Diagnosis Of Colorectal Carcinoma Research Articles

Outcomes of colorectal cancer hospitalization with and without coexisting nutritional anemia: A National Inpatient Sample (NIS) 2016 to 2019 database study.

e15648 Background: Colorectal carcinoma (CRC) is third most commonly diagnosed cancer in males and second in females. Implications of CRC with coexisting anemia and its outcomes of hospitalization have not been studied. We aim to evaluate the outcomes of CRC hospitalization with and without coexisting nutritional anemia. Methods: A total of 504,515 patients (male: 52.61%, female: 47.39%), aged ≥18 years, admitted from 2016 to 2019 with principal admission diagnosis of CRC were identified using International Classification of Disease 10 (ICD-10) coding for NIS database. Patients were stratified into those with and without nutritional anemia (16.19% vs 83.81%) which included iron, B12, folate deficiency and other nutritional anemia per ICD-10 coding. Mortality was the primary outcome of the study whereas length of stay (LOS), total treatment cost, acute kidney injury (AKI), pulmonary embolism (PE), deep vein thrombosis (DVT), colonoscopy, abdominal surgery and lower gastrointestinal (GI) bleeding were secondary outcomes. Multivariate regression model was used to estimate the outcomes of CRC hospitalization with and without coexisting nutritional anemia after adjusting for confounders like age, sex, race, insurance provider, co-morbidities, median income, hospital region, location, etc. Results: Mean age of patients admitted with CRC with and without anemia was 69.06 and 65.77 years respectively. Among two groups, mortality was significantly lower among patients with nutritional anemia (2.05 % vs 2.64 %). Lower GI bleeding (12.24% vs 4.77%) and colonoscopy during inpatient stay (43.97% vs 23.05%) were significantly higher among CRC cohort with nutritional anemia. Similarly, LOS, cost of inpatient hospitalization, AKI, PE and DVT were also significantly higher among anemia cohort. However, the need for abdominal surgery was significantly higher among CRC patients without nutritional anemia. Table 1 summarizes the results of multivariate regression analysis. Conclusions: Nutritional anemia in CRC patients is associated with longer length of stay, increased cost, higher risk of developing venous thrombosis along with lower GI bleed and colonoscopy. Therefore, it should be corrected to optimize outcomes among CRC patients. [Table: see text]

The Usefulness of Vitamin K-Dependent Proteins in the Diagnosis of Colorectal Carcinoma.

Colorectal cancer (CRC) is one of the most common neoplasms in developed countries, with increasing incidence and mortality, even in young people. A variety of serum markers have been associated with CRC (CEA, CA 19-9), but neither should be used as a screening tool for the diagnosis or evolution staging of CRC. The sensitivity and specificity of these markers are not as good as is required, so new ones need to be found. Matrix Gla protein and PIVKA II are involved in carcinogenesis, but few studies have evaluated their usefulness in predicting the presence and severity of CRC. Two hundred patients were divided into three groups: 80 patients were included in the control group; 80 with CRC and without hepatic metastasis were included in Group 1; 40 patients with CRC and hepatic metastasis were included in Group 2. Vitamin K-dependent proteins (VKDPs) levels in plasma were determined. Patients with CRC without methastasis (Group 1) and CRC patients with methastasis (Group 2) presented significantly higher values of CEA, CA 19-9, PIVKA II (310.05 ± 38.22 vs. 430.13 ± 122.13 vs. 20.23 ± 10.90), and ucMGP (14,300.00 ± 2387.02 vs. 13,410.52 ± 2243.16 vs. 1780.31 ± 864.70) compared to control group (Group 0). Interestingly, Group 1 presented the greatest PIVKA II values. Out of all the markers, significant differences between the histological subgroups were found only for ucMGP, but only in non-metastatic CRC. Studying the discrimination capacity between the patients with CRC vs. those without, no significant differences were found between the classical tumor markers and the VKDP AUROC curves (PIVKA II and ucMGP AUROCs = 1). For the metastatic stage, the sensitivity and specificity of the VKDPs were lower in comparison with those of CA 19-9 and CEA, respectively (PIVKA II AUROC = 0.789, ucMGP AUROC = 0.608). The serum levels of these VKDPs are significantly altered in patients with colorectal carcinoma; it is possible to find additional value of these in the early stages of the disease.

Incidence of Colorectal Cancer After Intestinal Infection Due to Clostridioides difficile.

Clostridioides difficile (C. difficile or C. diff) is a toxin-producing bacteria that is notorious for causing life-threatening diarrhea. Recent literature has investigated various effects of Clostridioides difficile infection (CDI) in cancer patients, but research into the impact of CDI on the development of cancer and its effects on the microbiome is limited. CDI predominately affects the colon, which urges consideration into the sequalae of infection. This study investigated the correlation between CDI and the incidence of colorectal carcinoma (CRC). A retrospective study (2010 - 2020) was conducted using a Health Insurance Portability and Accountability Act (HIPAA) compliant national database. The International Classification of Disease ninth and 10th Codes (ICD-9, ICD-10), Current Procedural Terminology (CPT), and National Drug Codes were used to identify CRC diagnosis, CDI, and matching or control parameters. Patients were matched for age, sex, Charlson Comorbidity Index (CCI), region of residence, and CDI treatment. An additional, but separate, query was executed to include obese patients with and without CDI, who were similarly matched and assessed for CRC. Statistical analyses were implemented to assess significance and estimate odds ratios (ORs). CDI was associated with a decreased incidence of CRC (OR = 0.59, 95% confidence interval (CI): 0.55 - 0.63), and the difference was statistically significant (P < 2.2 × 10-16). CDI treatment, including appropriate antibiotics and fecal microbiota transplant (FMT), was controlled for in both infected and noninfected populations. Patients with a prior CDI who received relevant treatment were compared to patients with no history of CDI and received analogous treatment. Both populations subsequently developed CRC. Results remained statistically significant (P < 2.2 × 10-16) with a relative risk (RR) of 0.57 (95% CI: 0.54 - 0.60). Obesity was explored as a controlled variable in relation to CRC development in patients with and without prior CDI. Obese patients without a history of CDI were found to have a decreased risk of developing CRC. Results were statistically significant (P < 4.3 × 10-13) with an OR of 0.70 (95% CI: 0.63 - 0.77). This study shows a statistically significant correlation between CDI and decreased incidence of CRC. Additionally, there is a statistically significant correlation between obese patients with CDI and an increased incidence of CRC. Further research is needed to explore the mechanism of this striking relationship and the implications of CDIs on the microbiome.

DPY30 knockdown suppresses colorectal carcinoma progression via inducing Raf1/MST2-mediated apoptosis

Colorectal Carcinoma (CRC) is one of the most common malignant tumors of the digestive tract, with a high mortality rate. DPY30 is one of the core subunits of the histone methyltransferase complex, which was involved in many cancer processes. However, the role of DPY30 in the occurrence and progression of CRC remains unclear. In this study, we sought to evaluate the role and mechanism of DPY30 in CRC cells apoptosis. Here, we identified that knockdown of DPY30 significantly inhibited the HT29 and HCT116 cells proliferation in vitro. Moreover, the knockdown of DPY30 significantly increased the apoptosis rate and promoted the expression of apoptosis-related proteins in CRC cells. Meanwhile, DPY30 knockdown promoted CRC cells apoptosis through endogenous programmed death and in a caspase activation-dependent manner. Furthermore, RNA-seq analysis revealed that the action of DPY30 is closely related to the apoptosis biological processes, and screened its potential effectors Raf1. Mechanistically, DPY30 downregulation promotes MST2-induced apoptosis by inhibiting Raf1 transcriptional activity through histone H3 lysine 4 trimethylation (H3K4me3). In vivo experiments showed that DPY30 was correlated with Raf1 in nude mouse subcutaneous xenografts tissues significantly. Clinical colorectal specimens further confirmed that overexpression of DPY30 in malignant tissues was significantly correlated with Raf1 level. The vital role of the DPY30/Raf1/MST2 signaling axis in the cell death and survival rate of CRC cells was disclosed, which provides potential new targets for early diagnosis and clinical treatment of CRC.

Comparative Study on Handheld, Modular, and Laboratory Raman Instruments for the Analysis of Colon Tissues and Colorectal Polyps

Portable Raman spectrometers may offer advantages for clinical medical diagnostics over laboratory instruments by allowing for quick measurements in the field and provision of data suitable for screening analyses. This work evaluates the potential of using available handheld, modular, and laboratory Raman spectrometers for screening normal colon tissues and benign and malignant colon polyps. The Raman spectra of tissue samples and reference biological macromolecules were measured with these instruments and analyzed using curve fitting and multivariate statistics. The spectra of calf thymus DNA measured with portable devices showed suitable signal-to-noise levels and half-widths of the prominent bands. Band positions, resolution, and relative intensities in the Raman spectra of colon tissues and reference compounds varied for the instruments, and the laboratory device demonstrated the best spectral feature. The principal component analysis (PCA) of the spectra obtained with all Raman devices showed well discrimination of normal colon tissue, adenomatous polyp, and adenocarcinoma. Dendrograms of similarity obtained using hierarchy cluster analysis (HCA) for the Raman spectra of all three devices also showed good separation of these samples. The soft independent modeling of class analogy (SIMCA) and support vector machine (SVM) models efficiently classified normal colon tissues and benign/malignant colorectal polyps based on the Raman data from all three devices. Despite its less pronounced spectral characteristics, the handheld Raman spectrometer can be used in early diagnosis of colorectal carcinoma, comparable to the modular and laboratory instruments.

Diagnostic accuracy of Perfusion Computed tomography (PCT) for diagnosis of colorectal carcinoma (CRC) taking histopathology as gold standard.

Objective: To determine diagnostic accuracy of Profusion Computed tomography (PCT) for diagnosis of colorectal carcinoma (CRC) taking histopathology as gold standard. Study Design: Descriptive, Cross-sectional. Setting: Department of Radiology, Allied Hospital Faisalabad. Period: 10th March 2022 to 9th September 2022. Material &amp; Methods: A total of 451 patients with colorectal cancer suspicion and ages 50-80 years of either gender were included in the study. Patients having severe renal disease, preoperative radiation therapy or chemotherapy, no surgical intervention after CT, contrast media contraindication, pathologically benign colorectal mass, and tumor depth less than 2 cm based on CT were not included. Pre-operative perfusion CTs was performed on all patients. Dynamic perfusion CTs were performed for 65 seconds following intravenous administration of contrast media, and blood flow (BF) and blood volume (BV) in the tumor were assessed. The surgical specimens were forwarded to the hospital's pathology laboratory, where the presence of CRC was labeled according to operational definitions. CT perfusion was performed in radiology department and results of PCT were compared with that of histopathology. Results: Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Profusion Computed tomography (PCT) in diagnosing colorectal carcinoma (CRC) with histopathology being gold standard was 90.26%, 88.59%, 91.98%, 86.24% and 89.58% respectively. Conclusion: This study concludes that Profusion Computed tomography (PCT) is a highly sensitive and accurate modality for the diagnosis of colorectal carcinoma.

PTEN Expression and Specific Clinicopathological Associations in Colorectal Carcinomas

Introduction: Colorectal carcinoma (CRC) refers to any cancerthat affects the colon and the rectum and it is a significantpublic health issue.1 It is the third most common cancer to bediagnosed globally and the fourth most frequent reason forcancer-related mortality. The diagnosis of CRCs occurs inplaces with affluent economies about 60% of the time. Thepresent study assessed phosphatase and tensin homolog(PTEN) expression in colorectal cancer and its associationwith tumor characteristics.Materials and Methods: The study was carried out over thecourse of 18 months, from 1 February 2021 to 31 July 2022, atthe SRMS IMS Bareilly Department of Pathology. The analysisincluded surgically removed specimens of colorectal cancerthat had been obtained at the SRMS, IMS Department ofPathology. The patient’s medical records provided the clinicalinformation.Results: Loss of PTEN expression was seen in 76.9% of CRCcases, while 23.1% of cases revealed positive expression.Maximum cases were of age&gt;60 years and male predominancewas noted. In 62.5% of cases with tumor size ≥5 cm displayedloss of PTEN expression. In 52.5% loss of PTEN tumor caseswere histologically moderately differentiated, 37.5% were welldifferentiated, and 10% were poorly differentiated. 50% of caseswith pathologic tumor stage (pT3) and 65% left-sided tumorsshowed loss of PTEN expression.Conclusion: Loss of PTEN expression was observed in themajority of colorectal tumors along with its negative associationwith tumor size and pathologic tumor staging.

Clinicopathological Profile of Colorectal Cancers in a Tertiary Care Hospital of Central, Nepal

IntroductionThere is an increasing incidence of colorectal carcinoma (CRC) in developing countries like Nepal. The objective of this research is to study the CRC its demography, mode of presentation, type of surgery, complications and Histopathological evaluation (HPE) after surgery.MethodsThis was a retrospective descriptive observational study at College of Medical Sciences, Bharatpur, Nepal. Patients diagnosed with colorectal cancer admitted to gastrointestinal surgery department from July 2019 to June 2022 (3 years) were included. Data of patients were retrieved from hospital records. Pre-operative, intra-operative and post-operative diagnosis of CRC on HPE were also included in the study.ResultsOut of 52 CRC, males were 30 (57.7%) and females were 22 (42.3%), mean age was 52.7 years. Overall, left colon was affected in 33 (63.5%) and right in 19 (36.5%). More than one quarter of patients 14 (26.9%), had disease recurrence by 6 months follow-up. HPE revealed half of the disease condition as adenocarcinoma, moderately differentiated in (50%) cases.ConclusionsColorectal cancer is predominant in male patients and older age group. Incidence is high in younger people &lt;40 years and low in extreme age group &gt;80 years. Meticulous surgery is the only proven cure for malignancy.

Immuno-PET of colorectal cancer with a CEA-targeted [68Ga]Ga-nanobody: from bench to bedside.

An accurate diagnosis of colorectal carcinoma (CRC) can assist physicians in developing reasonable therapeutic regimens, thereby significantly improving the patient's prognosis. Carcinoembryonic antigen (CEA)-targeted PET imaging shows great potential for this purpose. Despite showing remarkable abilities to detect primary and metastatic CRC, previously reported CEA-specific antibody radiotracers or pretargeted imaging are not suitable for clinical use due to poor pharmacokinetics and complicated imaging procedures. In contrast, radiolabeled nanobodies exhibit ideal characteristics for PET imaging, for instance, rapid clearance rates and excellent distribution profiles, allowing same-day imaging with sufficient contrast. In this study, we developed a novel CEA-targeted nanobody radiotracer, [68Ga]Ga-HNI01, and assessed its tumor imaging ability and biodistribution profile in preclinical xenografts and patients with primary and metastatic CRC. The novel nanobody HNI01 was acquired by immunizing the llama with CEA proteins. [68Ga]Ga-HNI01 was synthesized by site-specifically conjugating [68Ga]Ga with tris(hydroxypyridinone) (THP). Small-animal PET imaging and biodistribution studies were performed in CEA-overexpressed LS174T and CEA-low-expressed HT-29 tumor models. Following successful preclinical assessment, a phase I study was conducted on 9 patients with primary and metastatic CRC. Study participants received 151.21 ± 25.25MBq of intravenous [68Ga]Ga-HNI01 and underwent PET/CT scans at 1h and 2h post injection. Patients 01-03 also underwent whole-body dynamic PET imaging within 0-40min p.i. All patients underwent [18F]F-FDG PET/CT imaging within 1week after [68Ga]Ga-HNI01 imaging. Tracer distribution, pharmacokinetics, and radiation dosimetry were calculated. [68Ga]Ga-HNI01 was successfully synthesized within 10min under mild conditions, and the radiochemical purity was more than 98% without purification. Micro-PET imaging with [68Ga]Ga-HNI01 revealed clear visualization of LS174T tumors, while signals from HT-29 tumors were significantly lower. Biodistribution studies indicated that uptake of [68Ga]Ga-HNI01 in LS174T and HT-29 was 8.83 ± 3.02%ID/g and 1.81 ± 0.87%ID/g, respectively, at 2h p.i. No adverse events occurred in all clinical participants after the injection of [68Ga]Ga-HNI01. A fast blood clearance and low background uptake were observed, and CRC lesions could be visualized with high contrast as early as 30min after injection. [68Ga]Ga-HNI01 PET could clearly detect metastatic lesions in the liver, lung, and pancreas and showed superior ability in detecting small metastases. A significant accumulation of radioactivity was observed in the kidney, and normal tissues physiologically expressing CEA receptors showed slight uptakes of [68Ga]Ga-HNI01. An interesting finding was that strong uptake of [68Ga]Ga-HNI01 was found in non-malignant colorectal tissues adjacent to the primary tumor in some patients, suggesting abnormal CEA expression in these healthy tissues. [68Ga]Ga-HNI01 is a novel CEA-targeted PET imaging radiotracer with excellent pharmacokinetics and favorable dosimetry profiles. [68Ga]Ga-HNI01 PET is an effective and convenient imaging tool for detecting CRC lesions, particularly for identifying small metastases. Furthermore, its high specificity for CEA in vivo makes it an ideal tool for selecting patients for anti-CEA therapy.

Evaluation of IR and Raman spectroscopic markers of human collagens: Insides for indicating colorectal carcinogenesis

Vibrational spectroscopic methods are widely used in the molecular diagnostics of carcinogenesis. Collagen, a component of connective tissue, plays a special role as a biochemical marker of pathological changes in tissues. The vibrational bands of collagens are very promising to distinguish between normal colon tissue, benign and malignant colon polyps. Differences in these bands indicate changes in the amount, structure, conformation and the ratio between the individual structural forms (subtypes) of this protein. The screening of specific collagen markers of colorectal carcinogenesis was carried out based on the FTIR and Raman (λex 785 nm) spectra of colon tissue samples and purified human collagens. It was found that individual types of human collagens showed significant differences in their vibrational spectra, and specific spectral markers were found for them. These collagen bands were assigned to specific vibrations in the polypeptide backbone, amino acid side chains and carbohydrate moieties. The corresponding spectral regions for colon tissues and colon polyps were investigated for the contribution of collagen vibrations. Mentioned spectral differences in collagen spectroscopic markers could be of interest for early ex vivo diagnosis of colorectal carcinoma if combine vibrational spectroscopy and colonoscopy.

Optimal Deep Transfer Learning Based Colorectal Cancer Detection and Classification Model

Colorectal carcinoma (CRC) is one such dispersed cancer globally and also prominent one in causing cancer-based death. Conventionally, pathologists execute CRC diagnosis through visible scrutinizing under the microscope the resected tissue samples, stained and fixed through Haematoxylin and Eosin (H&E). The advancement of graphical processing systems has resulted in high potentiality for deep learning (DL) techniques in interpretating visual anatomy from high resolution medical images. This study develops a slime mould algorithm with deep transfer learning enabled colorectal cancer detection and classification (SMADTL-CCDC) algorithm. The presented SMADTL-CCDC technique intends to appropriately recognize the occurrence of colorectal cancer. To accomplish this, the SMADTL-CCDC model initially undergoes pre-processing to improve the input image quality. In addition, a dense-EfficientNet technique was employed to extract feature vectors from the pre-processed images. Moreover, SMA with Discrete Hopfield neural network (DHNN) method was applied for the recognition and classification of colorectal cancer. The utilization of SMA assists in appropriately selecting the parameters involved in the DHNN approach. A wide range of experiments was implemented on benchmark datasets to assess the classification performance. A comprehensive comparative study highlighted the better performance of the SMADTL-CDC model over the recent approaches.

Study of carcinoembryonic antigen tumor marker in gastrointestinal pathology

Background: Cancer mortality and morbidity has been increased in recent years, with gastrointestinal cancers comprising the majority of overall malignant conditions. All Indian cancer registries identify the digestive system as the most common cancer site in males. In women, breast cancer exhibits the highest occurrence, followed by cancers of the genital organs and the digestive system. Tumor markers are usually proteins or glycoproteins produced by the body in response to cancerous growth or by the cancer tissue that are possible to detect in serum, urine, or tissue samples. CEA assay is an inexpensive and easy to perform test; however, repeated measurements to monitor disease, follow up and the response to therapy contribute to higher costs and increase laboratory workload. Materials and Methods: The present study was carried out on 100 patients. Type of sample includes blood sample in plain vacutte received in tumor marker section of the pathology department. Objective: To make a comparative analysis of CEA in various gastrointestinal lesions.  Pre and post operative study of Serum CEA in known case of gastrointestinal carcinoma.  To study the factors affecting serum CEA concentrations. Results: The present study was conducted from June 2018 to December2020 in the Department of Pathology, at tertiary care hospital, 100 cases were studied. Preoperative and postoperative mean CEA value, Mean CEA value in inflammatory, Benign and Malignant lesions as well as in well, moderately and poorly differentiated carcinoma were measured.Conclusion: In general, this study showed that serum CEA levels are increased in people with habit of cigarette smoking and in benign and inflammatory lesions of GIT along with Malignant GI lesions. Carcinoembryonic antigen (CEA) usually normalizes after surgery. After curative resection of primary CRC (colorectal carcinoma), a large number of patients' CEA levels declined to normal values within 4-6 weeks. Amongst many contradictory results, the measurement of CEA is a useful method for screening, diagnosis, follow-up and treatment of CRC but Physiological influences that need to be considered in interpreting the results include effects of aging and smoking. Serum CEA values fails to decline in patients with distant metastasis and advanced disease even after complete surgical removal of the tumour. Serum concentrations of CEA tend to be higher in patients with well-differentiated tumors compared with those with poorly differentiated tumors.

Interstitial High-Dose-Rate Brachytherapy of Liver Metastases in Oligometastatic Patients.

Simple SummaryLocal ablative treatments have emerged as a promising treatment strategy for patients with oligometastatic disease. Interstitial brachytherapy (iBT) is one of the locally ablative treatment options for unresectable liver metastases in oligometastatic disease. We report the feasibility and oncologic outcome of 141 iBT treatments of 244 oligometastatic liver metastases performed in patients with limited tumor burdens in a high-volume center. iBT was feasible, safe and effective in the treatment of oligometastatic liver metastases with good local control rates and low toxicity. Histology and total tumor volume had an impact on local control rates.Local ablative treatments have emerged as a promising treatment strategy for patients with oligometastatic disease. Among others, interstitial brachytherapy (iBT) is an upcoming treatment option for unresectable liver metastases. We report the feasibility and oncologic outcome of iBT of oligometastatic liver metastases performed in patients with limited tumor burdens in a high-volume center. Patients undergoing iBT between August 2017and March 2019 were included. A retrospective analysis of patient outcomes and treatment complications was performed. Patients treated for metastatic colorectal carcinoma (CRC) were compared to other histologies. A total of 141 iBT procedures were performed in 106 patients (male:52; female:54) and 244 liver metastases. Overall, 51% (54/106) of patients had a diagnosis of metastatic CRC. The median follow-up was 9 months, and overall survival (OS) was 92.3% at 6 months and 76.3% at 12 months. Local-relapse-free survival (LRFS) was 88.4% at 6 months and 71.5% at 12 months, with a significant difference between patients with CRC (84.1% and 50.6%) versus other histologies (92.4% and 92.4%, p < 0.001). A sub-group analysis showed a significant advantage in patients with CRC receiving a minimal dose (D100) of 20 Gy to the planning target volume. Treatments of smaller total liver-tumor volumes (<18 ccm) resulted in better LRFS rates. iBT is a safe and effective treatment approach for oligometastatic liver disease. A higher treatment dose is needed for patients with CRC. Moreover, lower metastatic burdens may be favorable for LRFS. Prospective studies are needed to assess the role of iBT in the oligometastatic setting as an alternative to other local ablative treatment approaches in patients with liver metastases.

A Portrait of Intratumoral Genomic and Transcriptomic Heterogeneity at Single-Cell Level in Colorectal Cancer.

In the study of cancer, omics technologies are supporting the transition from traditional clinical approaches to precision medicine. Intra-tumoral heterogeneity (ITH) is detectable within a single tumor in which cancer cell subpopulations with different genome features coexist in a patient in different tumor areas or may evolve/differ over time. Colorectal carcinoma (CRC) is characterized by heterogeneous features involving genomic, epigenomic, and transcriptomic alterations. The study of ITH is a promising new frontier to lay the foundation towards successful CRC diagnosis and treatment. Genome and transcriptome sequencing together with editing technologies are revolutionizing biomedical research, representing the most promising tools for overcoming unmet clinical and research challenges. Rapid advances in both bulk and single-cell next-generation sequencing (NGS) are identifying primary and metastatic intratumoral genomic and transcriptional heterogeneity. They provide critical insight in the origin and spatiotemporal evolution of genomic clones responsible for early and late therapeutic resistance and relapse. Single-cell technologies can be used to define subpopulations within a known cell type by searching for differential gene expression within the cell population of interest and/or effectively isolating signal from rare cell populations that would not be detectable by other methods. Each single-cell sequencing analysis is driven by clustering of cells based on their differentially expressed genes. Genes that drive clustering can be used as unique markers for a specific cell population. In this review we analyzed, starting from published data, the possible achievement of a transition from clinical CRC research to precision medicine with an emphasis on new single-cell based techniques; at the same time, we focused on all approaches and issues related to this promising technology. This transition might enable noninvasive screening for early diagnosis, individualized prediction of therapeutic response, and discovery of additional novel drug targets.

Ex Vivo Vibration Spectroscopic Analysis of Colorectal Polyps for the Early Diagnosis of Colorectal Carcinoma.

Colorectal cancer is one of the most common and often fatal cancers in humans, but it has the highest chance of a cure if detected at an early precancerous stage. Carcinogenesis in the colon begins as an uncontrolled growth forming polyps. Some of these polyps can finally be converted to colon cancer. Early diagnosis of adenomatous polyps is the main approach for screening and preventing colorectal cancer, and vibration spectroscopy can be used for this purpose. This work is focused on evaluating FTIR and Raman spectroscopy as a tool in the ex vivo analysis of colorectal polyps, which could be important for the early diagnosis of colorectal carcinoma. Multivariate analyses (PCA and LDA) were used to assist the spectroscopic discrimination of normal colon tissue, as well as benign and malignant colon polyps. The spectra demonstrated evident differences in the characteristic bands of the main tissue constituents, i.e., proteins, nucleic acids, lipids, polysaccharides, etc. Suitable models for discriminating the three mentioned diagnostic groups were proposed based on multivariate analyses of the spectroscopic data. LDA classification was especially successful in the case of a combined set of 55 variables from the FTIR, FT Raman and dispersion Raman spectra. This model can be proposed for ex vivo colorectal cancer diagnostics in combination with the colonoscopic extraction of colon polyps for further testing. This pilot study is a precursor for the further evaluation of the diagnostic potential for the simultaneous in vivo application of colonoscopic Raman probes.

S328 Screen for Nicotine

Introduction: One in 5 adults in the world smoke tobacco. The association of smoking and adenoma detection rate has been well established in the literature. Early detection of adenoma can lead to early diagnosis of colorectal carcinoma (CRC) and can affect cancer-related death rate. There are few tools that one can use on physical exam to risk stratify patients at high risk for colorectal cancer. Through this study we aim to identify a physical exam finding that can guide clinicians to risk stratify their patients. Methods: A prospective study of 975 patients undergoing colonoscopy at the Veterans Affairs Medical Center (VAMC) in Oklahoma City, Oklahoma from 2019-2020. Patient demographics, comorbidities, medications, bowel preparation score, and results of colonoscopy were extracted from the medical record. Patients completed a pre-endoscopy questionnaire asking about smoking history and tobacco usage and endoscopists completed a post-procedure questionnaire that identified any nicotine staining involving their mouth, hands, or teeth. Chi square test was used to compare variables among the three groups. A P-value < 0.05 was considered statistically significant. Results: Patients with nicotine staining were older (63.3±8.8, P= 0.03), white (84.9%, P= 0.01) had lower BMI (27.7 + 5.0, P < 0.0001) and increased incidence of cirrhosis (7.5 %, P=0.001), COPD (32.3%, P < 0.0001), and alcohol abuse (30.1%, P < 0.001) when compared to nonsmokers and smokers without nicotine staining. Analysis showed that patients with nicotine staining had a higher adenoma detection rate (ADR) (70.9%, P= 0.04) and advanced ADR (16.1%, P=0.008) and more likely to have ≥3 adenomas (43.1%, P=0.0007) and ≥5 adenomas (24.7%, P=0.002) (Table 1). Patient with nicotine staining showed a trend towards increased risk of colon carcinoma (4.4%) as compared to smokers that did not have stains (1%) and nonsmokers (1.8%), however this was no statistically significant (P=0.14). Conclusion: Our study shows higher risks of multiple adenomas and advanced adenoma among patients with nicotine staining on physical examination. We propose that this physical exam finding can be used as a guide for physicians to risk stratify their patients to pursue screening colonoscopies as opposed to non-invasive CRC screening methods.Table 1.: Analysis.

Tumor-infiltrating lymphocytes in colorectal carcinoma

Background: Immunotherapy has become an important modality of treatment for CRC. The cells contributing to an effective immune response are CD8+ T cells of tumor-infiltrating lymphocytes. The present study aimed to assess the tumor-infiltrating lymphocytes on colorectal cancer and correlate them with other prognostic parameters. Material and methods: Cases of colectomy from April 2019 -Sept 2020 with a diagnosis of colorectal carcinoma were included in the study. Parameters i.e age, sex, size, location of the tumor, lymphovascular invasion, perineural invasion, T stage, N status, histological tumor type, and grade, resected margins were retrieved from the database of the department. The intensity of overall inflammatory cell reaction at the invasive tumor front was evaluated in H and E stained sections. Results: 56 cases of colorectal cancers were reported during the study period with M: F ratio of 1.15:1. The age ranged from 23-79years with a mean age of 54.3years. The tumors were predominant in the colon (50 cases) than the rectum. Colonic carcinomas had high-grade tumor-infiltrating lymphocytes as compared to rectal carcinomas. The grade of tumor-infiltrating lymphocytes was statistically significantly associated with T, N status, and grade of tumors. Conclusions: Inflammatory reactions at the invasive tumor front can be easily analyzed in resection specimens of colorectal cancers without additional costs. Low-grade tumor-infiltrating lymphocytes are indicative of high-stage tumors with a poor prognosis. Hence, the inclusion of tumor-infiltrating lymphocytes in pathological reports for risk stratification of the patient is mandatory.

Sentinel Lymph Node in Colorectal Carcinoma

Background: Metastasis to the regional lymph nodes is an important prognostic factor in colorectal cancer and nodal evaluation is essential for accurate staging. Sentinel lymph node (SLN) mapping is an additional method for improving colorectal cancer nodal staging. Objective: To evaluate the identification of SLN sensitivity and accuracy of nodal staging, its upstaging benefits and pattern of nodal metastases in colorectal carcinoma. Patients and Methods: Lymphatic mapping was performed using patent blue in sixty patients with histopathologic diagnosis of colorectal carcinoma. Enhanced pathologic examination was carried out on (SLNs) using Haematoxylin & Eosin and immunohistochemistry. Results: The patients studied had an average tumor size 6.6 cm and rectal tumors represented 43.3% of the group. Colon tumors had SLN identification rate of 94.1%, while rectal tumors had 80.8%. Overall, SLN mapping accuracy was 75.4%, sensitivity 66.7% and 33.3% false negative rate. Upstaging rate was 10.5%. No aberrant lymphatic drainage could be detected in our patients. Conclusion: Intraoperative SLN mapping technique is feasible, safe, accurate, and has no apparent side effects. Implications for long-term survival and prognosis need to be further evaluated in additional studies.

Clinical Profile and Colonoscopic Findings in Patients Presented with Lower Gastrointestinal Bleeding in UCMS

INTRODUCTION&#x0D; The lower gastrointestinal bleeding (LGIB) is an alarming symptom and common disease with annual admission of 0.15% with mortality rate of 5-10%. LGIB is caused by neoplastic and non-neoplastic lesions. For accurate diagnosis of various colorectal lesions, colonoscopy is gold standard, convenient and cost effective procedure. It is the investigation of choice in LGIB and helps in early diagnosis of colorectal carcinoma. This study was aimed to scrutinize the clinical and colonoscopic findings in patients with LGIB in UCMS.&#x0D; &#x0D; MATERIAL AND METHODS&#x0D; This was a hospital based prospective observational study conducted after taking permission from institutional review committee in January 2017 at UCMS-TH from 15th January 2017 to 15th January 2018. All patients presenting with LGIB who fulfilled inclusion and exclusion criteria and gave written consent were included.&#x0D; &#x0D; RESULTS&#x0D; Total 88 patients were included in the study. The mean age of our patients was 48 ±17 years with age range from 17-81 years. Majority were in the age group 50-60 years (25%) (n=22). Colonoscopy detected abnormality in 73.8% cases. The common non-neoplastic were haemorrhoids and non-specific colitis (14.5% each) followed by 12.5% of neoplastic cases. The higher frequency of colorectal lesions was observed in males comprising 72.7% (n=64) patients. The most commonly diagnosed etiologies of LGIB were haemorrhoid and nonspecific colitis respectively.&#x0D; &#x0D; CONCLUSION&#x0D; Colonoscopy detected abnormality in 75% of cases. The common causes of LGIB were haemorrhoids and non-specific colitis followed by neoplastic lesion. A careful history, physical and colonoscopic examination with or without biopsy makes significant impact for early diagnosis and treatment.&#x0D;

ID: 3522787 IMPORTANCE OF OBSERVING DEPRESSED-TYPE COLORECTAL NEOPLASMS IN MAGNIFYING ENDOSCOPY AND ENDCYTOSCOPY

For colorectal carcinomas, “adenoma-carcinoma sequence” theory is generally regarded as the leading factor in the development of colorectal carcinomas. In other words, colorectal carcinomas are caused by polyps. However, the existence of depressed-type colorectal carcinomas has recently become apparent. These carcinomas are thought to emerge directly from the normal epithelium rather than at the adenomatous stage. This theory is called the "de novo" pathway. In the diagnosis of colorectal carcinomas, magnifying endoscopy (pit pattern classification) and endocytoscopy (EC classification) are useful. With these techniques, not only structural atypia but also the cellular atypia can be observed in vivo.