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European Journal of Obstetrics,... Jun 2019Endometrial polyps are a common condition. The risk of malignancy has often led to an overtreatment with high health care costs and huge psychological distress. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Endometrial polyps are a common condition. The risk of malignancy has often led to an overtreatment with high health care costs and huge psychological distress.
OBJECTIVE
We conducted a systematic review and a meta-analysis in order to estimate the prevalence of premalignant and malignant lesions in women undergoing hysteroscopic polypectomy.
DATA SOURCE
We developed the search using PubMed/MEDLINE and EMBASE databases to identify papers published between 2000- January 2019. The research strategy used on Pubmed was: ("polyps" (MESH) OR "endometrial polyp*") AND ("malignancy" OR "cancer" OR "histopathology" OR "hysteroscopy" OR "ultrasound", OR "sonohysterography"). The same search was modified for EMBASE.
STUDY ELIGIBILITY
We included all observational retrospective and prospective studies and studies were selected for the review if they met following inclusion criteria: pre-operative diagnosis of benign-looking endometrial polyps at ultrasound examination or at hysteroscopy, excision of endometrial polyps via surgical hysteroscopy, histopathological diagnosis of benign polyps, or hyperplasia without atypia, or premalignancy (atypical hyperplasia) or malignancy (endometrial cancer). Moreover, studies were included if number or percentage of subjects with and without malignancy was provided and if they reported data about menopausal and/or bleeding status. We excluded data presented exclusively as abstracts in national and international meetings, or case report or review articles that did not include original data and papers published in other than English language. Our primary outcome was the prevalence of endometrial premalignant or malignant polyps in the total series, among premenopausal and postmenopausal women and among women with or without abnormal bleeding and then in subgroup analysis according to study design, diagnostic method, study region and calendar year of publication.
RESULTS
A total of 51 studies reporting data on 35,345 women were included in this review. The prevalence of malignant polyps was 2.73% (95% CI 2.57-2.91) with very high heterogeneity among studies. The rates were lower for premenopausal women (1.12%) than post-menopausal ones (4.93%) and the difference was statistically significant (chi-square = 397.21. p < .0001). The risk of malignancy was higher among symptomatic (5.14%) than asymptomatic ones (1.89%) (chi-square = 133.13 p < .001). We observed higher rate of malignant polyps in prospective studies. In the meta-analysis selecting 10 prospective studies the random pooled estimate was 5.88 (95% CI: 4.06-7.97) with heterogeneity among studies (heterogeneity chi square = 17.55 P = .025) whereas in retrospective studies the random pooled estimate was 2.94 (95% CI:2.24-3.71) with high heterogeneity among studies (P < .001). This finding can be due to more strict diagnostic criteria in prospective studies.
CONCLUSION
Symptomatic vaginal bleeding and postmenopausal status in women with endometrial polyps increased the risk of malignancy. This finding could be an useful evidence to select patients who need to undergo hysteroscopic resection of endometrial polyps and women to whom, instead, an expectant management can be offer.
Topics: Female; Humans; Polyps; Precancerous Conditions; Prevalence; Risk; Uterine Diseases; Uterine Neoplasms
PubMed: 31009859
DOI: 10.1016/j.ejogrb.2019.04.009 -
Gastroenterology Jul 2020Sessile serrated polyps (SSPs) could account for a substantial proportion of colorectal cancers. We aimed to increase clarity on SSP prevalence and clinical features. (Comparative Study)
Comparative Study
BACKGROUND & AIMS
Sessile serrated polyps (SSPs) could account for a substantial proportion of colorectal cancers. We aimed to increase clarity on SSP prevalence and clinical features.
METHODS
We performed a systematic review of MEDLINE, Web of Science, Embase, and Cochrane databases for original studies published in English since 2000. We included studies of different populations (United States general or similar), interventions (colonoscopy, autopsy), comparisons (world regions, alternative polyp definitions, adenoma), outcomes (prevalence, clinical features), and study designs (cross-sectional). Random-effects regression was used for meta-analysis where possible.
RESULTS
We identified 74 relevant colonoscopy studies. SSP prevalence varied by world region, from 2.6% in Asia (95% confidence interval [CI], 0-5.9) to 10.5% in Australia (95% CI, 2.8-18.2). Prevalence values did not differ significantly between the United States and Europe (P = .51); the pooled prevalence was 4.6% (95% CI, 3.4-5.8), and SSPs accounted for 9.4% of polyps with malignant potential (95% CI, 6.6-12.3). The mean prevalence was higher when assessed through high-performance examinations (9.1%; 95% CI, 4.0-14.2; P = .04) and with an alternative definition of clinically relevant serrated polyps (12.3%; 95% CI, 9.3-15.4; P < .001). Increases in prevalence with age were not statistically significant, and prevalence did not differ significantly by sex. Compared with adenomas, a higher proportion of SSPs were solitary (69.0%; 95% CI, 45.9-92.1; P = .08), with diameters of 10 mm or more (19.3%; 95% CI, 12.4-26.2; P = .13) and were proximal (71.5%; 95% CI, 63.5-79.5; P = .008). The mean ages for detection of SSP without dysplasia, with any or low-grade dysplasia, and with high-grade dysplasia were 60.8 years, 65.6 years, and 70.2 years, respectively. The range for proportions of SSPs with dysplasia was 3.7%-42.9% across studies, possibly reflecting different study populations.
CONCLUSIONS
In a systematic review, we found that SSPs are relatively uncommon compared with adenoma. More research is needed on appropriate diagnostic criteria, variations in detection, and long-term risk.
Topics: Adenoma; Aged; Colon; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Female; Humans; Male; Middle Aged; Precancerous Conditions; Prevalence; Risk Factors; Sex Factors
PubMed: 32199884
DOI: 10.1053/j.gastro.2020.03.025 -
The Cochrane Database of Systematic... Apr 2016Although conventional colonoscopy is the most accurate test available for the investigation of the colorectum for polyps, data exist that raise concerns about its... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Although conventional colonoscopy is the most accurate test available for the investigation of the colorectum for polyps, data exist that raise concerns about its sensitivity. Chromoscopy (spraying dye onto the surface of the colon to make polyps more visible) may be one way of enhancing the ability of colonoscopy to detect polyps, particularly diminutive flat lesions, which otherwise may be difficult to detect.
OBJECTIVES
To determine whether the use of chromoscopy enhances the detection of polyps and neoplasia during endoscopic examination of the colon and rectum.
SEARCH METHODS
We searched the following databases: Cochrane Colorectal Cancer Group Specialised Register (October 2015), Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library; Issue 10, 2015), MEDLINE (January 1950 to October 2015), EMBASE (January 1974 to October 2015), and ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform (both November 2015). We also handsearched abstracts from relevant meetings from 1980 to 2015. Search terms included 'randomised trials' containing combinations of the following: 'chromoscopy' 'colonoscopy' 'dye-spray' 'chromo-endoscopy' 'indigo-carmine' 'magnifying endoscopy'.
SELECTION CRITERIA
We included all prospective randomised trials comparing chromoscopic with conventional endoscopic examination of the whole of the colon and rectum. We excluded studies of people with inflammatory bowel disease or polyposis syndromes and any studies that combined chromoscopy with additional interventions (cap assistance, water-perfused, etc.).
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed the methodological quality of potentially eligible trials, and two review authors independently extracted data from the included trials. Outcome measures included the detection of polyps (neoplastic and non-neoplastic), the detection of diminutive lesions, the number of participants with multiple neoplastic lesions, and the extubation time.
MAIN RESULTS
We included seven trials (2727 participants) in this update. Five trials were of sufficiently similar design to allow for pooled results. Two trials differed substantially in design and were included in a subgroup analysis. All the trials had some methodological drawbacks. However, combining the results showed a significant difference in favour of chromoscopy for all detection outcomes. In particular, chromoscopy was likely to yield significantly more people with at least one neoplastic lesion (odds ratio (OR) 1.53, 95% confidence interval (CI) 1.31 to 1.79; 7 trials; 2727 participants), and at least one diminutive neoplastic lesion (OR 1.51, 95% CI 1.19 to 1.92; 4 trials; 1757 participants). Significantly more people with three or more neoplastic lesions were also detected, but only when studies that used high-definition colonoscopy in the control group were excluded (OR 4.63, 95% CI 1.99 to 10.80; 2 trials; 519 participants). None of the included studies reported any adverse events related to the use of the contrast dye.
AUTHORS' CONCLUSIONS
There is strong evidence that chromoscopy enhances the detection of neoplasia in the colon and rectum. People with neoplastic polyps, particularly those with multiple polyps, are at increased risk of developing colorectal cancer. Such lesions, which presumably would be missed with conventional colonoscopy, could contribute to the interval cancer numbers on any surveillance programme.
Topics: Colonic Polyps; Colonoscopy; Humans; Indicators and Reagents; Indigo Carmine; Intestinal Polyps; Precancerous Conditions; Randomized Controlled Trials as Topic; Rectal Diseases
PubMed: 27056645
DOI: 10.1002/14651858.CD006439.pub4 -
Journal of Medical Imaging and... Mar 2021Gallbladder adenoma (GA) is a precancerous neoplasm and needs surgical resection. It is difficult to differentiate adenoma from other gallbladder polyps using imaging... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Gallbladder adenoma (GA) is a precancerous neoplasm and needs surgical resection. It is difficult to differentiate adenoma from other gallbladder polyps using imaging examinations. The aim of present systematic review and meta-analysis was to evaluate the diagnostic accuracy of contrast-enhanced ultrasound in the diagnosis of gallbladder adenoma.
METHODS
The searches were conducted by two independent researchers to find the relevant studies published from 1/1/2009 until end of 30/06/2019. The search included published literature in the English language in MEDLINE via PubMed, EMBASE via Ovid, The Cochrane Library, and Trip databases. For literature published in other languages, national databases (Magiran and SID), KoreaMed, and LILACS were searched. The risk of bias of every article was evaluated by using QUADAS-2. On the basis of the results from the 2 × 2 tables, pooled measures for sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curves (AUC) along with their 95% confidence intervals (CIs) were calculated using the DerSimonian Lair methodology.
RESULTS
Overall, 868 patients were studied in the 10 studies chosen for inclusion. Of these 10 studies, 5 (50%) were retrospective and 5 (50%) were prospective. The total prevalence of gallbladder adenoma in 10 studies was 16% (95% CI 13%, 18%). The sensitivity and specificity of contrast-enhanced ultrasound were 0.846 (95% CI 0.818-0.871) and 0.870 (95% CI: 0.844-0.894), respectively. The diagnostic odds ratio was 40.807 (95% CI 18.838-88.393).
CONCLUSION
CEUS is a reliable, non-invasive, and no-radiation-exposure imaging modality with a high sensitivity and specificity for detection of gallbladder adenoma. Nonetheless, it should be applied cautiously, and large scale, well-designed trials are necessary to assess its clinical value.
Topics: Adenoma; Contrast Media; Diagnosis, Differential; Gallbladder Neoplasms; Humans; Ultrasonography
PubMed: 33129756
DOI: 10.1016/j.jmir.2020.09.014 -
Journal of Minimally Invasive Gynecology 2018In this study, we aimed to estimate the frequency of premalignant and malignant lesions in endometrial polyps, and to evaluate associated clinical and demographic... (Meta-Analysis)
Meta-Analysis
In this study, we aimed to estimate the frequency of premalignant and malignant lesions in endometrial polyps, and to evaluate associated clinical and demographic factors. A literature search was performed in major databases and the gray literature using the terms polyps OR endometrial polyp AND endometrial neoplasms OR endometrial cancer OR endometrial hyperplasia OR malignan*. Studies describing the frequency of premalignant and malignant lesions in endometrial polyps and any clinical or demographic factors associated with malignant lesions extracted using hysteroscopy were considered eligible. Independent investigators selected the studies and extracted the data. A meta-analysis was performed using a random-effects model and meta-regression. We identified 37 studies (comprising 21,057 patients) of endometrial polyps. The prevalence of premalignant and malignant lesions was 3.4% (95% confidence interval [CI], 2.8-4.1; I, 80.5%). Abnormal uterine bleeding (prevalence ratio [PR], 1.47; 95% CI, 1.27-1.69; I, 82.4%), menopausal status (PR, 1.67; 95% CI, 1.48-1.89; I, 78.4%), age >60 years (PR, 2.41; 95% CI, 1.84-3.16; I, 81.5%), diabetes mellitus (PR, 1.76; 95% CI, 1.43-2.16; I, 0.0%), systemic arterial hypertension (PR, 1.50; 95% CI, 1.20-1.88; I, 75.9%), obesity (PR, 1.41; 95% CI:1.13-1.76; I, 41.2%), and tamoxifen use (PR, 1.53; 95% CI, 1.06-2.21; I, 0.0%) were associated with endometrial polyp malignancy. However, breast cancer (PR, 0.83; 95% CI, 0.44-1.57; I, 0.0%), hormonal therapy (PR, 0.93; 95% CI, 0.67-1.30; I, 31.7%), parity (PR, 0.87; 95% CI, 0.39-1.96; I, 78.1%), and endometrial polyp size (PR, 1.05; 95% CI, 0.70-1.57; I, 44.7%) were not associated with malignancy of endometrial polyps. Three of every 100 women with clinically recognized polyps, a condition associated with specific clinical and demographic factors, will harbor premalignant or malignant lesions.
Topics: Adult; Endometrial Neoplasms; Endometrium; Female; Humans; Hysteroscopy; Polyps; Precancerous Conditions; Pregnancy; Prevalence; Risk Factors; Uterine Neoplasms
PubMed: 29454147
DOI: 10.1016/j.jmig.2018.02.004 -
BMJ Open Gastroenterology 2020Circulating tumour DNA from colorectal cancer (CRC) is a biomarker for early detection of the disease and therefore potentially useful for screening. One such biomarker... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Circulating tumour DNA from colorectal cancer (CRC) is a biomarker for early detection of the disease and therefore potentially useful for screening. One such biomarker is the methylated SEPT9 (mSEPT9) gene, which occurs during CRC tumourigenesis. This systematic review and meta-analysis aims to establish the sensitivity, specificity and accuracy of mSEPT9 tests for the early diagnosis of CRC.
METHODS
A systematic search of the relevant literature was conducted using Medline and Embase databases. Data were extracted from the eligible studies and analysed to estimate pooled sensitivity, specificity and diagnostic test accuracy.
RESULTS
Based on 19 studies, the pooled estimates (and 95% CIs) for mSEPT9 to detect CRC were: sensitivity 69% (62-75); specificity 92% (89-95); positive likelihood ratio 9.1 (6.1-13.8); negative likelihood ratio 0.34 (0.27-0.42); diagnostic OR 27 (15-48) and area under the curve 0.89 (0.86-0.91). The test has a positive predictive value of 2.6% and negative predictive value of 99.9% in an average risk population (0.3% CRC prevalence), and 9.5% (positive predictive value) and 99.6% (negative predictive value) in a high-risk population (1.2% CRC prevalence).
CONCLUSION
The mSEPT9 test has high specificity and moderate sensitivity for CRC and is therefore a potential alternative screening method for those declining faecal immunochemical test for occult blood (FIT) or other screening modalities. However, it is limited by its poor diagnostic performance for precancerous lesions (advanced adenomas and polyps) and its relatively high costs, and little is known about its acceptability to those declining to use the FIT.
Topics: Colorectal Neoplasms; Diagnostic Tests, Routine; Early Detection of Cancer; Humans; Occult Blood; Septins
PubMed: 32128229
DOI: 10.1136/bmjgast-2019-000355 -
Surgical Endoscopy Sep 2020Colonoscopies are effective means of detecting and removing precancerous adenomatous polyps. The adenoma detection rate (ADR) is a marker of colonoscopy quality and an... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Colonoscopies are effective means of detecting and removing precancerous adenomatous polyps. The adenoma detection rate (ADR) is a marker of colonoscopy quality and an independent predictor of colorectal cancer incidence. Focused training interventions may improve an endoscopist's ADR, but the supporting research is limited. This systematic review and meta-analysis identified, critically appraised, and meta-analyzed data from randomized trials (RCTs) evaluating the effect of training interventions on ADRs.
METHODS
Ovid Medline, EMBASE, CENTRAL, Eric, CINAHL, Scopus, Web of Science, and ClinicalTrials.gov were searched for RCTs investigating the effect of an educational intervention on ADRs. Two reviewers independently screened, identified, and extracted trial-level data. Internal validity was assessed in duplicate using the Risk of Bias tool. Our primary outcome was the ADR. Secondary outcomes were advanced ADR, adenocarcinoma detection rate, polyp detection rate, and withdrawal times. Safety outcomes were post-polypectomy bleeding rate and colonoscopy-related perforation rate.
RESULTS
From 2837 screened citations, we identified 3 trials (119 endoscopists) meeting our inclusion criteria. Training interventions were associated with a trend toward increased ADRs (odds ratio 1.16, 95% confidence interval (CI) 1.00-1.34; I 83%; 3 trials; 119 endoscopists). When limited to screening colonoscopies, the odds ratio for ADRs associated with training interventions was 1.17 (95% CI 1.00-1.36; I 80%; 3 trials; 119 endoscopists). There was a high level of heterogeneity between the trials' training interventions. Training intervention improved the advanced ADR, adenocarcinoma detection rate, polyp detection rate, and withdrawal times. Safety outcomes were not reported.
CONCLUSIONS
A focused training intervention was associated with a strong trend toward increased ADRs among certified endoscopists. While the described training interventions definitely show promise, further efforts around continuing professional developments activities are needed to more consistently improve ADRS among certified endoscopists.
Topics: Adenoma; Clinical Trials as Topic; Colonic Neoplasms; Colonoscopy; Female; Humans; Male; Middle Aged; Odds Ratio; Polyps; Publication Bias; Risk; Treatment Outcome
PubMed: 31595401
DOI: 10.1007/s00464-019-07153-7 -
Digestive Diseases and Sciences Jun 2023Colorectal cancer (CRC) is the third most common malignancy in the US. Several factors are associated with increased/decreased CRC risk and often linked to adenomatous... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Colorectal cancer (CRC) is the third most common malignancy in the US. Several factors are associated with increased/decreased CRC risk and often linked to adenomatous colorectal polyps (CRP). Recent studies suggest a lower risk of neoplastic lesions among irritable bowel syndrome (IBS) patients. We aimed to systematically assess the occurrence of CRC and CRP in IBS patients.
METHODS
Searches of the Medline, Cochrane, and EMBASE databases were performed, blindly and independently, by two investigators. Studies of CRC or CRP incidence in IBS patients (diagnosed by Rome or other symptom-based criteria) were eligible for inclusion. CRC and CRP effect estimates were pooled in meta-analyses using random models.
RESULTS
Of 4941 non-duplicate studies, 14 were included, comprising 654,764 IBS patients and 2,277,195 controls in 8 cohort studies, and 26,641 IBS patients and 87,803 controls in 6 cross-sectional studies. Pooled analysis revealed a significantly decreased prevalence of CRP in IBS subjects vs. controls, with a pooled odds ratio (OR) of 0.29 (95% CI (0.15, 0.54)). There was significant heterogeneity between studies (I = 96%, p < 0.01). This finding persisted when studies which did not report pre-cancerous polyps separately were excluded (OR 0.23, 95% CI (0.15, 0.35), I = 85%, p < 0.01). CRC prevalence was lower in IBS subjects, but this did not reach statistical significance (OR 0.40, 95% CI (0.09, 1.77]).
CONCLUSION
Our analyses reveal a decreased incidence of colorectal polyps in IBS, although CRC did not reach significance. Mechanistic studies with detailed genotypic analysis and clinical phenotyping are needed to better elucidate the potentially protective effect of IBS on CRC development.
Topics: Colonic Polyps; Irritable Bowel Syndrome; Colorectal Neoplasms; Incidence; Humans
PubMed: 36871131
DOI: 10.1007/s10620-023-07885-6 -
The Surgeon : Journal of the Royal... Oct 2016There are no evidence-based guidelines to dictate when Gallbladder Polyps (GBPs) of varying sizes should be resected. (Review)
Review
BACKGROUND
There are no evidence-based guidelines to dictate when Gallbladder Polyps (GBPs) of varying sizes should be resected.
AIM
To identify factors that accurately predict malignant disease in GBP; to provide an evidence-based algorithm for management.
METHODS
A systematic review following PRISMA guidelines was performed using terms "gallbladder polyps" AND "polypoid lesion of gallbladder", from January 1993 and September 2013. Inclusion criteria required histopathological report or follow-up of 2 years. RTI-IB tool was used for quality analysis. Correlation with GBP size and malignant potential was analysed using Euclidean distance; a logistics mixed effects model was used for assessing independent risk factors for malignancy.
RESULTS
Fifty-three articles were included in review. Data from 21 studies was pooled for analysis. Optimum size cut-off for resection of GBPs was 10 mm. Probability of malignancy is approximately zero at size <4.15 mm. Patient age >50 years, sessile and single polyps were independent risk factors for malignancy. For polyps sized 4 mm-10 mm, a risk assessment model was formulated.
CONCLUSIONS
This review and analysis has provided an evidence-based algorithm for the management of GBPs. Longitudinal studies are needed to better understand the behaviour of polyps <10 mm, that are not at a high risk of malignancy, but may change over time.
Topics: Age Factors; Algorithms; Cholecystectomy; Diagnosis, Differential; Disease Progression; Evidence-Based Medicine; Gallbladder Diseases; Guidelines as Topic; Humans; Polyps; Precancerous Conditions; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 26825588
DOI: 10.1016/j.surge.2015.12.001 -
Annals of Gastroenterology 2023Add-on devices with projections, e.g., Endocuff, Endocuff Vision, EndoRings, and Wingcap, placed on the distal tip of the colonoscope promise to improve the detection of...
BACKGROUND
Add-on devices with projections, e.g., Endocuff, Endocuff Vision, EndoRings, and Wingcap, placed on the distal tip of the colonoscope promise to improve the detection of precancerous lesions. We performed a meta-analysis to evaluate the performance of these devices exclusively among individuals undergoing colonoscopy for screening purpose.
METHODS
A computerized literature search was performed across MEDLINE and Cochrane Library databases for randomized controlled trials that compared standard colonoscopy (SC) to procedures using add-on devices. The primary outcome was adenoma detection rate (ADR), while secondary outcomes included polyp detection rate (PDR), advanced ADR (AADR), and sessile serrated lesion detection rate (SSLDR). The effect size on study outcomes was calculated using a random-effects model and presented as the risk ratio (RR) and 95% confidence interval (CI).
RESULTS
Seven studies enrolling a total of 5785 patients were included. The use of add-on-devices with projections was associated with a higher ADR compared to SC: 45.9% vs. 41.1%; RR 1.18, 95%CI 1.02-1.37; P=0.03; =79%. Although PDR was higher in screening colonoscopies assisted by add-on devices as compared to SC, the difference failed to reach significance: 55.1% vs. 50.8%; RR 1.10, 95%CI 0.96-1.26; P=0.17; =75%. No difference was found between procedures assisted by add-on devices with projections and SC colonoscopies in terms of AADR (18.5% vs. 17.6%; RR 1.00, 95%CI 0.79-1.27; P=0.98; =56%) or SSLDR (6.8% vs. 5.8%; RR 1.17, 95%CI 0.95-1.44; P=0.15; =0%).
CONCLUSION
Colonoscopy assisted by add-on devices with projections achieves a better ADR compared to SC among individuals undergoing screening for bowel cancer.
PubMed: 37664236
DOI: 10.20524/aog.2023.0820