Early-stage Neoplasms Research Articles

Cryoablation of breast lesions: our experience

Cryoablation is a therapeutic technique that uses very low temperatures to destroy cells; transcutaneous cryoablation can be performed under imaging guidance. This simple procedure is done on an outpatient basis with local anesthesia. Cryoablation has proven effective in the treatment of benign breast lesions, such as fibroadenomas. Nowadays, its main use in malignant breast lesions is to reduce the size of the mass in cases where surgery is contraindicated. Nevertheless, other uses in malignant breast disease are being investigated. Cryoablation can strengthen the tumor response to immunotherapy. Likewise, in the near future, it may become an alternative to surgery for the local control of early-stage neoplasms. This article aims to describe our experience using cryoablation with liquid nitrogen to treat benign and malignant breast lesions and to review the fundamentals of the technique and its indications. Since 2019 we have used cryoablation to treat 7 benign and 9 malignant lesions without significant complications, achieving excellent esthetic outcomes. Cryoablation has been incorporated into our institution's breast unit's protocol.

Tratamiento con crioablación de lesiones de mama: nuestra experiencia

Cryoablation is a therapeutic technique that uses very low temperatures to destroy cells; transcutaneous cryoablation can be performed under imaging guidance. This simple procedure is done on an outpatient basis with local anesthesia. Cryoablation has proven effective in the treatment of benign breast lesions, such as fibroadenomas. Nowadays, its main use in malignant breast lesions is to reduce the size of the mass in cases where surgery is contraindicated. Nevertheless, other uses in malignant breast disease are being investigated. Cryoablation can strengthen the tumor response to immunotherapy. Likewise, in the near future, it may become an alternative to surgery for the local control of early-stage neoplasms. This article aims to describe our experience using cryoablation with liquid nitrogen to treat benign and malignant breast lesions and to review the fundamentals of the technique and its indications. Since 2019 we have used cryoablation to treat 7 benign and 9 malignant lesions without significant complications, achieving excellent esthetic outcomes. Cryoablation has been incorporated into our institution's breast unit's protocol.

Correlation of p53 Immunoexpression with Depth of Tumor in Microinvasive Oral Squamous Cell Carcinoma

Introduction: “Oral squamous cell carcinoma (OSCC)” is a major health issue in India, the incidence of OSCC is 3-7 times more in developing countries than developed countries. OSCC is the ‘3rd most common cancer’ in India followed by “cervical and breast cancer”. One side of OSCC that has not much explore is the ‘microinvasive squamous cell carcinoma’ which is an early stage neoplasm without infiltration in the deeper tissues. There is no particular definition of “microinvasive oral squamous cell carcinoma (MIOSCC)” There are no specific guideline are present to categories the “microinvasive squamous cell carcinoma (MIOSCC)”. Most of the time the infiltrating neoplastic cells are masked under the background of the inflammatory cell infiltrate present connective tissue stroma. So this study is humble attempt to recognized and measured depth of invasion of infiltrative neoplastic cells to categories MIOSCC and to find better management protocol for it
 Aim: This study aims to: Measure p53 immunoexpression in “microinvasive oral squamous cell carcinoma, evaluate the depth of invasion in MIOSCC in H & E stained section, and correlate the p53 immunoexpression with the depth of tumor in it.
 Methodology: The 25 cases of “microinvasive oral squamous cell carcinoma” will be selected and 10 cases of “normal oral mucosa (NOM)” will be obtained from “gingiva and vestibular mucosa” as controls after extraction of impacted teeth. “The depth of tumor” will be measured from the “basement membrane or in areas of basement membrane loss, from an imaginary line reconstructing the basement membrane from the adjacent epithelium to the deepest point of invasion in connective tissue” by Leica DMLB2 research microscope with Leica Q-win standard software (Switzerland).
 Results: The results show that the depth of invasion in MIOSCC, will be categorized the lesion and give the better guidelines for histological grading and treatment protocol for MIOSCC
 Conclusion: There are no definite guidelines for histological grading and final treatment protocol for MIOSCC. The assessments of depth of tumor through p53 immunoexpression may be one of the criteria for grading in MIOSCC. Thus the correlation of p53 immunoexpression with the depth of tumor in MIOSCC helps to determine the treatment modalities of MIOSCC.

Clinical, pathologic, and demographic characteristics of colorectal cancer in patients under age 50 in a third level Mexican cancer center.

e15592 Background: Colorectal cancer (CRC) is the most common gastrointestinal neoplasia, with 1.36 million cases worldwide, representing the third cause of death due to cancer. Commonly affects people after the 6th decade of life, but recently the diagnosis in patients below 50 years is increasing. Methods: We conducted an observational, retrospective, longitudinal analysis based on medical records of patients diagnosed with colorectal cancer treated in the ABC Medical Center. Information was collected between January 2016 and January 2021. Descriptive statistics were utilized regarding data analysis. Results: We identified 289 patients with CRC, of which 23 (8.2%) patients were less than 50 years of age at diagnosis. Gender distribution reflected slightly more feminine patients (56%). The median age at diagnosis was 43 years, oncologic family history in first- or second-degree family members was documented in 31.4% of patients. At diagnosis, 22% of patients presented with an early-stage neoplasm, 31% had locoregional disease and 50% had advanced disease. Left sided disease was present in 78% of patients, 8% on the right colon and 13% were in rectum. Adenocarcinoma was found in 95% of patients. Mucinous pattern was present in 39% of patients studied, intestinal tumors in 21%, singlet ring cells in 4.3%. Histologic grade was G2: 69%. Molecular analysis was conducted in 86% of tissue biopsies. Regarding RAS mutations, 15% were positive (Gly12asp, K117N and Gly13Asp), but none in NRAS. BRAF mutation was studied in 43% of patients, no mutations were found. The search for microsatellite instability was conducted in all tumors, finding it present in only one patient (5%). At median follow up of 31.8 months, 91.4% remainded alive. Patients with early stage cancer were given adjuvant therapy in 69%. mean RFS was 40 months. All patients diagnosed in stage IV disease received systemic therapy, with a medium PFS of 10 months. First line treatment was FOLFOX in 58% of patients. Target therapy with anti-EGFR and anti-VEGF was prescribed in 83.3% and 8.3% of patients in the first line respectively. Conclusions: We found that patients under 50 years with dignosis of colorectal cancer, have a family history of cancer in up to a third of patients, the most frecuent histology reported was adenocarcinoma with mucinous pattern. We observed a low frecuency of KRAS mutations compared with literature reports. A longer follow-up is requiered to asses overall survival.

IL-17A inhibitors in patients with chronic plaque psoriasis and history of malignancy: A case series with systematic literature review.

The treatment of moderate to severe plaque psoriasis in patients with history of malignancy is challenging. To review the studies reporting the experience with IL-17A inhibitors in patients with psoriasis and history of malignancy; secondly, to investigate cancer recurrence in a series of patients with a prior malignancy and plaque psoriasis treated with IL-17A inhibitors. A systematic literature review and an observational retrospective analysis of patients with history of malignancy and plaque psoriasis treated with IL-17A inhibitors was performed. About 5 original articles out of 601 were retrieved, reporting a total of 10 patients with a median age of 59 years, interquartile range (IQR) 50-63. Seven patients were treated with secukinumab, one with ixekizumab and two with both sequentially. Although the stage ranged from in situ to IV stage, most of the cases were early-stage neoplasm. The IL-17A inhibitor was initiated after a median of 10 months, interquartile range (IQR) 5-30 (range 0-144) from the diagnosis of malignancy. In addition, a series of 12 patients with history of malignancy were identified from the University Hospital of Verona, including 9 cases with cancer in clinical remission and 3 with advanced disease at time of initiating IL-17 inhibitor. No malignancy recurrence was reported within a median of 12 (IQR 6-23) and 46 (IQR 36-48) months follow up in case series from literature and our experience, respectively. Data on use of IL-17A inhibitors in patients with chronic plaque psoriasis and history of malignancy are limited. Registries and proactive pharmacovigilance activities are needed to guide clinical practice.

Standardized definitions and concepts of radicality during minimally invasive thymoma resection

Radical thymectomy is the gold standard treatment for thymoma; in particular, completeness of surgical resection of a well-encapsulated thymoma and adequate margins are considered the most important prognostic factors. According to the International Thymic Malignancy Interest Group instructions, in fact, the thymus should be resected en bloc with its upper cervical poles and the surrounding mediastinal fat and through a no-touch surgical technique. For years, the open approaches have been considered the gold standard treatment for thymic masses, because of technical advantages and proved good oncological results. When applied to properly chosen patients on the basis of the tumor stage, dimension, and histology, minimally invasive approaches could be as effective as open ones in terms of long-term outcomes. To accomplish a minimally invasive thymoma resection, several minimally invasive techniques (transcervical, subxiphoid, thoracoscopic, and robotic) have been described, each presenting advantages and drawbacks. Moreover, when dealing with early stage neoplasms, many authors have proposed to perform the thymomectomy alone, not involving the rest of the thymic gland, but evidence is still imprecise and vague, and some studies have described a higher rate of local recurrence when using this technique. Finally, many studies suggest that surgeons with expertise in minimally invasive lymphadenectomy for lung cancer may easily endorse the idea of nodal dissection, to be performed at least in advanced thymomas involving neighboring structures, large masses, and thymic carcinomas.

Abstract 149: Non-small cell lung cancer (NSCLC) detection by DNA methylation profiling and computational deconvolution

Abstract Purpose: Early detection of pulmonary malignancies is critical to achieving positive treatment outcomes. However, due to the minimal symptom burden often associated with early-stage neoplasms, in addition to the cost and limitations of advanced imaging modalities, detection of disease is often delayed until nodal or metastatic spread has occurred. Ongoing cellular turnover releases DNA into systemic circulation where it is able to achieve a steady state level. We postulated that we could identify methylation sites specific to pulmonary Squamous Cell Carcinoma (SCC) and Adenocarcinoma (AD) and then computationally determine the presence or absence of neoplastic signatures from a heterogeneous tissue sample, such as is found in cell free DNA isolated from plasma. Methods: We designed a computational framework for the detection of informative methylation sites based on an iterative Euclidean Distance algorithm. After generation of a reference matrix comprised of 25 cells of origin, SCC and AD (via 444 biopsy-derived methylomes), we sought informative methylation sites which had unique expression patterns among the tested cell types. To quantify the reliability of this approach, we generated synthetic In sillico “plasma” samples comprised of varying compositions of SCC, AD and whole blood methylation data which we then deconvolved using a NNLS algorithm. Results: We identified 200 informative sites out of 390,000 tested. Based on the 200 identified informative sites, we were able to define a Euclidean Space with robust separation of individual cell types (L2>5). Pairings of CD4+/CD8+ T-Cells and SCC/AD had the closest Euclidean distances, likely related to cellular origin and biologic similarities. However, we accurately distinguished between these cell type pairs in >95% of In silico experiments. Additionally, we demonstrated accurate detection of neoplastic signature within synthetic heterogeneous mixtures ranging from .1 to 100% of neoplastic “spike-in” (PearsonR =.92, p=1.5e-42). Going forward, we hope to further define the operating characteristics of this approach In vivo and develop its capability as we look to recapitulate our results with plasma samples from patients with and without pulmonary malignancies. Conclusion: Here, we describe a computational framework for the detection of pulmonary malignancy via methylation signatures. Using this framework we identified 200 informative methylation sites which allow for In silico deconvolution and detection of NSCLC within heterogeneously complex samples. Citation Format: Nicholas J. Hornstein, Zorawar S. Noor, Matteo Pellegrini, Edward Garon. Non-small cell lung cancer (NSCLC) detection by DNA methylation profiling and computational deconvolution [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 149.

Step-up strategy with limited resection for early stage neoplasms of the ampulla of vater

Step-up strategy with limited resection for early stage neoplasms of the ampulla of vater

Acquired factor XII deficiency following transanal excision of rectal lesion by transanal minimally invasive surgery (TAMIS): a case report and literature review

BackgroundLocal excision (LE) is currently one of the most effective methods used in cases of large benign polyps, not suitable for endoscopic treatment, or early-stage neoplasms. LE is also alternative to anterior rectal resection in selected patients suffering from major comorbidities and limits for major abdominal procedure. Furthermore, LE results in less pain, reduced impact on bowel function, shorter duration of hospital stay, and lower rates of morbidity, mortality and stoma creation. In particular, early data on transanal minimally invasive surgery (TAMIS) are promising, but they come from single centre case series related to small groups of patients and more data are needed to draw a final conclusion on the safety of this novel approach for transanal resection.Case presentationA 62-year-old woman, following a positive faecal occult blood test and with unremarkable medical history, was admitted to hospital for excision of a large flat neoplastic lesion. Endoscopic biopsy demonstrated a tubular adenoma with high-grade dysplasia and was decided to proceed with surgical excision by TAMIS. After surgery, short-term outcomes revealed prolonged activated partial thromboplastin time, undetectable factor XII activity, fever, and partial dehiscence of rectal wall defect suture. Cross-mixing studies of patient plasma show no correction in either the immediate or incubated activated partial thromboplastin time, indicating the presence of an acquired factor XII inhibitor. Activated partial thromboplastin time and factor XII improved in the following weeks without any specific therapy in addition to antibiotic therapy.ConclusionThis is the first report in which acquired inhibitor of coagulation factor XII is associated with a specific surgical procedure. This case has shown how trans-anal excision of rectal lesions, even when performed by minimally invasive means such as in case of TAMIS, is not free of complications. We consider the acute infection, resulting from early dehiscence of the suture, the trigger in an abnormal immune response, and inhibitor development.

Surgery for Malignant Sublingual and Minor Salivary Gland Neoplasms.

Malignant sublingual gland neoplasms are rare, early-stage neoplasms presenting as painless non-ulcerated masses in the antero-lateral floor of the mouth. The majority of patients present with advanced disease, with symptoms of pain or anaesthesia of the tongue. Malignant minor salivary gland neoplasms are more common, the majority (>80%) of which present in the oral cavity, most frequently in the palatal area, as painless masses or as obstructive symptoms in the head and neck region. The most frequent pathologies are adenoid cystic carcinoma and mucoepidermoid carcinoma (>85%), with the majority presenting at an advanced stage (III/IV). Wide tumour-free surgical margin excision is the treatment of choice, followed by radiotherapy, after discussion of the multidisciplinary head and neck cancer tumour board. Improvements in survival and quality of life have been achieved since the introduction of endoscopic and robotic surgeries for many minor salivary gland malignancies.

Cancer communication and informatics research across the cancer continuum.

Over the past decade, dramatic changes brought about by a rapid diffusion of Internet technologies, cellular telephones, mobile devices, personal digital assistants, electronic health records, and data visualization have helped to create a revolution in health communication. To understand the implications of this communication revolution for cancer care, the National Cancer Institute launched an ambitious set of research priorities under its "extraordinary opportunities" program. We present an overview of some of the relevant behavioral research being conducted within the perspective of this extraordinary opportunity in cancer communication research. We begin by tracing the implications of this research for behavioral scientists across the continuum of cancer care from primary prevention (e.g., tobacco control, diet, exercise, sun protection, and immunization against human papilloma virus), to secondary prevention (e.g., screening for polyps, lesions, and early stage neoplasms), to diagnosis and treatment, posttreatment survivorship, and end of life. Along each point of the continuum, we describe a natural evolution of knowledge from studies on the traditional role of media to research on the changing role of new media and informatics, and we carefully highlight the role that psychological research has played in improving communication- and health-related outcomes along the way. We conclude with an appeal to psychologists of many different backgrounds to join with biomedical researchers, engineers, clinical practitioners, and others to accelerate progress against cancer.

What Is the Oncologic Risk of Stem Cell Treatment for Heart Disease?

See related article, pages 1340–1347 Every therapy has toxic and therapeutic windows, and defining the side effects of any new therapeutic modality is the first order of business in the development of a treatment. With transformative therapies such as cell-based approaches, treatment side effects can be unpredictable and unanticipated. In some cases, experimental data raise serious concerns that must be appropriately managed. In the face of the promise and enthusiasm for cell-based therapy for heart disease, results from rodent experiments have consistently raised the specter of a dreaded side effect—can the use of stem cells lead to cancer, either directly or through promotion of existing early-stage neoplasms? Mesenchymal stem cells (MSCs) are a multipotent immunotolerant cell source that can be readily expanded into therapeutic quantities from a variety of tissues such as the bone marrow, cord blood, and fat, and as such their use in cell-based therapeutic strategies holds great promise.1 With regard to heart disease, accumulating preclinical2–11 and clinical studies12–15 demonstrate that MSC transplantation may be salutary for both acute myocardial infarction and cardiomyopathy with an acceptable risk profile. The translational development of cell-based therapy has required rigorous large-animal experimentation, recognizing inherent limitations with rodent experimentation. In this context, more than 500 large animals (swine, canine, and sheep) have been tested to assess the safety and efficacy of MSC therapeutics for treating heart disease with the results demonstrating that MSC transplantation is a safe and durable approach that may be more effective than bone marrow mononuclear cells.16 Importantly, large-animal work provides a phenotyping opportunity not available in rodents, and rigorous cardiac MRI (CMR) and histological analysis in porcine hearts supported the regenerative effects subsequently demonstrated in the adult human heart.12,15 The mechanism of action appears multifaceted, involving direct …

A case of steroid-dependent myeloid granulocytic sarcoma masquerading as Crohn’s disease

Small bowel tumors and Crohn's disease are common causes of small bowel obstruction. Early stage neoplasms can easily be mistaken for Crohn's disease. Therefore, thorough work-ups including imaging studies and endoscopic evaluation with biopsies are critical for accurate diagnosis. Here we report a case of an otherwise healthy female with progressive onset of multiple, recurrent obstructive symptoms secondary to terminal ileal narrowing who was referred for management of steroid-dependent Crohn's disease. After thorough evaluation, the diagnosis was revised to myeloid granulocytic sarcoma involving the terminal ileum. In this case, a delay in diagnosis can be detrimental for prognosis, as myeloid granulocytic sarcoma is highly predictive of underlying acute myeloid leukemia and needs urgent referral for chemotherapy and/or resection.

Usefulness of bispectral monitoring of conscious sedation during endoscopic mucosal dissection

To assess the usefulness of bispectral index (BIS) monitoring in order to carry out endoscopic submucosal dissection (ESD) safely and with patients' satisfaction. Three hundred sixty-six patients with an early-stage neoplasm of the digestive tract were enrolled. The BIS monitor (A-1050: Aspect medical systems/NIHON KOHDEN, Tokyo, Japan) was used. The appropriate sedative condition was set at 55 to 75 BIS levels (BIS value) during the endoscopic procedures. Among 366 cases, 13 were accompanied by adverse events during and/or after ESD. All episodes occurred in cases with BIS value between 56 and 65. Hypotension was observed in four cases, and bradycardia in six. Respiratory distress was observed in two cases with chronic pulmonary obstructive disease. All patients with adverse events were able to leave the hospital without extension of the hospitalization. BIS monitoring is useful to safely perform ESD. A BIS value of 70 to 75 is suitable for ESD.

Clinical impact of endoscopic submucosal dissection for superficial adenocarcinoma located at the esophagogastric junction

Surgery is the standard treatment for neoplasms located at the esophagogastric junction (EGJ), and, recently, EMR, photodynamic therapy (PDT), or both have also been used for early stage neoplasms located at the EGJ. Endoscopic submucosal dissection (ESD) is a newly developed technique in the field of endoscopic treatments for GI neoplasms because of its high rate of en bloc resection. We used ESD for superficial adenocarcinoma located at the EGJ and evaluated its clinical impact. Twenty-five lesions of superficial adenocarcinomas located at the EGJ from 24 patients were treated with ESD between June 2001 and January 2006. An adenocarcinoma located at the EGJ was defined as a "junctional carcinoma (type II)" according to Siewert's classification. Complications, en bloc resection rate, curative resection rate, local recurrence, and distant metastasis were evaluated. No complications except stenosis occurred. The en bloc resection rate was 100%. Seventeen lesions (72.0%) were judged as "curative resection" and showed no local or distant recurrence during a median follow-up period of 30.1 months. Seven lesions were diagnosed as "noncurative resection." Two patients underwent additional surgical resections. In 1 of 2 of the surgical resections, however, we could not identify a residual cancer. In 1 patient, who refused additional surgical resection, lung metastases were found after 3 years. The limitation of the study was its retrospective design. After long-term follow-up, although surgery for a noncurative resection remains a standard treatment, ESD can be adequately adopted as an effective treatment for superficial adenocarcinomas at the EGJ.

Clinical Impact of ESD for Superficial Adenocarcinoma Located On SCJ

Background & Aims: Surgery is the standard treatments for neoplasms located on squamous-columner junction (SCJ), and recently endoscopic mucosal resection (EMR) and/or photodynamic therapy (PDT) are also used for early stage neoplasms located on SCJ. Endoscopic submucosal dissection (ESD) is a newly developed technique in the field of endoscopic treatment for gastrointestinal neoplasms because of its high rate of en-bloc resection. We applied ESD for superficial neoplasm located on SCJ. Methods: Twenty-four lesions of superficial adenocarcinoma located on SCJ from 23 patients were treated with ESD between June 2001 and January 2006 at NCCH.

The Use of Preoperative Endoscopic Tattooing in Laparoscopic Colorectal Cancer Surgery for Endoscopically Advanced Tumors: A Prospective Comparative Clinical Study

Endoscopic India ink marking techniques are often used for the intraoperative location of colonic polyps and early stage neoplasms. The aim of this study was to compare how effective this technique is compared with conventional localization methods, as well as its influence on the results of colorectal laparoscopy (LSCRC) for endoscopically advanced tumors. From January 2003 to January 2005, 47 patients with colorectal carcinomas were included in the study. In one group, lesions were localized preoperatively by endoscopic India ink tattooing (n = 21; tattooed group, TG), while conventional methods were used in the others (n = 26; non-tattooed group, NTG). Patients' perioperative clinical and pathoanatomical data were prospectively collected. Both groups were comparable in age, sex distribution, American Society of Anesthesiologists (ASA) score, body mass index (BMI), technique performed, tumor size and proportion of patients who had previous abdominal surgery. Three patients presented ink spillage without clinical repercussions. Visualization of the correct resection site was higher in the TG (100% vs. 80.8%, P = 0.03). Operative time (147.3 +/- 46.2 vs. 187.0 +/- 52.7 minutes, P = 0.02) and blood loss (99.3 +/- 82.8 vs. 163.6 +/- 96.6 cc, P = 0.03) were lower in the TG. There were no differences between groups regarding peristalsis, introduction of oral intake, hospital stay or intra- and postoperative complication rates. No differences were observed amongst pathoanatomical data studied. Preoperative endoscopic tattooing is a safe and effective technique for intraoperative localization of advanced colorectal neoplasms, improving the operative results of LSCRC.

Depressed-type (0-IIc) colorectal neoplasm in patients with family history of first-degree relatives with colorectal cancer: A cross-sectional study

To investigate the correlation of depressed-type (0-IIc) colorectal neoplasm and family history of first-degree relatives (FDR) with colorectal cancer (CRC). This cross-sectional study was conducted from June 2000 to October 2002 at National Cancer Center Hospital East. Eligible patients undergoing initial total colonoscopy were surveyed regarding family history of CRC among FDR by a questionnaire prior to colonoscopic examinations. All endoscopic findings during colonoscopy were recorded and the macroscopic classification of the early stage neoplasm/cancer was classified into two types (0-IIc vs non 0-IIc). Odds ratios (OR) and 95% confidence intervals (CI) were calculated by univariate and multivariate logistic regression to estimate the association between macroscopic features and clinicopathological data including gender, age, and family history of FDR with CRC. The OR of an association between family history of FDR with CRC and overall early stage neoplasm adjusted by gender and age was 1.85 (95% CI: 1.31-2.61, P = 0.0004), that for non 0-IIc neoplasm was 1.71 (95% CI: 1.22-2.41, P = 0.0017) and for 0-IIc colorectal neoplasm was 2.78 (95% CI: 1.49-5.16, P = 0.0031). Our study shows a significant association between a family history of FDR with CRC and 0-IIc colorectal neoplasm. When patients with a family history of FDR with CRC undergo colonoscopy, colonoscopists should check carefully for not only polypoid, but also depressed-type (0-IIc) lesions.

DNA methylation, a biomarker for colorectal cancer: implications for screening and pathological utility.

Currently up to one-third of colorectal cancer patients present with locally advanced or metastatic disease that precludes a surgical cure. Performance limitations and low uptake of current screening tools have fueled research to develop minimally invasive approaches that can detect early-stage neoplasms. The observation that altered DNA can be amplified from the stool or circulation has stimulated research on its use as a biomarker of occult neoplasia. De novo methylation of CpG islands 5' to certain tumor suppressor genes has been associated with epigenetic silencing. At certain loci this phenomenon is specific for neoplastic populations, and it is frequently detected at early stages in colorectal tumorigenesis. Accordingly, hypermethylation events have been proposed by researchers as ideal targets for the basis of a screening panel to detect peripheral tumor DNA. This critique reviews research findings on the use of epigenetic biomarkers in screening for occult neoplasia. In addition, the authors consider the pathological utility of epigenetic testing in refining tumor staging and predicting disease recurrence.

Should screening for lung cancer be revisited?

J Thorac Cardiovasc Surg 2001;121:1031-2