Features Of Polyps Research Articles

Analysis of risk factors for postoperative bleeding and polyp recurrence in adolescents with gastric polyps treated with endoscopic mucosal resection: a retrospective cohort study.

The incidence of gastric polyps in adolescents has been increasing every year in recent years. Endoscopic mucosal resection (EMR) is one of the most common treatments for adults, but there are few reports on the association between EMR of gastric polyps and the occurrence of bleeding and recurrence after the procedure in adolescents. This study sought to analyze the independent risk factors for postoperative bleeding and polyp recurrence after EMR to provide a reference for reducing the occurrence of postoperative complications. We retrospectively analyzed the data of 579 adolescent patients who developed gastric polyps from June 2016 to June 2021. Postoperative follow-up was conducted for 1 year by telephone, e-mail, and outpatient review. The general characteristics of the study population were compiled using a general information questionnaire designed by the investigators. The relationship between the patients' clinical characteristics and postoperative bleeding or recurrence was analyzed using the chi-square test. A binary logistic regression analysis was conducted to analyze the independent risk factors for the occurrence of postoperative bleeding and polyp recurrence in patients. The results of the binary logistic regression analysis showed that being female [odds ratio (OR) =0.306, P=0.009], polyps >1 cm in diameter (OR =2.557, P=0.029), polyps in gastric sinus (OR =3.889, P=0.032), sessile lesions (OR =0.398, P=0.036), the need for additional intraoperative sedation (OR =3.469, P=0.005), concurrent diverticulum (OR =3.570, P=0.004), and intraoperative bleeding (OR =4.855, P=0.001) were independent risk factors for postoperative bleeding. We also found that polyps >1 cm in diameter (OR =2.134, P=0.003), multiple polyps (OR =2.117, P=0.005), adenomatous polyps (OR =2.684, P=0.041), combined Helicobacter pylori infection (OR =2.036, P=0.009), the occurrence of postoperative gastrointestinal reflux (OR =1.998, P=0.015), and an operative time ≥40 min (OR =2.021, P=0.010) were independent risk factors for the recurrence of polyps. There is still a high probability of postoperative bleeding and polyp recurrence after EMR in adolescents with gastric polyps. Clinicians should pay close attention to the clinical features of polyps, such as polyp size, number, morphology, and pathological type, to identify the related risk factors as early as possible and reduce the probability of postoperative bleeding and polyp recurrence in patients.

RA-DENet: Reverse Attention and Distractions Elimination Network for polyp segmentation

To address the problems of polyps of different shapes, sizes, and colors, low-contrast polyps, various noise distractions, and blurred edges on colonoscopy, we propose the Reverse Attention and Distraction Elimination Network, which includes Improved Reverse Attention, Distraction Elimination, and Feature Enhancement. First, we input the images in the polyp image set, and use the five levels polyp features and the global polyp feature extracted from the Res2Net-based backbone as the input of the Improved Reverse Attention to obtain augmented representations of salient and non-salient regions to capture the different shapes of polyp and distinguish low-contrast polyps from background. Then, the augmented representations of salient and non-salient areas are fed into the Distraction Elimination to obtain the refined polyp feature without false positive and false negative distractions for eliminating noises. Finally, the extracted low-level polyp feature is used as the input of the Feature Enhancement to obtain the edge feature for supplementing missing edge information of polyp. The polyp segmentation result is output by connecting the edge feature with the refined polyp feature. The proposed method is evaluated on five polyp datasets and compared with the current polyp segmentation models. Our model improves the mDice to 0.760 on the most challenge dataset (ETIS).

Serrated polyps in patients with ulcerative colitis: Unique clinicopathological and biological characteristics.

Serrated polyps have recently been reported in patients with ulcerative colitis (UC); however, their prevalence and detailed characteristics remain unclear. The prevalence and clinicopathological and biological characteristics of serrated polyps in patients with UC were retrospectively examined in a single tertiary inflammatory bowel disease center in Japan from 2000 to 2020. Among 2035 patients with UC who underwent total colonoscopy, 252 neoplasms, including 36 serrated polyps (26 in colitis-affected segments, 10 in colitis-unaffected segments), were identified in 187 patients with UC. The proportion of serrated polyps was 1.8% (36/2035). Serrated polyps in colitis-affected segments were common with extensive colitis (88%), history of persistent active colitis (58%), and long UC duration (12.1 years). Serrated polyps in colitis-affected segments were more common in men (88%). Of the 26 serrated polyps in colitis-affected segments, 15, 6, and 5 were categorized as sessile serrated lesion-like dysplasia, traditional serrated adenoma-like dysplasia, and serrated dysplasia not otherwise specified, respectively. Sessile serrated lesion-like dysplasia was common in the proximal colon (67%) and with BRAF mutation (62%), whereas traditional serrated adenoma-like dysplasia and serrated dysplasia not otherwise specified were common in the distal colon (100% and 80%, respectively) and with KRAS mutations (100% and 75%, respectively). Serrated polyps comprised 14% of the neoplasias in patients with UC. Serrated polyps in colitis-affected segments were common in men with extensive and longstanding colitis, suggesting chronic inflammation in the development of serrated polyps in patients with UC.

Clinicopathological Features of Sessile Serrated Polyps in China: A Retrospective Study of a Tertiary Hospital.

Serrated polyps have been recognized as the important premalignant lesions. In this study, we aimed to analyze the clinicopathological features of sessile serrated polyps and determine the association between sessile serrated polyps and synchronous advanced adenomas. Consecutive patients undergoing diagnostic or therapeutic colonoscopies (including 156 681 diagnostic colonoscopies) from 2011 to 2019 were included. A total of 958 patients, including 699 (73%) males, were detected with at least 1 sessile serrated polyp, and 65.9% (n = 658) of sessile serrated polyps were located in the distal colon. Advanced serrated lesions accounted for 9.1% (n = 91) of all the sessile serrated polyp (n = 999). The types of SSP included flat type (953/999, 95.4%) and sub-pedunculated or pedunculated type (46/999, 4.6%). Meanwhile, there was no obvious evidence supporting the association between advanced adenomas and characteristics of advanced serrated lesions or sessile serrated polyps. Sessile serrated polyps seem to be more frequently seen in the distal colon of men in this study. However, more evidence is required to confirm the actual distribution of sessile serrated polyp in colon among Chinese people. There is still much room for improvement of sessile serrated polyp detection rate, and more importance should be attached to sessile serrated polyp both for pathologists and endoscopists.

A Reliable and Sensitive Framework for Simultaneous Type and Stage Detection of Colorectal Cancer Polyps.

With the goal of enhancing the early diagnosis of colorectal cancer (CRC) polyps and reducing the risk of mortality in cancer patients, in this article, we present a unique diagnosis framework including a Vision-based Surface Tactile Sensor (VS-TS) and complementary Artificial Intelligence algorithms. Leveraging the morphological characteristics (i.e., shape and texture) and stiffness features of the CRC polyps, the proposed framework is able to reliably and sensitively identify their type and stage. To thoroughly characterize and identify the required VS-TS sensitivity for reliable identification of polyps, we first fabricated three different VS-TSs and qualitatively evaluated their performances on 48 different types of polyp phantoms fabricated based on four different types of realistic CRC polyps and three different materials. Next, to quantitatively compare the performance and sensitivity of the fabricated VS-TSs, we used Support Vector Machine (SVM) algorithm and employed various statistical metrics (i.e., accuracy, reliability, and sensitivity). Next, using the most sensitive VS-TS, we classified the type of tumors using the SVM algorithm and applied the t-Distributed Stochastic Neighbor Embedding algorithm to successfully identify the stiffness of classified polyp phantoms solely based on the output images of the VS-TS sensor. Results demonstrated that an SVM algorithm applied on the image outputs of a VS-TS with a Shore hardness of 00-40 scale is able to classify all types of polyps with > 90% accuracy, sensitivity, and reliability. We also repeated experiments on samples of ex-vivo lamb tripe tissues and successfully verified the high sensitivity and reliability of the proposed framework (i.e., > 94%).

P571 Frequency and risk factors of advanced neoplasia in Korean IBD patients with Low Grade Dysplasia in previous surveillance

Abstract Background There are insufficient studies on clinical outcome after surveillance of low grade dysplasia (LGD) in patients with inflammatory bowel disease (IBD). We aimed to evaluate the clinical feature, frequency and risk factors of advanced neoplasia in IBD patients after diagnosis of LGD Methods From 2003 to 2020, medical records of 166 IBD patients from 6 university hospitals in Korea were reviewed retrospectively. All of the patients were diagnosed as LGD in surveillance. Patents’ baseline characteristics, disease status, polyp characteristics and treatment were evaluated. The frequency and risk factors of advanced neoplasia were also analyzed. Results Disease duration was 11.47 years (7.85-14.50), and follow-up duration was 3.74 years (1.95-7.58). Colitis associated LGD was noted in 56 cases (33.7%), Advanced neoplasia developed in 12 cases (6 large LGD, 3 tubulovillous adenoma, 3 high grade dysplasia) and all the cases developed from UC. Patients with advanced neoplasia had significantly higher Mayo score and colitis-related dysplasia were more common than sporadic lesions (83.3% vs. 29.9%; P<0.001). In multivariate analysis, colitis-associated LGD significantly increased the risk of developing advanced neoplasia (Odds ratio [OR], 10.516; 95% confidence interval [CI], 2.064-53.577; P=0.005). Among patients with colitis-associated lesions, a significant risk factor for advanced neoplasia was a history of LGD (OR, 9.429; 95% CI, 1.330-66.863; P=0.025). Conclusion Advanced neoplasia developed in 7.2% of IBD patients with LGD. Because most of advanced neoplasia developed from colitis-associated lesions, more careful examination is suggested in patients with colitis -associated LGD, especially with previous history, in surveillance colonoscopy.

An automatic gastric polyp detection technique using deep learning

AbstractOver the last few years, researchers have focused on computer‐aided polyp detection in gastroscopy. Deep learning (DL) has shown great promise for polyps' identification. The most exceptional contribution of DL methods in gastroenterology is their ability to identify polyps quickly and accurately using convolution neural network. Nonetheless, despite significant advancements, automatic detection of small polyps remains a challenging and complex task. Furthermore, due to multiple pooling operations, the features of small polyps are lost, resulting in low detection accuracy. This paper proposes an efficient object detection method for polyp detection using gastric images to address this issue. A single‐shot multi‐box detector (SSD) was combined with the feature extractor VGG‐16, and the Refined Map Block (RMB) was integrated into SSD's high‐resolution feature maps to get more semantic information. The RMB output was used as the input to the successive layers. The RMB comprises of attention cascade and feature map concatenation cascade. The attention cascade improved the localization accuracy, while the feature map concatenation cascade improved the classification accuracy. Using the former, the proposed attention‐based SSD for gastric polyps (ASSD‐GPNet) model focused on the specific information, a polyp, rather than the background. Furthermore, the feature map concatenation cascade adds semantic information while reducing computational complexity. The output of these two cascades was combined to produce a refined feature map that enhances the detection of small polyps. The model was trained and tested on 1970 gastric images and Pascal VOC07 + 12. Image augmentation was applied to increase the training data of gastric images to reduce overfitting and skip connections were used to overcome the vanishing gradient problem. Overall, the experimental results demonstrated that the proposed model outperformed than compared models in both medical and natural images. The ASSD‐GPNet obtained mean average precision (mAP) of 94.2% on gastric images and 76.9% on Pascal VOC.

Characteristics of adenomatous colorectal polyps among a Saudi population

ObjectivesColorectal cancer is a common cause of cancer-related mortality in KSA with a rising incidence. Although adenomatous polyps are well-recognized as precursors of colorectal cancer, local data are scarce. Therefore, in this study, we aimed to evaluate the characteristics of adenomatous colon polyps in the Saudi population. MethodsWe retrospectively reviewed the electronic databases of all patients who underwent colonoscopy for any indication between January 2015 and December 2019 at a tertiary care hospital. This study included adult patients who were found to have colorectal polyps with identified histopathology reports. We collected clinical and pathological data, including patient age, sex, and histopathological polyp characteristics. A p-value <0.05 was considered significant for descriptive and analytical statistics. ResultsA total of 184 patients with colorectal polyps with identified histopathology reports were included in the analysis. Of these, 130 (70.6%) patients were aged 50 years or older, and 135 (73.3%) were male. Among all polyps, 127 (69%) were adenomatous, 31 (16.8%) were hyperplastic, and 24 (13%) were inflammatory. For adenomatous polyps, 31 (24.4%) were observed in patients younger than 50 years, and high-grade dysplasia was observed in 23 (18%) polyps. Among patients with adenomatous polyps, the anatomical location was as follows: 27 (23%) in the cecum/ascending colon, 12 (9%) in the transverse colon, 45 (35%) in the descending/sigmoid colon, 25 (19%) in the rectum, and 18 (14%) at multiple sites. Age >50 years was significantly associated with adenomatous polyps (P = 0.03). ConclusionApproximately one-third of adenomatous polyps were detected proximal to the splenic flexure. Although adenomatous polyps were significantly associated with increasing age, 24% were observed in patients younger than 50 years of age. This finding supports the current recommendation to start screening at the age of 45.

Leveraging Natural Language Processing to Extract Features of Colorectal Polyps From Pathology Reports for Epidemiologic Study.

Histopathologic features are critical for studying risk factors of colorectal polyps, but remain deeply embedded within unstructured pathology reports, requiring costly and time-consuming manual abstraction for research. In this study, we developed and evaluated a natural language processing (NLP) pipeline to automatically extract histopathologic features of colorectal polyps from pathology reports, with an emphasis on individual polyp size. These data were then linked with structured electronic health record (EHR) data, creating an analysis-ready epidemiologic data set. We obtained 24,584 pathology reports from colonoscopies performed at the University of Utah's Gastroenterology Clinic. Two investigators annotated 350 reports to determine inter-rater agreement, develop an annotation scheme, and create a reference standard for performance evaluation. The pipeline was then developed, and performance was compared against the reference for extracting polyp location, histology, size, shape, dysplasia, and the number of polyps. Finally, the pipeline was applied to 24,225 unseen reports and NLP-extracted data were linked with structured EHR data. Across all features, our pipeline achieved a precision of 98.9%, a recall of 98.0%, and an F1-score of 98.4%. In patients with polyps, the pipeline correctly extracted 95.6% of sizes, 97.2% of polyp locations, 97.8% of histology, 98.3% of shapes, and 98.3% of dysplasia levels. When applied to unseen data, the pipeline classified 12,889 patients as having polyps, 4,907 patients without polyps, and extracted the features of 28,387 polyps. Tubular adenomas were the most common subtype (55.9%), 8.1% of polyps were advanced adenomas, and the mean polyp size was 0.57 (±0.4) cm. Our pipeline extracted histopathologic features of colorectal polyps from colonoscopy pathology reports, most notably individual polyp sizes, with considerable accuracy. This study demonstrates the utility of NLP for extracting polyp features and linking these data with EHR data to create an epidemiologic data set to study colorectal polyp risk factors and outcomes.

Morphology, Histopathology, and Anatomical Distribution of Sporadic Colorectal Polyps in Chinese Patients.

There are limited data regarding the morphology, histopathology, and anatomical distribution of sporadic colorectal polyps in Chinese patients. We evaluated these characteristics of sporadic polyps to guide the endoscopic detection and excision of colorectal polyps. This was a retrospective single-center observational study involving 7381 patients with sporadic colorectal polyps. All polyps were removed endoscopically. The morphology and histopathology of polyps were evaluated according to the Paris classification and the World Health Organization classification, respectively. A total of 22,174 polyps removed endoscopically from 7322 patients were included. In the sigmoid colon, 24.70% of colorectal polyps occurred, followed by the transverse colon (18.58%) in frequency. 0-Is type polyps accounted for 60.60% of all sporadic colorectal polyps. Polyps with 0-Ip, 0-Isp, and 0-IIa types were frequently found in the sigmoid colon, but laterally spreading lesions usually occurred in the ascending colon (24.61%) and rectum (20.51%). Irrespective of the Paris classification and anatomical location, as the polyps enlarge, the proportion of adenomatous polyps gradually increases while the proportion of serrated lesions decreases. Polyps with size ≥1 cm located in the left-sided colon were more likely to have villous/tubulovillous or high-grade dysplasia histology than those located in the right-sided colon, and about 1% of them were demonstrated with adenocarcinoma. Sigmoid colon should be detected adequately during colonoscopy, and polyps with size ≥1 cm should be treated carefully, especially in the left-sided colon.

An early Cambrian polyp reveals a potential anemone‐like ancestor for medusozoan cnidarians

AbstractCnidarians form a disparate phylum of animals and their diploblastic body plan represents a key step in animal evolution. Cnidarians are split into two main classes; anthozoans (sea anemones, corals) are benthic polyps, while medusozoans (hydroids, jellyfishes) generally have alternating life cycle stages of polyps and medusae. A sessile polyp is present in both groups and is widely regarded as the ancestral form of their last common ancestor. However, the nature and anatomy of the ancestral polyp, particularly of medusozoans, is controversial, owing to the divergent body plans of the extant lineages and the scarcity of medusozoan soft tissues in the fossil record. Here, we redescribe Conicula striata Luo &amp; Hu from the early Cambrian Chengjiang biota, south China, which has previously been interpreted as a polyp, lophophorate or deuterostome. Through re‐examination of the holotype and 51 exceptionally preserved specimens, we show that C. striata possessed features of both anthozoans and medusozoan polyps. A conical, annulated organic skeleton (periderm) fully encasing a polyp is found in fossil and living medusozoans, while a tubular pharynx extending from the mouth into a gut partitioned by c. 28 mesenteries, resembling the actinopharynx of anthozoans. Our phylogenetic analyses recover C. striata as a stem‐group medusozoan, implying that the wealth of medusozoan diversity derived, ultimately, from an anemone‐like ancestor.

Automated polyp segmentation based on a multi-distance feature dissimilarity-guided fully convolutional network.

Colorectal malignancies often arise from adenomatous polyps, which typically begin as solitary, asymptomatic growths before progressing to malignancy. Colonoscopy is widely recognized as a highly efficacious clinical polyp detection method, offering valuable visual data that facilitates precise identification and subsequent removal of these tumors. Nevertheless, accurately segmenting individual polyps poses a considerable difficulty because polyps exhibit intricate and changeable characteristics, including shape, size, color, quantity and growth context during different stages. The presence of similar contextual structures around polyps significantly hampers the performance of commonly used convolutional neural network (CNN)-based automatic detection models to accurately capture valid polyp features, and these large receptive field CNN models often overlook the details of small polyps, which leads to the occurrence of false detections and missed detections. To tackle these challenges, we introduce a novel approach for automatic polyp segmentation, known as the multi-distance feature dissimilarity-guided fully convolutional network. This approach comprises three essential components, i.e., an encoder-decoder, a multi-distance difference (MDD) module and a hybrid loss (HL) module. Specifically, the MDD module primarily employs a multi-layer feature subtraction (MLFS) strategy to propagate features from the encoder to the decoder, which focuses on extracting information differences between neighboring layers' features at short distances, and both short and long-distance feature differences across layers. Drawing inspiration from pyramids, the MDD module effectively acquires discriminative features from neighboring layers or across layers in a continuous manner, which helps to strengthen feature complementary across different layers. The HL module is responsible for supervising the feature maps extracted at each layer of the network to improve prediction accuracy. Our experimental results on four challenge datasets demonstrate that the proposed approach exhibits superior automatic polyp performance in terms of the six evaluation criteria compared to five current state-of-the-art approaches.

Association between diverticular disease and prevalence of colorectal adenomatous polyps or adenocarcinomas

Background/Aim: Although the link between diverticular disease (DD) of the colon and colon polyp is known, the relationship between colon adenocarcinoma is not clear. This study evaluated the association between DD and adenomatous polyp or colon adenocarcinoma. Methods: Patients who underwent colonoscopy for the first time in 2020-2021 were evaluated and included in this retrospective cohort study. Patients with a previous history of cancer diagnosis, colon surgery, DD, and inflammatory bowel disease were excluded from the study. Age, gender, colonoscopy indications, colonoscopy diagnoses, presence of DD, characteristics of polyps (pathology, diameter, number, localization), and presence of adenocarcinoma were recorded. Obtained data were analyzed between DD and non-DD groups. Results: A total of 2633 patients were included in the study. The prevalence of DD was 16.4%. Colon adenocarcinoma was detected in 4.7%. The adenomatous polyp rate was 14.1%. A significantly higher rate of adenomatous polyps was detected in the DD group compared to the non-DD group (19.7% vs. 12.9%; P = 0.001). Higher rates of high-grade dysplasia (3.0 vs. 1.1%; P = 0.002) and colon adenocarcinoma (7.2% vs. 4.2%; P = 0.008) were observed in the DD group also. In logistic regression analyses, it was observed that the presence of concomitant DD increases the risk of adenomatous polyps (OR: 1.469, 95% CI: 1.158–1.865), the risk of adenomatous polyps with positive villous component (OR: 2.378, 95% CI: 1.437–3.934), the risk of adenomatous polyps with high-grade dysplasia (OR: 2.822, 95% CI: 1.426–5.582), and the risk of colon adenocarcinoma (OR: 2.953, 95% CI: 1.445–6.533). Conclusion: DD is associated with precancerous lesions of the colon (adenomatous polyp, villous adenoma, high-grade dysplasia) and colon adenocarcinoma. Further studies are needed to investigate its association with colon carcinogenesis and its role and value in cancer screening.

Clinical, endoscopic, histopathological characteristics of patients with colorectal polyps - Endoscopy Gastroenterology Center, Hue University of Medicine and Pharmacy Hospital

Background: Colorectal polyps are a relatively common diseases in the group of lower gastrointestinal tract diseases. The prevalence of colorectal polyps ranges from 20 to 50%. Polyps are formed due to excessive hyperplasia of the mucosa and the malignancy rate of colorectal polyps is higher than other sites. Objectives: (1) To describe some clinical and endoscopic features of colorectal polyps; (2) To evaluate the histopathological characteristics and the relationship between histopathology and some clinical and endoscopic features of colorectal polyps. Subjects: The patients aged 16 years old and older who were diagnosed with colon polyps at the Center for Gastroenterology - Endoscopy at Hue University of Medicine and Pharmacy Hospital from April 1st, 2020 to March 30th, 2021. Methods: Cross-sectional, retrospective description. Results: Study on 67 patients who were dianosiged as having colorectal polyps through endoscopy, in which, 48 patients underwent polypectomy and histopathology. The mean age is 55.8 ± 15.7 years old, the most common age group is ≥ 45 years old, male/female is 2/1. The time from symptoms onset to disease detection is usually 6 months to less than 1 year (37.4%). The common clinical symptoms: abdominal pain (83.6%), diarrhea (29.9 %), constipation (28.4%), dysentery syndrome (13.4%), bloody stools (31.3%). The position of polyps: anus (1.5%), rectum (47.8%), sigmoid colon (40.3%), descending colon (31.3%), transverse colon (22.4%), ascending colon (28.4) %), cecum (13.4%). The proportion of patients having ≥ 2 polyps (59.7%), 1 polyp (40.3%). Polyp sizes: 5 - &lt; 10 mm (50.7%), &lt; 5 mm (37.4%), ≥ 10 mm (11.9%). The percentage of sessile polyps is higher than that of pedunculated polyps at each locations. Histopathological types: adenomatous polyps (60.4%), hyperplastic polyps (20.8%), malignant polyps (4.2%). Polyps with dysplasia (64.6%), mild – grade dysplasia (56.3%), severe-grade dysplasia (8.3%). The differences were statistically significant between the grade of dysplasia and the polyp size groups, between the histopathology and the grade of dysplasia (p &lt; 0.05). Conclusions: Colorectal polyps are more common in patients ≥ 45 years old, male are much more of having than female. Abdominal pain, bloody stools are common symptoms. Common polyp phenotypes are sessile polyps, ≥ 2 polyps, 5 - &lt; 10 mm in size, mainly in the rectum. Adenomatous polyps are the most common histopathological type, with the high rate of dysplasia. Key words: clinical, endoscopy, histopathology, colorectal polyps.

Image-enhanced endoscopy for real-time differentiation between hyperplastic and fundic gland polyps in the stomach.

Fundic gland polyps (FGP) of stomach are benign, while some hyperplastic polyps (HP) may harbor dysplasia or malignancy. Conventional white light endoscopy (WLE) cannot reliably distinguish FGP from HP. We investigated the role of image-enhanced endoscopy in differentiating FGP from HP. Patients with gastric polyps were recruited prospectively. The characteristics of the polyps were assessed using WLE and magnification narrow band imaging (mNBI). The microsurface, intervening space (IS), and microvascular (V) features of polyps were evaluated on mNBI. The pattern characteristic of FGP and HP were determined. Histopathology of polyps was the gold standard for diagnosis. Finally, in the validation phase, five endoscopists applied the characteristic features identified in this study to predict the type of gastric polyp and their performance was assessed. Forty-five patients with a total of 70 gastric polyps (HP-46, FGP-24) were included in this study. On mNBI, the pattern characteristic of HP included peripheral curved type of white structures forming large circular/villous loops (microsurface), enlarged intervening space, and microvessels appearing as dark patches in the intervening space (p<0.001 vs. FGP). These were noted in 95.7% HP. In contrast, 95.8% FGP had a pattern characterized by dotted/elliptical/tubular white structures (microsurface), normal width of intervening space, and microvessels surrounding the white structures in a network pattern. This IS-V pattern classification had an accuracy of >90% in the validation phase with intra-class correlation coefficient of 0.95. The accuracy of mNBI was higher than WLE (97.1% vs. 67%) in predicting the type of gastric polyp. Image-enhanced endoscopy with mNBI (IS-V pattern) performs very well in differentiating HP from FGP.

Giant Antrochoanal Polyp in a Six-years-old Boy: A Case Report and Literature Review

Antrochoanal polyps are more prevalent in children than adults. Unilateral nasal obstruction and rhinorrhea are usually the features of unilateral antrochoanal polyps. Bilateral nasal obstruction can be a feature of antrochoanal polyp if it is large and obstruct both choanae. The giant antrochoanal polyp is rarely reported in the literature. We are reporting this scenario of giant left antrochoanal polyp in a 6-years-old boy who presented with bilateral nasal obstruction, nasal and postnasal mucopurulent discharge, hypo-nasal speech, mouth breathing, snoring, and obstructive sleep apnea syndrome. The physical examination revealed a mass seen in the oropharynx behind the uvula. Further examination by nasal endoscopy, computerized tomography, and histopathological evaluation of the excised polyp have confirmed the diagnosis of an antrochoanal polyp. Although this entity is not commonly seen in daily clinical practice, careful assessment is needed to not miss the diagnosis for early treatment to avoid unwanted complications.

Incidental Findings of Gallbladder and Bile Ducts-Management Strategies: General Aspects, Gallbladder Polyps and Gallbladder Wall Thickening-A World Federation of Ultrasound in Medicine and Biology (WFUMB) Position Paper.

The World Federation of Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings with a series of position papers to give advice on characterization and management. The biliary system (gallbladder and biliary tree) is the third most frequent site for incidental findings. This first part of the position paper on incidental findings of the biliary system is related to general aspects, gallbladder polyps and other incidental findings of the gallbladder wall. Available evidence on prevalence, diagnostic work-up, malignancy risk, follow-up and treatment is summarized with a special focus on ultrasound techniques. Multiparametric ultrasound features of gallbladder polyps and other incidentally detected gallbladder wall pathologies are described, and their inclusion in assessment of malignancy risk and decision- making on further management is suggested.

RESEARCH ON KRAS MUTATIONS IN PATIENTS WITH COLORECTAL POLYPS LARGER THAN 10 MM

Objectives: Determine the prevalence of KRAS mutations using RNA samples and the association with endoscopic and histopathological images of colorectal polyps larger than 10mm. Subjects and methods: A cross-sectional study on 84 patients at the Gastroenterology-Hepatobiliary center - Bach Mai Hospital from 01/2017 - 12/2021. Perform a colonoscopy, select the largest polyp over 10mm in size to characterize and perform polypectomy, taking the specimen for histopathology according to WHO criteria 2010. Identification of KRAS gene mutations in tissue samples using RNA samples. Results: 10.7% of the KRAS gene is mutated. KRAS gene mutation rates tended to be higher in villous polyps compared to tubular polyps (33.3% vs. 9.2%) and high-grade dysplastic polyps compared to low-grade dysplastic polyps (23.1% vs. 8.6%), though no correlation between KRAS gene mutations and endoscopic imaging characteristics of polyps has been reported. Conclusion: KRAS gene mutations are not common in polyps larger than 10 mm but are related to the villious component and the degree of dysplasia on the histopathology of the polyp.

HMA-Net: A deep U-shaped network combined with HarDNet and multi-attention mechanism for medical image segmentation.

Automatic segmentation of lesion, organ, and tissue from the medical image is an important part of medical image analysis, which are useful for improving the accuracy of disease diagnosis and clinical analysis. For skin melanomas lesions, the contrast ratio between lesions and surrounding skin is low and there are many irregular shapes, uneven distribution, and local and boundary features. Moreover, some hair covering the lesions destroys the local context. Polyp characteristics such as shape, size, and appearance vary at different development stages. Early polyps with small sizes have no distinctive features and could be easily mistaken for other intestinal structures, such as wrinkles and folds. Imaging positions and illumination conditions would alter polyps' appearance and lead to no visible transitions between polyps and surrounding tissue. It remains a challenging task to accurately segment the skin lesions and polyps due to the high variability in the location, shape, size, color, and texture of the target object. Developing a robust and accurate segmentation method for medical images is necessary. To achieve better segmentation performance while dealing with the difficulties above, a U-shape network based on the encoder and decoder structure is proposed to enhance the segmentation performance in target regions. In this paper, a novel deep network of the encoder-decoder model that combines HarDNet, dual attention (DA), and reverse attention (RA) is proposed. First, HarDNet68 is employed to extract the backbone features while improving the inference speed and computational efficiency. Second, the DA block is adopted to capture the global feature dependency in spatial and channel dimensions, and enrich the contextual information on local features. At last, three RA blocks are exploited to fuse and refine the boundary features to obtain the final segmentation results. Extensive experiments are conducted on a skin lesion dataset which consists of ISIC2016, ISIC2017, and ISIC 2018, and a polyp dataset which consists of several public datasets, that is, Kvasir, CVC-ClinicDB, CVC-ColonDB, ETIS, Endosece. The proposed method outperforms some state-of-art segmentation models on the ISIC2018, ISIC2017, and ISIC2016 datasets, with Jaccard's indexes of 0.846, 0.881, and 0.894, mean Dice coefficients of 0.907, 0.929, and 03939, precisions of 0.908, 0.977, and 0.968, and accuracies of 0.953, 0.975, and 0.972. Additionally, the proposed method also performs better than some state-of-art segmentation models on the Kvasir, CVC-ClinicDB, CVC-ColonDB, ETIS, and Endosece datasets, with mean Dice coefficients of 0.907, 0.935, 0.716, 0.667, and 0.887, mean intersection over union coefficients of 0.850, 0.885, 0.644, 0.595, and 0.821, structural similarity measures of 0.918, 0.953, 0.823, 0.807, and 0.933, enhanced alignment measures of 0.952, 0.983, 0.850, 0.817, and 0.957, mean absolute errors of 0.026, 0.007, 0.037, 0.030, and 0.009. The proposed deep network could improve lesion segmentation performance in polyp and skin lesion images. The quantitative and qualitative results show that the proposed method can effectively handle the challenging task of segmentation while revealing the great potential for clinical application.

Clinical, Endoscopic, Histopathological Characteristics Of Colorectal Polyps In Adults At Gastroenterology – Endoscopy Center, Hue University Of Medicine and Pharmacy Hospital

Background: Colorectal polyps are relatively common diseases in the group of lower gastrointestinal tract diseases. The prevalence of colorectal polyps ranges from 20 to 50%. Polyps are formed due to excessive hyperplasia of the mucosa and the malignancy rate of colorectal polyps is higher than other sites. Target: Describe some clinical, endoscopy and histopathology characteristics. Subjects: The patients aged 16 years old and older who were diagnosed colon polyps at the Center for Gastroenterology - Endoscopy at Hue University of Medicine and Pharmacy Hospital from April 1st, 2020 to April 30th, 2021. Methods: Crosssectional, retrospective description. Results: The mean age was 55.8 ± 15.7 years old, the most common age was ≥ 45 years old, male/female was 2/1. The common clinical symptoms: abdominal pain (83.6%), diarrhea (29.9%), constipation (28.4%), dysentery syndrome (13.4%), bloody stools (31.3%). The position of polyps: anus (1.5%), rectum (47.8%), sigmoid colon (40.3%), descending colon (31.3%), transverse colon (22.4%), ascending colon (28.4)%), cecum (13.4%). The proportion of patients ≥ 2 polyps (59.7%), 1 polyp (40.3%). Polyp sizes: 5 - &lt; 10 mm (50.7%), &lt; 5 mm (37.4%), ≥ 10 mm (11.9%). The percentage of sessile polyps was higher than that of pedunculated polyps at each locations. Histopathological types: adenomatous polyps (60.4%), hyperplastic polyps (35.4%), malignant polyps (4.2%). Polyps with dysplasia (64.6%), mild - grade dysplasia (56.3%), severe-grade dysplasia (8.3%). The differences were statistically significant between the grade of dysplasia and the polyp size groups, between the histopathology and the grade of dysplasia (p &lt; 0.05). Conclusions: Colorectal polyps are more common in patients ≥ 45 years old, male are much more than female. Abdominal pain, bloody stools are common symptoms. Common polyp phenotypes are sessile polyps, ≥ 2 polyps, 5 - &lt; 10 mm in size, mainly in the rectum. Adenomatous polyps are the most common histopathological type, with the high rate of dysplasia Key words: clinical, endoscopy, histopathology, colorectal polyps