom. Flexible sigmoidoscopy may provide a viable alternative. The outcomes of the flexible sigmoidoscopy trial are awaited but the most obvious disadvantage is that only the lower third of the colon is examined and proximal pathology cannot be excluded. The relationship between proximal pathology and distal findings at flexible sigmoidoscopy is uncertain. The aim of this study was to determine the incidence of distal neoplasia in patients with confirmed proximal cancers of the colon. METHOD All confirmed proximal colonic cancers (defined as those proximal to the splenic flexure) were identified from a database of pathology specimens at a single centre between January 1999 and August 2006. A retrospective analysis of preoperative and peri-operative mucosal imaging (contrast enema, colonoscopy and CT colonography) was conducted to identify any distal neoplasia in these patients. RESULTS A total of 348 patients were identified. Pre- or peri-operative mucosal imaging was identified in 231 (66%) and 49 (21%) had distal neoplasia. Nineteen (8%) of these patients would have gone on to have a colonoscopy based on the UK flexible sigmoidoscopy trial protocol and 92% of the cohort would not have had a colonoscopy. CONCLUSION Nearly 80% of confirmed proximal cancers in our series did not have any demonstrable distal neoplasia. Only 8% of our cohort would have proceeded to colonoscopy. A very significant number of proximal cancers would not have been detected.
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Affiliation(s)
- R Peravali
- Department of Colorectal Surgery, University Hospital Birmingham, NHS Foundation Trust, Birmingham, UK.
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Roy HK, Gomes A, Turzhitsky V, Goldberg MJ, Rogers J, Ruderman S, L YK, Kromine A, Brand RE, Jameel M, Vakil P, Hasabou N, Backman V. Spectroscopic microvascular blood detection from the endoscopically normal colonic mucosa: biomarker for neoplasia risk. Gastroenterology 2008; 135:1069-78. [PMID: 18722372 PMCID: PMC3405534 DOI: 10.1053/j.gastro.2008.06.046] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Revised: 06/11/2008] [Accepted: 06/19/2008] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS We previously used a novel biomedical optics technology, 4-dimensional elastically scattered light fingerprinting, to show that in experimental colon carcinogenesis the predysplastic epithelial microvascular blood content is increased markedly. To assess the potential clinical translatability of this putative field effect marker, we characterized the early increase in blood supply (EIBS) in human beings in vivo. METHODS We developed a novel, endoscopically compatible, polarization-gated, spectroscopic probe that was capable of measuring oxygenated and deoxygenated (Dhb) hemoglobin specifically in the mucosal microcirculation through polarization gating. Microvascular blood content was measured in 222 patients from the endoscopically normal cecum, midtransverse colon, and rectum. If a polyp was present, readings were taken from the polyp tissue along with the normal mucosa 10-cm and 30-cm proximal and distal to the lesion. RESULTS Tissue phantom studies showed that the probe had outstanding accuracy for hemoglobin determination (r(2) = 0.99). Augmentation of microvasculature blood content was most pronounced within the most superficial ( approximately 100 microm) layer and dissipated in deeper layers (ie, submucosa). EIBS was detectable within 30 cm from the lesion and the magnitude mirrored adenoma proximity. This occurred for both oxygenated hemoglobin and DHb, with the effect size being slightly greater for DHb. EIBS correlated with adenoma size and was not engendered by nonneoplastic (hyperplastic) polyps. CONCLUSIONS We show, herein, that in vivo microvascular blood content can be measured and provides an accurate marker of field carcinogenesis. This technological/biological advance has numerous potential applications in colorectal cancer screening such as improved polyp detection and risk stratification.
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Affiliation(s)
- Hemant K. Roy
- Dept of Internal Medicine, Evanston-Northwestern Healthcare, Evanston IL
| | - Andrew Gomes
- Biomedical Engineering Department, Northwestern University, Evanston IL
| | | | - Michael J Goldberg
- Dept of Internal Medicine, Evanston-Northwestern Healthcare, Evanston IL
| | - Jeremy Rogers
- Biomedical Engineering Department, Northwestern University, Evanston IL
| | - Sarah Ruderman
- Biomedical Engineering Department, Northwestern University, Evanston IL
| | - Young Kim L
- Dept of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh PA
| | - Alex Kromine
- Biomedical Engineering Department, Northwestern University, Evanston IL
| | - Randall E. Brand
- Dept of Biomedical Engineering, Purdue University, West Lafayette IN
| | - Mohammed Jameel
- Dept of Internal Medicine, Evanston-Northwestern Healthcare, Evanston IL
| | - Parmede Vakil
- Biomedical Engineering Department, Northwestern University, Evanston IL
| | - Nahla Hasabou
- Dept of Internal Medicine, Evanston-Northwestern Healthcare, Evanston IL
| | - Vadim Backman
- Biomedical Engineering Department, Northwestern University, Evanston IL
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Rabeneck L, Lewis JD, Paszat LF, Saskin R, Stukel TA. Risk of proximal and distal colorectal cancer following flexible sigmoidoscopy: a population-based cohort study. Am J Gastroenterol 2008; 103:2075-82. [PMID: 18684198 DOI: 10.1111/j.1572-0241.2008.01932.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Little is known about the risk of proximal and distal colorectal cancer (CRC) following flexible sigmoidoscopy (FS) in usual clinical practice. Our objective was to estimate the annual incidence of CRC within 7 yr following FS and to identify factors associated with incident CRC in those with a negative FS. METHODS In this population-based retrospective cohort study, we included men and women 50-80 yr of age who had a negative or positive FS during 1996-1998 in Ontario. We followed each individual through December 31, 2005 and calculated the age- and sex-standardized incidence rates (SIRs) and 95% confidence intervals (CIs) for distal and proximal CRC. We compared the relative rate (RR) and 95% CIs of incident CRC between the negative and positive FS cohorts and the remaining Ontario population. Cox models were used to evaluate factors associated with incident cancers. RESULTS The RR for distal CRC was significantly lower among those with a negative FS than in the Ontario population during each year of follow-up except the first year. For example, at 7 yr, the SIR for distal CRC following negative FS was 0.74 cancers/1,000 persons (95% CI 0.46-1.13) compared with 1.07/1,000 (95% CI 1.02-1.11) in the Ontario population (RR = 0.69, 95% CI 0.40-0.99). The RR for proximal CRC, except for year 2, did not differ between the negative FS cohort and the Ontario population during follow-up. In the positive FS cohort, the RR for distal CRC was significantly higher in the first year of follow-up compared with the Ontario population, but not thereafter. The results were similar for the RR for proximal CRC in the positive FS cohort. Only age was significantly associated with incident CRC following negative FS. CONCLUSIONS Following negative FS, the incidence of distal but not proximal CRC was reduced for up to 7 yr. Following a positive FS, the incidence of distal and proximal cancer after the first year of follow-up did not differ from the Ontario population. The benefit of FS was confined to the distal colon, emphasizing the potential limitation of FS in practice.
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Affiliation(s)
- Linda Rabeneck
- Department of Medicine, Management and Evaluation, University of Toronto, Toronto, Canada
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