Cancer Polyps Research Articles

Mean platelet volume/platelet count ratio in colorectal cancer: a retrospective clinical study

BackgroundMean platelet volume (MPV) is a marker of platelet activation. MPV and platelet count (PC) are negatively correlated, and their ratio (MPV/PC) is informative for the diagnosis of malignant tumors. However, the relationship between MPV/PC and colorectal cancer is unclear. This retrospective clinical study aimed to evaluate the diagnostic value of MPV/PC in colorectal cancer.MethodsHematological examinations were performed at initial diagnosis in patients with colorectal cancer (n = 186) or adenomatous polyp (n = 132) and healthy controls (n = 108). Hematological parameters evaluated included white blood cells, red blood cells, hemoglobin, neutrophils, lymphocytes, monocytes, PC, and MPV. Statistical analyses included Student’s t-test, one-way ANOVA or Kruskal-Wallis H test, chi-square tests, Spearman’s correlation test and receiver operating characteristic (ROC). ROC curve was used to evaluate the diagnostic values of MPV and MPV/PC in colorectal cancer.ResultsAmong these groups, MPV was significantly lower in colorectal cancer than in adenomatous polyp (p = 0.002) and healthy controls (p < 0.001) but did not significantly differ between adenomatous polyp and healthy controls (p = 0.210). MPV/PC was lower in colorectal cancer compared with adenomatous polyp and healthy controls (p < 0.001) and in adenomatous polyp compared with healthy controls (p = 0.010). MPV did not significantly differ among colorectal cancer subgroups, while MPV/PC significantly differed between TNM stages and the presence/absence of lymph node metastasis. MPV/PC was negatively correlated with the neutrophil to lymphocyte ratio(NLR) (p = 0.002) and platelet to lymphocyte ratio(PLR) concentration (p < 0.001). In the differential diagnosis between colorectal cancer and adenomatous polyp, MPV/PC produced a larger ROC curve than MPV, NLR or PLR alone. Using MPV/PC to distinguish between colorectal cancer and controls produced a larger AUC than using MPV or NLR alone.ConclusionsMPV/PC may be useful for the diagnosis of colorectal cancer. However, further studies are warranted to include additional regions and more data, to assess the utility of MPV/PC as a novel diagnostic screening tool for colorectal cancer.

Endometrial patolojilerin araştırılmasında iki endometrial biyopsi tekniğinin araştırılması

Objective: The purpose of this study is to compare the diagnostic performance of hysteroscopic endometrial biopsy (H/S) and probe curettage (P/C) in the diagnosis of endometrial pathologies. Material and Methods: Our study was conducted at a tertiary obstetrics and gynecology clinic between December 2010 and July 2011. In our prospective study, histopathological results of both biopsies with H/S and P/C applied to 83 patients admitted to our clinic for evaluation of endometrium, were examined and compared with combine procedure (H/S and P/C). Results: Histopathological results were as follows: endometrial polyps (48%), endometrial hyperplasia (13.2%), submucous myoma (4.8%), endometrial cancer (4.8%), and normal endometrial tissue (28.9%). Sensitivity values of biopsy with H/S versus biopsy with P/C for the endometrial polyp, submucous myoma, endometrial hyperplasia and endometrial cancer were found as 97.5% vs. %54,6, 100% vs.%25 , 75% vs. %100 and 63.6% vs. %100, respectively. Conclusion: H/S was apparently superior to P/C in diagnosis of focal lesions such as endometrial polyps and submucous myoma. We determined none of the interventions to be statistically superior to the other in diagnosis of diffuse lesions such as endometrial hyperplasia and endometrial cancer.

Mechano-growth Factor Expression in Colorectal Cancer Investigated With Fluorescent Gold Nanoparticles.

Fluorescent gold nanoparticles demonstrate strong photoluminescence, photostability, and low cellular toxicity, making them attractive agents for biomedical applications. Mechano-growth factor (MGF) is an isoform of IGF1 and its expression has been demonstrated in malignancies including prostate cancer. Near-infrared-emitting gold nanoparticles (AuNPs) were synthesized and conjugated to MGF. Following characterization and confirmation of conjugation, these AuNPs were used to investigate the expression of MGF in colon cancer cell lines (HT29 and SW620) and tissues comparing normal and colon cancer. The prostate cancer cell line PC3 and adenocarcinoma tissues were used as positive controls. Colon cancer cell lines, adenocarcinoma tissues and polyp tissues demonstrated evidence of MGF peptide expression, which was not found in normal colon tissues and human umbilical vein endothelial cells. MGF appears to be overexpressed in colon cancer tissues, offering a potential unique target for imaging and drug delivery in colon cancer.

Prevalence of hyperplasia and cancer in endometrial polyps in women with postmenopausal bleeding: A systematic review and meta-analysis.

There is wide variation in reporting the prevalence of hyperplasia and cancer in endometrial polyps in women with postmenopausal bleeding. Most studies reported heterogenous populations of pre- and postmenopausal women both symptomatic and asymptomatic, making data interpretation difficult. The aim of this work is to quantify the prevalence of hyperplasia and cancer in polyps in women with postmenopausal bleeding aiming to produce data that help inform clinical practice as whether it is safer to remove all polyps, or some women could be offered expectant management. The search terms used were Medical Subject Headings terms, text words, truncations and word variations of the words or phrases ‘endometrial polyp’ or ‘uterine polyp’ or ‘womb polyp’ and ‘postmenopause’ or ‘menopause’. Search was limited to human studies and English language articles. Studies reporting separate analysis for women with postmenopausal bleeding were included. The included articles were assessed for risk of bias using the ‘Quality in Prognosis Studies’ tool. The prevalence was estimated with a random effect model using ‘DerSimonian and Laird’ method. The pooled estimate of prevalence of hyperplasia and cancer was 9% (95% confidence interval: 6.5%–11.5%). An I2 statistic of 77.2% suggests likely substantial heterogeneity. However, adjustment for small study effects had no influence on the pooled prevalence estimate suggesting no evidence for publication bias. Sensitivity analyses showed that no study exerted a big influence on the pooled estimate. The prevalence of hyperplasia and cancer in endometrial polyps in women with postmenopausal bleeding is high enough to warrant removal for accurate histopathological diagnosis.

Robotic Transanal Minimally Invasive Surgery for the Excision of Rectal Neoplasia: Clinical Experience With 58 Consecutive Patients.

Given the significant perioperative risks and costs of total mesorectal excision, minimally invasive transanal surgical approaches have grown in popularity for early rectal cancer and rectal polyps. This article discusses a transanal robotic surgery technique to perform full-thickness resections of benign and malignant rectal neoplasms. The purpose of this study was to describe an initial experience with robotic transanal minimally invasive surgery. This was a retrospective cohort study of consecutive patients who underwent robotic transanal minimally invasive surgery. The study was conducted at a high-volume colorectal surgery practice with a large health maintenance organization. Patients at Southern California Kaiser Permanente with early rectal cancer and rectal polyps amenable to transanal excision were included. Transanal resection of rectal tumors were removed using robotic transanal minimally invasive surgery. Local recurrence of rectal pathology was measured. A total of 58 patients underwent robotic transanal minimally invasive surgery with full-thickness rectal resection by 4 surgeons for the following indications: rectal cancer (n = 28), rectal polyp (n = 18), rectal carcinoid (n = 11), and rectal GI stromal tumor (n = 1). Mean operative time was 66.2 minutes (range, 17-180 min). The mean tumor height from the anal verge was 8.8 cm (range, 4-14 cm), and the mean specimen size was 3.3 cm (range, 1.3-8.2 cm). A total of 57 (98.3%) of 58 specimens were intact, and 55 (94.8%) of 58 specimens had negative surgical margins. At a mean follow-up of 11.5 months (range, 0.3-33.3 mo), 3 patients (5.5%) developed local recurrences, and all underwent successful salvage surgery. The study was limited by being a retrospective, nonrandomized trial with short follow-up. Robotic transanal minimally invasive surgery is a safe, oncologically effective surgical approach for rectal polyps and early rectal cancers. It offers the oncologic benefits and perioperative complication profile of other transanal minimally invasive surgical approaches but also enhances surgeon ergonomics and provides an efficient transanal rectal platform. See Video Abstract at http://links.lww.com/DCR/A759.

Significant polyp and early colorectal cancer - SPECC: The role of the Colorectal Cancer Clinical Nurse Specialist (CNS): promoting patient-centred care.

The colorectal Clinical Nurse Specialist (CNS) makes an important contribution to the care of individuals diagnosed with a significant polyp and early colorectal cancer (SPECC). This paper offers an expert opinion on the role of the CNS in SPECC, informed by relevant literature. A CNS can support the patient through the diagnostic and treatment pathway acting as the patient's advocate as a core member of the multidisciplinary team. They will offer support and information to help patients understand their diagnosis, make choices about their available treatment options and help them to feel prepared for any treatment undertaken. By providing care that is respectful of, and responsive to, individual patient preferences, needs and values, the CNS can play an important role in promoting patient-centred care.

Endoscopic excision of significant polyp and early colorectal cancer lesions.

Endoscopic excision of significant polyp and early colorectal cancer lesions.

Defining, recognizing and describing significant polyp and early colorectal cancer lesions.

Defining, recognizing and describing significant polyp and early colorectal cancer lesions.

Significant polyp and early colorectal cancer - decision-making and treatment planning in regional networks and multidisciplinary teams.

Significant polyp and early colorectal cancer - decision-making and treatment planning in regional networks and multidisciplinary teams.

Assessment of a rectal SPECC lesion by endoluminal ultrasound.

Assessment of a rectal SPECC lesion by endoluminal ultrasound.

Performance Characteristics of Fecal Immunochemical Tests for Colorectal Cancer and Advanced Adenomatous Polyps: A Systematic Review and Meta-analysis.

Studies report inconsistent performance of fecal immunochemical tests (FITs) for colorectal cancer (CRC) and advanced adenomas. To summarize performance characteristics of FITs for CRC and advanced adenomas in average-risk persons undergoing screening colonoscopy (reference standard) and to identify factors affecting these characteristics. Ovid MEDLINE, PubMed, Embase, and the Cochrane Library from inception through October 2018; reference lists of studies and reviews. Two reviewers independently screened records to identify published English-language prospective or retrospective observational studies that evaluated FIT sensitivity and specificity for colonoscopic findings in asymptomatic, average-risk adults. Two authors independently extracted data and evaluated study quality. Thirty-one studies (120255 participants; 18 FITs) were included; all were judged to have low to moderate risk of bias. Performance characteristics depended on the threshold for a positive result. A threshold of 10 µg/g resulted in sensitivity of 0.91 (95% CI, 0.84 to 0.95) and a negative likelihood ratio of 0.10 (CI, 0.06 to 0.19) for CRC, whereas a threshold of greater than 20 µg/g resulted in specificity of 0.95 (CI, 0.94 to 0.96) and a positive likelihood ratio of 15.49 (CI, 9.82 to 22.39). For advanced adenomas, sensitivity was 0.40 (CI, 0.33 to 0.47) and the negative likelihood ratio was 0.67 (CI, 0.57 to 0.78) at 10 µg/g, and specificity was 0.95 (CI, 0.94 to 0.96) and the positive likelihood ratio was 5.86 (CI, 3.77 to 8.97) at greater than 20 µg/g. Studies had low to high heterogeneity, depending on the threshold. Although several FITs had adequate performance, sensitivity and specificity for CRC for 1 qualitative FIT were 0.90 and 0.91, respectively, at its single threshold of 10 µg/g; positive and negative likelihood ratios were 10.13 and 0.11, respectively. Comparison of 3 FITs at 3 thresholds was inconclusive: CIs overlapped, and the comparisons were across rather than within studies. Only English-language studies were included. Incomplete reporting limited quality assessment of some evidence. Performance characteristics are for 1-time rather than serial testing. Single-application FITs have moderate to high sensitivity and specificity for CRC, depending on the positivity threshold. Sensitivity of 1-time testing for advanced adenomas is low, regardless of the threshold. Department of Medicine, Indiana University School of Medicine.

The Burgeoning Role of the Gastrointestinal Microbiota

With the release of the landmark publication containing the information that there were more microorganisms in the gastrointestinal tract than any other cells [1] the scientiic community began to look at the functional role of these organisms. We edited a book on “The Microbiota in Gastrointestinal Pathophysiology, with emphasis on probiotics, prebiotics, and dysbiosis†[2] The book was published in 2018 but since that time a great deal of new information and manuscripts have appeared. Particularly in the area of probiotics and supplements containing probiotics or prebiotics so that organizations are now sponsoring national and international meetings on the subject. Until the 20th century scientiic interest in the lora of the gut was largely in infectious organisms but when it was realized that the predominance of the lora in the gastrointestinal tract scientists began to look at the role of these organisms in health and disease Our book on the microbiota was divided into essentially four areas of interest. First the distribution of bacteria in the GI tract, secondly detailed microbiology on the speciic bacteria used as probiotics. Thirdly on the functional role of these bacteria and fourthly on the speciic literature that support these facts being related to the microbiota in these conclusions. Since publication of this text important new observations have widened the ield of interest into common cancer. Colorectal cancer and colon polyps are the fourth most common cancer in the human population so that interest is intense in the western and Asian populations.

Evaluation of the prevalence of glucose metabolism disorders in patients with dyspepsia

Introduction. As estimated by IDF, by 2045 there will be about 628 million of people living with diabetes, of which 87–91% will have type 2 diabetes. Therefore, early diagnosis of diabetes is very important, and cur­rently only 4–50% of cases are diagnosed early enough. The aim of the study was to establish whether patients with dyspepsia may potentially be a group at high risk of developing diabetes in which screening for glucose metabolism disorders would be particularly important. Material and methods. The study included 59 women (65.5%) and 31 men (34.5%), with a mean age of 36 years, hospitalized in order to perform gastroscopy due to symptoms of dyspepsia. All patients were apparently healthy, without the history of cardiovascular diseases or diabetes, and were non-smokers. The patients were subjected to laboratory tests (random blood glucose, oral glucose tolerance test [OGTT], lipid profile, C-reac­tive protein level), gastroscopy and a rapid urease test for detection of active Helicobacter pylori infection. Body mass index (BMI) was also calculated. Subjects with abnormal results of the oral glucose tolerance test (OGTT) were assigned to the group with glucose metabolism disorders and the remaining subjects — to the group without glucose metabolism disorders. Statistical analysis of the obtained research results was carried out using the Statistica 7.0 PL software. Results. The subjects were divided into two subgroups based on the result of the oral glucose tolerance test, adopting the principles of diagnosing carbohydrate metabolism disorders according to the Diabetes Po­land. The group with glucose metabolism disorders included 33 patients (36.5%): 5 subjects (5.5%) with impaired fasting glucose, 20 patients (22%) with impaired glucose tolerance and 8 patients (9%) with diabetes. The remaining 57 (63.5%) patients had nor­mal results of OGTT and were assigned to the group without glucose metabolism disorders. The mean BMI in the whole examined population was 26.7 kg/m2. Patients with glucose metabolism disorders (GMD) had a significantly higher BMI (31.1 kg/m2). The levels of total cholesterol, LDL cholesterol and TG were higher in patients with GDM; however, the difference was not statistically significant. Random blood glucose values were significantly higher in the group with GDM, but no patient had random blood glucose ≥ 200 mg/dL. The HbA 1c value was significantly higher in the GMD group. Also, the C-reactive protein (CRP) level was significantly higher in the group of patients with GMD than in the group of healthy subjects. All patients un­derwent gastroscopy and abnormal results were found in 41 patients (45.5% of total study population) — in 67% in the group with GMD and 33% in the group without GDM. The most frequent pathology was Heli­cobacter pylori infection (25.5%). This infection was more prevalent in the group with GDM (45%) than in the group without GDM (14%). In addition, gastritis, gastric cancer, gastro-esophageal reflux, hiatal hernia, and gastric polyps were found, without significant differences between the subgroups. Conclusions. Over 1/3 of the subjects with dyspepsia had prediabetes or diabetes; therefore, it seems that this group of patients should be screened for glucose metabolism disorders. High prevalence of GMD among patients with dyspepsia indicates potential benefits of performing OGTT in this group of patients. Gastroin­testinal symptoms may be an early manifestation of glucose metabolism disorders. There is a correlation between Helicobacter pylori infection and the pres­ence of glucose metabolism disorders.

Plasma Histone H4 and H4K20 Trimethylation Levels Differ Between Colon Cancer and Precancerous Polyps

No blood-based biomarkers are available to differentiate between colonic tumors and precancerous polyps. Previously we demonstrated levels of trimethylated H4K20 (H4K20me3) to be lower in blood plasma from patients with colon cancer than those from cancer-free individuals. Herein, we added individuals with precancerous polyps for the first time in order to analyze and investigate the usefulness of plasma H4K20me3 and histone H4 to discriminate colon tumors from precancerous polyps. The study included a cohort of 185 individuals undergoing colonoscopy. H4K20me3 and histone H4, measured by an enzyme-linked immunosorbent assay-like assay in plasma, were analyzed according to colonoscopy findings. Levels of H4K20me3 were lower in patients with colon cancer than in individuals with normal colonoscopy and those with precancerous polyps (p=0.02 and p=0.01, respectively). In contrast, highest quantities of histone H4 were measured in those with colon cancer compared to other groups (all p<0.01). Beside H4K20me3, plasma histone H4 is a useful marker to discriminate colonic tumors from precancerous polyps and other conditions.

Thick "Swiss Cheese" Appearance of Uterine Endometrium in Postmenopausal Women with Different Gynecologic Conditions.

ObjectivesTo uncover gynecologic conditions with similar transvaginal sonographic findings of thick uterine endometrium with honeycomb appearance in pre-and postmenopausal women.MethodsWe retrospectively reviewed cases of patients with endometrial tissue biopsy from January 2010 to December 2016. We also collected office flexible hysteroscopic findings and surgical pathologic results. We analyzed data from 393 patients with confirmed endometrial pathology. Among these patients, 69 had transvaginal ultrasonographic images with thick uterine endometrium and honeycomb or “Swiss cheese” appearance.ResultsWe found gynecologic conditions such as submucosal leiomyoma with degeneration, endometrial polyp, pseudocystic endometrial change associated with tamoxifen use, progesterone associated endometrial change, pyometra, retained placenta, and uterine synechiae manifested with similar thick endometrium with “Swiss cheese” appearance in transvaginal sonographic images. The most common diagnosis in postmenopausal women was atrophic endometritis, followed by endometrial cancer and endometrial polyps. The most common diagnosis in premenopausal women was abnormal uterine bleeding without pathologic conditions.ConclusionsSonographic findings of thick uterine endometrium with “Swiss cheese” appearance need to be considered together with a thorough review of the patient's history and chief complaint before making a tentative diagnosis due to the various conditions sharing the feature.

Trainee colonoscopy quality is influenced by the independent and unobserved performance characteristics of supervising physicians.

Background Endoscopy training remains an apprenticeship, and the characteristics that facilitate transfer of high quality procedural skills from role models to trainees are unknown. We sought to determine whether unobserved supervisor performance influences the quality of colonoscopy performed by trainees, by studying how supervisors perform alone and how trainees perform while under those same supervisors. Methods This was a retrospective cross-sectional study conducted among ambulatory adults ≥ 50 years old who underwent colonoscopy for cancer screening or polyp surveillance from 2006 to 2015 at one academic medical center. The primary exposures were the colonoscopy withdrawal time (WT) and adenoma detection rate (ADR) of supervisors while performing colonoscopies alone. The primary outcomes were the WT and ADR of trainees performing colonoscopies under supervision. Results Data were included from 22 attending gastroenterologist supervisors, 56 gastroenterology fellow trainees, and 2777 adults undergoing 3094 colonoscopy procedures. Among all supervised colonoscopies, mean trainee WT was 12.7 minutes (SD 4.9) and trainee ADR was 33.5 %. The trainee WT was 0.42 minutes longer (standard error = 0.16, P = 0.01) per minute increase in supervisor WT. Similarly, trainee ADR was higher under a high ADR supervisor, and the odds ratio of high compared to low supervisor ADR category was 1.28 (95 %CI 1.01 – 1.62, P = 0.04) after adjusting for other factors. Conclusions The unobserved performance characteristics of supervising endoscopists may influence the quality of colonoscopy performed by trainees.

Complete endoscopic mucosal resection of malignant colonic sessile polyps and clinical outcome of 51 cases.

BackgroundMeta-analyses and guidelines recommend that deep submucosal invasion (>1 mm) of malignant sessile colonic polyps is an important risk factor for lymph node metastasis. However, existing data are based on small retrospective studies with marked heterogeneity. We herein aimed to investigate the long-term outcomes of patients who underwent complete endoscopic mucosal resection (EMR) of malignant colonic sessile polyps invading the submucosal layer.MethodsEndoscopy records for the period 2000-2016 were reviewed retrospectively. All enrolled patients exhibited an endoscopically resected malignant colonic sessile polyp. All patients were advised to undergo surgery, but some opted for conservative treatment and endoscopic follow up.ResultsFifty-one patients with confirmed infiltrative submucosal adenocarcinoma in sessile colonic polyps that had undergone complete EMR were detected. A total of 32 (62.7%) patients opted for surgery after EMR and 19 (37.3%) chose endoscopic follow up. In 44 (86.3%) patients the submucosal invasion was >1 mm. Residual malignant disease was identified in the surgical pathological specimen of only 1 patient. During a median follow up of 23.41 months (interquartile range 33.45, range 1.84-144.92), no local recurrences or lymph node metastasis were identified. Forty-nine patients are alive without evidence of disease and 2 died of other causes (without evidence of local or metastatic disease at last follow up).ConclusionOur data suggest that complete EMR of cancerous colonic sessile polyps, even in cases of submucosal invasion >1 mm carries a low risk of recurrence and therefore may need further evaluation as an alternative strategy to surgical resection.

The value of oral contrast ultrasonography in the diagnosis of gastric cancer in elderly patients

BackgroundThis study aims to investigate the value of oral contrast ultrasonography (OCUS) in the diagnosis of gastric cancer in elderly patients.MethodsOCUS data obtained from patients ≥ 60 years old were retrospectively analyzed and compared with gastroscopy results.ResultsAmong the 12,716 subjects examined by OCUS, 5021 subjects were ≥ 60 years old, which accounted for 39.48% (5021/12,716). Gastritis, gastric polyp, benign ulcer, and gastric cancer were detected by OCUS in 1099 patients. Among them, 196 patients underwent gastroscopy. Furthermore, ulcerative lesions were detected in 32 patients by OCUS and in 51 patients by gastroscopy, and the coincidence rate was 62.74%. Among these patients, gastric cancer was diagnosed in 18 patients by OCUS with a detection rate of 1.64% (18/1099) and detected in 19 patients by gastroscopy with a diagnostic coincidence rate of 94.73% (18/19). Furthermore, benign ulcer was detected in 14 patients by OCUS and in 32 patients by gastroscopy, and the diagnostic coincidence rate was 43.75% (14/32).ConclusionOCUS helps to timely detect senile gastric cancer and can be used as a suitable technique for the detection of gastric diseases.

Adenoma Detection before and after the age of 50: a retrospective analysis of Lebanese outpatients

Background and aimColorectal cancer (CRC) has an increased impact on the Lebanese population’s morbidity and mortality. This study evaluated the situation of adenoma detection in an outpatient clinic in Lebanon.Patients...

Premium Service: Comparing Cost and Quality for Colorectal Cancer Screening

Despite emphasis on paying for value, few studies have identified the relationship between price and quality for health care services. One reason why the relationship between price and quality remains uncertain is inherent selection bias: the same patients who are likely to receive care from high-priced providers are also more likely to be at higher risk for complications. This selection is particularly relevant for an important cancer screening test, colonoscopy, which is both an invasive procedure and among the most expensive cancer screening test. This paper uses an exogenous source of variation that influences the supply of low-priced providers, state Certificate of Need (CON) laws, as an instrumental variable for receiving a colonoscopy at low-priced providers. Patients who live in a state with a CON law are 22% less likely to receive a colonoscopy from a particular form of low-priced provider, ambulatory surgical centers (ASCs). Using this source of variation, receiving a colonoscopy from an ASC reduces procedure costs by 39% and patient cost sharing by 44%. For quality outcomes, the results are more ambiguous–use of ASCs leads to a 1.9 percentage point reduction in surgical complication rates but an 8.1 percentage point reduction in potentially cancerous polyp removal. Using the same sources of variation, higher colonoscopy prices, lower market share of ASCs, and increased market concentration reduce colonoscopy utilization, but increase the use of substitute cancer screening tests. This substitution produces the counterintuitive result that higher prices leads to lower overall cancer screening spending.