Diagnosis Of Adenomatous Polyps Research Articles

THE IMPACT OF THE COVID-19 PANDEMIC RESTRICTIVE MEASURES ON THE DIAGNOSIS OF ADENOMATOUS POLYPS AND COLORRECTAL ADENOCARCINOMA IN A POPULATION SUBMITTED TO COLONOSCOPY.

•The impact of the COVID-19 pandemic on the diagnosis of adenomatous polyps and colorectal cancer. •A cross-sectional study evaluating COL performed during the periods from 20 March to 31 October of 2019 and of 2020, which analyzed 10,232 colonoscopies. •There was a 51,0% reduction in the number of COL performed in 2020 when compared to 2019. Of the altered exams, adenomatous polyps were diagnosed in 68.8% in 2019 and 78.3% in 2020. CRC was diagnosed in 0.9% in 2019 and 1.6% in 2020. •The increase in adenomatous polyps and colorectal cancer diagnoses was observed, it was not enough to compensate for the reduction in the number of exams. Colorectal cancer (CRC) is globally the third most common malignant neoplasm and the second leading cause of cancer-related death worldwide. The COVID-19 pandemic led to the suspension of routine screening tests by health services. A 35.5% drop in total cancer diagnoses in 2020 is estimated when compared to 2019. To evaluate the impact of the COVID-19 pandemic on the diagnosis of adenomatous polyps (AP) and CRC in a population undergoing colonoscopy (COL) in a clinic in Goiânia, Brazil. A cross-sectional study evaluating COL performed during the periods from 20 March to 31 October of 2019 and of 2020, was approved by the Research Ethics Committee (CAAE-45631421.0.0000.0037). We analyzed data related to identification, referral for medical examination, colonoscopic and histopathological findings. We evaluated 10,232 (93.4%) COL, divided into two groups according to the year of performance. In 2019, 6,777 (66.2%) COL were performed and in 2020, 3,455 (33.8%), demonstrating a reduction of 51.0%. A total of 3,267 (31.9%) colonoscopies found polyps, 72.1% of which were AP (68.8% in 2019 and 78.3% in 2020, P<0.001). High-grade dysplasia was found in 5.0% of the AP (4.9% in 2019 and 5.8% in 2020, P<0.34). CRC was diagnosed in 121 (1.2%) (0.9% in 2019 and 1.6% in 2020, P<0.001). The COVID-19 pandemic significantly reduced COL in 2020, mainly due to infection fears and restrictions. However, the detection rate of cancer and polyps per procedure increased, indicating more symptomatic patients sought medical attention. Despite this, the absolute number of tumors and adenomas found decreased, potentially causing diagnostic losses and fewer prevented colorectal cancer cases. Thus, adaptive strategies are vital for maintaining essential healthcare services during similar crises.

Self-reported Metabolic Risk Factor Associations with Adenomatous, Sessile Serrated, and Synchronous Adenomatous and Sessile Serrated Polyps.

Studies have found a positive association between metabolic risk factors, such as obesity and diabetes, and adenomatous polyps (AP). However, fewer studies have assessed the association between sessile serrated polyps (SSP) or synchronous diagnosis of APs and SSPs (synch polyps). Study participants (N = 1,370; ages 40-85) undergoing screening colonoscopy were enrolled between August 2016 and February 2020. Self-reported metabolic risk factors, including diabetes, hypertension, hyperlipidemia, and overweight/obesity, were evaluated for associations with new diagnoses of APs, SSPs, and synch polyps at the present colonoscopy. Average participant age was 60.73 ± 8.63 (SD) years; 56.7% were female and 90.9% white. In an assessment of individual metabolic risk factors, adjusted for age, sex, race, and smoking status, increased body mass index (BMI; overweight or obese vs. normal BMI of <25 kg/m2) was associated with an increased odds for new onset of colon APs (P trend < 0.001) as was a diagnosis of diabetes [adjusted conditional OR (aCOR) = 1.59 (1.10-2.29)]. No associations were seen between the metabolic risk factors and onset of SSPs. Being obese or hypertensive each increased the odds of new onset of synch polyps with aCOR values of 2.09 (1.01-4.32) and 1.79 (1.06-3.02), respectively. Self-reported risk factors may help assess polyp type risk. Because SSPs and synch polyps are rare, larger studies are needed to improve our understanding of the contribution of these factors to polyp risk. These data lead us to hypothesize that differences in observed metabolic risk factors between polyp types reflect select metabolic impact on pathways to colorectal cancer. PREVENTION RELEVANCE: Self-reported medical history provides valuable insight into polyp risk, potentially enabling the use of larger retrospective studies of colonoscopy populations to assess knowledge gaps. More aggressive colonoscopy screening, critical to colorectal cancer prevention, may be considered in populations of individuals with metabolic risk factors and modifiable lifestyle risk factors.

Su1035 Hyperplastic Polyps Predict the Subsequent Occurrence of Adenomatous Polyps on Follow-up Colonoscopy

Background: The occurrence of hyperplastic polyps during colonoscopy is usually considered an incidental finding of little or no clinical significance. We pursued the hypothesis that diagnosis of hyperplastic polyps on index colonoscopy predicted the occurrence of adenomatous polyps on follow-up colonoscopy. Methods: Miraca Life Sciences is a centralized pathology laboratory that serves 1,500 gastroenterologists distributed throughout the United States with more than 400,000 pathology specimens processed annually. From its computerized database, we selected 13,929 subjects who were represented in the database by two consecutive colonoscopies. On the first colonoscopy, patients harbored only hyperplastic polyps (3,000 subjects) or no polyps at all (10,929 subjects). In a case-control study, we compared whether the occurrence of adenomatous polyps on second colonoscopy (in 2,549 subjects) was influenced by the initial diagnosis of hyperplastic polyps on first colonoscopy. Odds ratios (OR) and their 95% confidence intervals (CI) were calculated to describe the strengths of the associations between various types of colonic neoplasms. Multivariate logistic regression was used to adjust the odds ratios for age, sex, and other patient characteristics. Results: The prevalence of hyperplastic polyps on first colonoscopy was similar in males and females, 22% vs. 21%, respectively. Males harbored more adenomatous polyps on second colonoscopy, 20% vs. 17%, respectively, with OR = 1.27, 1.17-1.39. The prevalence of hyperplastic and adenomatous polyps both increased with older age. Compared with hyperplastic polyps the age distribution of adenomatous polyps was shifted towards older age groups, with mean ages (SD) of 59.9 (11.7) vs. 62.8 (11.3) years and t = 9.19, p ,0.001. Increasingly longer time intervals between the first and second colonoscopy were associated with a significant increase in the diagnosis of adenomatous polyps during the second colonoscopy. The finding of hyperplastic polyps during the first colonoscopy was significantly associated with the occurrence of colonic neoplasms on second colonoscopy, the odds ratios (CI) being 3.06 (2.79-3.36) for any type of adenoma, 2.14 (1.71-2.66) for advanced adenoma, and 6.85 (5.44-8.62) for sessile serrated adenoma. Conclusion: Male sex, old age, length of interval between the two colonoscopies, and presence of hyperplastic polyps during the initial colonoscopy were all positive and statistically significant predictors for the diagnosis of adenoma during a second subsequent colonoscopy. The presence of hyperplastic polyps may indicate a general underlying tendency of the colonic mucosa for neoplastic growth.

Su1036 Phenotypic Expression of Large (≥ 20mm) Sessile Serrated Adenomas of the Colon As a Predictor of High Grade Dysplasia or Colorectal Cancer in a Multicenter Prospective Cohort

Background: The occurrence of hyperplastic polyps during colonoscopy is usually considered an incidental finding of little or no clinical significance. We pursued the hypothesis that diagnosis of hyperplastic polyps on index colonoscopy predicted the occurrence of adenomatous polyps on follow-up colonoscopy. Methods: Miraca Life Sciences is a centralized pathology laboratory that serves 1,500 gastroenterologists distributed throughout the United States with more than 400,000 pathology specimens processed annually. From its computerized database, we selected 13,929 subjects who were represented in the database by two consecutive colonoscopies. On the first colonoscopy, patients harbored only hyperplastic polyps (3,000 subjects) or no polyps at all (10,929 subjects). In a case-control study, we compared whether the occurrence of adenomatous polyps on second colonoscopy (in 2,549 subjects) was influenced by the initial diagnosis of hyperplastic polyps on first colonoscopy. Odds ratios (OR) and their 95% confidence intervals (CI) were calculated to describe the strengths of the associations between various types of colonic neoplasms. Multivariate logistic regression was used to adjust the odds ratios for age, sex, and other patient characteristics. Results: The prevalence of hyperplastic polyps on first colonoscopy was similar in males and females, 22% vs. 21%, respectively. Males harbored more adenomatous polyps on second colonoscopy, 20% vs. 17%, respectively, with OR = 1.27, 1.17-1.39. The prevalence of hyperplastic and adenomatous polyps both increased with older age. Compared with hyperplastic polyps the age distribution of adenomatous polyps was shifted towards older age groups, with mean ages (SD) of 59.9 (11.7) vs. 62.8 (11.3) years and t = 9.19, p ,0.001. Increasingly longer time intervals between the first and second colonoscopy were associated with a significant increase in the diagnosis of adenomatous polyps during the second colonoscopy. The finding of hyperplastic polyps during the first colonoscopy was significantly associated with the occurrence of colonic neoplasms on second colonoscopy, the odds ratios (CI) being 3.06 (2.79-3.36) for any type of adenoma, 2.14 (1.71-2.66) for advanced adenoma, and 6.85 (5.44-8.62) for sessile serrated adenoma. Conclusion: Male sex, old age, length of interval between the two colonoscopies, and presence of hyperplastic polyps during the initial colonoscopy were all positive and statistically significant predictors for the diagnosis of adenoma during a second subsequent colonoscopy. The presence of hyperplastic polyps may indicate a general underlying tendency of the colonic mucosa for neoplastic growth.

Statin use is associated with a reduced incidence of colorectal adenomatous polyps

Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) have been shown to have potentially useful anticancer effects against colorectal cancers in experimental studies, but clinical studies have shown inconsistent results on colorectal cancer incidence. Most colorectal cancers are believed to develop through the polyp-cancer sequence. We hypothesized that statins may protect against the development of adenomatous polyps, and this may contribute to the apparent cancer-protective effects. This study aims to compare previous statin use in patients with newly diagnosed adenomatous polyps against a control group without polyps. A case-control study involving 264 patients attending for diagnostic colonoscopy at the Norfolk and Norwich University Hospital was used. Polyp cases were age and sex matched against controls with normal colonoscopies. Structured patient interviews and clinical notes were used to ascertain drug and risk factor. Logistic regression was used to compare statin exposure and correct for confounding factors. There was a significant negative association between prior statin use and a diagnosis of adenomatous polyps [odds ratio (OR) = 0.40 (0.24-0.76)]. The association was significantly stronger with higher statin doses [≥40 mg simvastatin or equivalent; OR 0.33 (0.10-0.53)] or longer duration of use [>5 years; OR 0.36 (0.10-0.67)]. Statin use was negatively associated with both high- and low-risk polyps. Statins may have a protective effect against the development of adenomatous polyps. The negative association between statin use and polyp incidence showed a significant dose and duration relationship.

Dynamic Shift in the Distribution of Colorectal Cancer

Purpose: Colorectal cancer (CRC) is the second leading cause of cancer death overall for both men and women in the U.S. Knowledge of CRC distribution is important as it can guide CRC screening, surveillance, and management. The purpose of this study was to elucidate the CRC distribution patterns in a population of U.S. patients. Methods: This retrospective study was conducted at Caris Life Sciences, a national specialized gastrointestinal pathology laboratory which receives specimens from ambulatory endoscopy centers across the U.S. Electronic data from the Caris database were analyzed, including demographics, clinical information, endoscopic findings, biopsy sites, and histopathologic findings. We extracted the records of all patients who had a diagnosis of CRC by Caris pathologists or a diagnosis of adenomatous polyps (AP) by a single Caris pathologist between 01/01/09 and 12/31/09. Patients were stratified by age into: >90, 80-89, 70-79, 60-69, 50-59, and <49 years old, and by CRC anatomic sites into right, left-sided colon, transverse colon, as well as non otherwise specific. Results: A total of 1,757 patients (age 66+13.3, range 21-96; 53.7% males) had CRC and 1,341 patients (age 60+10.7, 21-89; 59.3% males) had AP. The distributions of CRC and AP had a similar pattern with predominance in left colon, especially the rectosigmoid. Of CRC patients, the age group 60-69 had the highest frequency of CRC (25.8%). Women had more right-sided CRC than men (p=0.037). CRC was consistently less common in hepatic and splenic flexure and descending colon than in other locations. The trend of left-side CRC predominance was significantly correlated with the patient's age and was strongest (84.31%, p<0.001) in patients <49 years old. However, this pattern became progressively less defined with advancing age, and in patients older than 89 there was no difference between right and left colon distribution of CRC. Conclusion: Although the CRC distribution followed similar patterns with its adenomatous precursor, the strength of these correlations gradually diminished with advancing age and was weaker in women. Left-side predominance was strongly associated with younger age. The reason for the lower frequency of CRC in the hepatic and splenic flexure and the descending colon is unclear, but it could be related to a shorter stool transit or stasis time within the colon. Disclosure: One author is employed by Caris Life Sciences.

Abstract B8: Sex-specific association between IL-1B-511 polymorphism and colorectal cancer in Colombian populations

Abstract Background: In Colombia, colorectal cancer (CRC) has the fastest raising mortality rates. Carcinogenesis is related to chronic inflammation and single nucleotide polymorphisms (SNPs) in cytokines can affect gene expression, causing an effect in the degree of inflammation and carcinogenesis. IL-1 cytokine have a proinflammatory and carcinogenic effect. IL-1 B511C/TSNP has been related with gastric, breast, lung, cervical and colorectal cancer; however, results are not consistent among populations. Research supports the importance of inflammation in CRC, but few publications have explored its association with IL-1B polymorphisms. Aim: To evaluate the association of CRC and adenomatous polyps (AP) with IL-1 B-511 polymorphism in Colombian populations. Methods: We genotyped 324 invasive CRC cases and 206 low grade AP and 397 age-sex matched controls from a multicenter hospital-based case-control study, aimed to identify environmental and genetic risk factors for CRC in Colombian populations. All cases had incident diagnosis of CRC or AP, confirmed by histopathology. Controls that expressed no gastrointestinal symptoms were recruited at outpatient services from primary care units. Age ranged from 30 to 75 years old, subjects were unrelated and neither cases nor controls had personal history of other cancers. All the subjects gave informed consent to participate in this study, which includes answering guided-questionnaires (demographic, environmental and dietary factors) and blood collection. The study was approved by the ethical committee of the Instituto Nacional de Cancerologia. All the patients were genotyped for the IL-1B-517C/TSNP by TaqMan. Controls of known genotype for this SNP and negative controls were used. TaqMan analyses were repeated for 26% of the samples with 100% correlation. Hardy-Weinberg equilibrium was assessed in the control group for male and female separately. Statistical analysis was done by means of conditional logistic regression adjusting for potential confounding variables (familiar history of cancer, concomitant chronic diseases, smoking, NSAID and aspirin consumption, and place of origin). Recessive and codominant models were explored for genotype analysis. All analyses were run in STATA v11.0 Results: Control group was in Hardy-Weinberg equilibrium; allele frequencies in control men and women were the same (C, 0.45; T, 0.55) and were not significantly different from invasive cancer subjects (C, 0.45; T, 0.55) or adenomatous polyps subjects (C, 0.50; T, 0.50). After controlling for confounding factors, no association was observed between IL-1 B-511 polymorphism genotypes neither with polyps nor with invasive CRC. When analyzing separately by sex and specific site (right/left sided colon and rectum), higher risk of right-sided colon cancer was found only in male carriers with −511 C/T or T/T genotypes (OR 2.34; 95% Cl 1.42–3.87; p&amp;lt;0.005). No association was observed in cancer or polyps from the left sided colon or rectum in males and females. Conclusions: IL-1B-511 is associated with right-sided colon cancer in males supporting the general notion of different carcinogenic pathways involved in the origin of left and right-sided CRC in humans. Our results warrant further analyses to help understand the role of these and other related genetic variants in CRC or AP risk in Colombian population. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the Second AACR International Conference on Frontiers in Basic Cancer Research; 2011 Sep 14-18; San Francisco, CA. Philadelphia (PA): AACR; Cancer Res 2011;71(18 Suppl):Abstract nr B8.

Narrow Band Imaging in Gastroesophageal Reflux Disease and Barrett’s Esophagus

Narrow Band Imaging (NBI), developed by Olympus Medical Systems (Olympus, Japan), is a new and well-recognized advance in endoscopic imaging. Although conventional white-light endoscopy uses the entire spectrum of visible light (400 nm to 700 nm) to examine tissue, the NBI system uses optic filters to isolate two specific bands of light: 415 nm blue and 540 nm green (1–4). By isolating these two bands of light and taking into account their absorptive and reflective properties on the mucosal surface, an image that enhances visualization of superficial mucosal and vascular structures is created. The highlight of NBI endoscopy is the proposed ability to predict pathology in real-time based on the mucosal and vascular changes detected. NBI has been investigated for use as a diagnostic modality in a variety of lesions in the gastrointestinal, respiratory and genitourinary tract (4–6). Conveniently, the NBI mode on an endoscope can be activated with the depression of a switch similar to taking a picture. Dr Robert Enns NBI, often referred to as ‘digital chromoendoscopy’, was developed as an alternative method of obtaining visual enhancement of tissue similar to that seen in chromoendoscopy – a procedure that uses the absorptive properties of various dyes, such as indigo carmine, rather than optical filters (1–4). Although much research concerning the use of chromoendoscopy has been conducted, its widespread use has not been adopted for various reasons including the increased time involved with the procedure and the lack of training (ie, many training centres do not use it regularly). In the January 2009 issue of The Canadian Journal of Gastroenterology, we discussed the role of NBI for the detection of neoplastic lesions of the lower gastrointestinal tract; specifically its utility in the diagnosis of adenomatous polyps and dysplasia in ulcerative colitis, hereditary nonpolyposis colorectal cancer and screening colonoscopy. The purpose of the present paper is to review the use of NBI endoscopy as a diagnostic modality for lesions of the upper gastrointestinal tract with particular emphasis on Barrett’s esophagus (BE).

The Association of Elevated HbA1c on the Behavior of Adenomatous Polyps in Patients with Type-II Diabetes Mellitus

The high level of circulating insulin in diabetic patients and the potential proliferative properties of insulin as a result of its cross interaction with insulin-growth factor-I (IGF-I) receptors suggest a proto-oncogenic role on the colonocyte. The aim of our study was to determine whether poor control of diabetes mellitus (DM) is associated with increased prevalence of colonic adenomatous polyps (APs), especially those that are advanced . A retrospective review of all patients with type-2 DM diagnosed with APs from 1996 to 2006 was performed. Hemoglobin A1c (HbA1c) levels were evaluated as an index of glycemic control over the year that preceded the diagnosis of APs. A total of 33 factors were assessed in the patients grouped as well controlled (HbA1c < 7.5%) and poorly controlled (HbA1c > or = 7.5%). Factors associated with advanced APs in each group were examined using univariate analysis (UA). Significant variables by UA were included in a stepwise logistic regression analysis to determine independent predictors of aggressive clinical behavior by the polyps. All values are presented as means +/- SE, and statistical significance was determined at P < or = 0.05. Approximately 652 patients with DM type-2 and APs were identified. UA demonstrated that patients with poorly controlled DM-2 had a significantly increased incidence of right-sided APs (P = 0.001), a greater number of APs (P < 0.005), more advanced APs (P < 0.005), a younger age of presentation (P = 0.001), a history of smoking (P = 0.05), and greater use of exogenous insulin (P = 0.01). Logistic regression, as measured by HbA1c, demonstrated that poorly controlled DM-2 independently predicted a greater prevalence of right-sided AP, a more advanced lesion at the time of presentation, a greater number of polyps, and greater use of exogenous insulin. Poor glycemic control in patients with DM-2 independently predicts an aggressive clinical course for patients with APs. Small differences in HbA1c elevation and, by inference, small differences in circulating insulin levels may lead to large variations in the behavior of APs.