Comparative Evaluation of Colon Cancer Specific Antigen-2 Test and Chromocolonoscopy for Early Detection of Egyptian Patients with Colorectal Cancer

Background: Effective screening of colorectal cancer (CRC) in early stage could reduce the advancement of CRC and therefore mortality. Effective screening is based on either stool dependent tests or colon dependent examination.

Aims: The aim of the study was a comparative evaluation of chromocolonoscopy and Colon Cancer-Specific Antigen-2 test for early detection of colorectal cancer in Egyptian patients.

Methods: This case control study was carried out on 55 patients classified into 3 groups: Group I consisted of twenty patients with precancerous lesions detected by colonoscopy, Group II consisted of twenty patients diagnosed with colorectal cancer and Group III consisted of fifteen individuals (who underwent colonoscopy for other indications) as a control group. All the subjects were subjected to measure occult blood in the stool, measurement of Colon Cancer-Specific Antigen-2 level in serum and tissue and chromo colonoscopy using Indigo Carmine stain.

Results: In group II, there was a statistically significant increase in CCSA2 in serum as compared to the other 2 groups. Cutoff >11.3 CCSA2 in serum showed 65% sensitivity, 85% specificity, 81.2% PPV, 70.8% NPV and 70.3% accuracy in the differentiation of group II with cancer colon from group I with premalignant colonic lesions. A cutoff > 9.1 CCSA2 in serum showed 95% sensitivity, 46.67% specificity, 70.4% PPV, 87.5% NPV and 73.5% accuracy in differentiating group II with cancer colon from normal controls (group III).

Conclusion: CCSA-2 level in serum was significantly higher in cancer colon. Chromoendoscopy has a role in the detection of polyps, both neoplastic and non-neoplastic.

Intravitreal diclofenac versus intravitreal bevacizumab in persistent diabetic macular edema: Anatomical and functional outcome

PURPOSE

To compare the efficacy of diclofenac versus bevacizumab following single intravitreal injection in eyes with persistent diabetic macular edema.

METHODS

Fifty eyes with persistent DME were randomly allocated to intravitreal injection of 500 µg/0.1 ml of diclofenac (N = 20) or 1.25 mg/0.05 mL of bevacizumab (N = 20) or to non-treatment (10 eyes). Preoperative and postoperative visual acuity, central, paracentral macular thickness and intraocular pressure (IOP) were recorded and compared between the three groups up to 4 weeks.

RESULTS

Diclofenac and bevacizumab groups showed statistically significant reduction in central and paracentral macular thickness (diclofenac: p = 0.006, 0.02 and bevacizumab: p = 0.02, 0.01), without statistically significant difference between the two groups. The two groups showed no statistically significant difference in mean visual acuity or mean line improvement. Mean visual acuity improvement didn't reach statistical significance in either group. Diclofenac group showed statistically significant reduced IOP (P = 0.02). Control eyes did not show any change in mean visual acuity, macular thickness or IOP.

CONCLUSION

In persistent DME, diclofenac has a structural effect comparable to bevacizumab on central macular thickness. However, significant functional gain may not be accomplished by single injection. Unlike naïve DME, persistent cases may be confounded by systemic and local factors necessitating repeated injection of diclofenac.