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Gastrointestinal Endoscopy Jan 2021Colonoscopy is the preferred modality for colorectal cancer screening because it has both diagnostic and therapeutic capabilities. Current consensus states that... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Colonoscopy is the preferred modality for colorectal cancer screening because it has both diagnostic and therapeutic capabilities. Current consensus states that colonoscopy should be performed with initial rapid passage of the instrument to the cecum, followed by thorough evaluation for and removal of all polyps during a deliberate slow withdrawal. Reports have suggested that polyps that are seen but not removed during insertion are sometimes quite difficult to find during withdrawal.
METHODS
We performed a comprehensive literature search of several major databases (from inception to March 2020) to identify randomized controlled trials comparing inspection and polypectomy during the insertion phase as opposed to the traditional practice of inspection and polypectomy performed entirely during the withdrawal phase. We examined differences in terms of adenoma detection rate (ADR), polyps detected per patient (PDPP), cecal intubation time (CIT), withdrawal time, and total procedure time.
RESULTS
Seven randomized controlled trials, including 3834 patients, were included in our final analysis. The insertion/withdrawal cohort had 1951 patients and the withdrawal-only cohort 1883 patients. Pooled odds of adenoma detection in the insertion/withdrawal cohort was .99 (P = .8). ADR was 47.2% in the insertion/withdrawal cohort and 48.6% in the withdrawal-only cohort. Although total procedure and withdrawal times were shorter in the insertion/withdrawal cohort, PDPP in both cohorts were not statistically significant (1.4 vs 1.5, P = .7).
CONCLUSIONS
Additional inspection and polypectomy during the insertion and withdrawal phases of colonoscopy offer no additional benefit in terms of ADR or PDPP.
Topics: Adenoma; Cecum; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Humans; Randomized Controlled Trials as Topic
PubMed: 32540312
DOI: 10.1016/j.gie.2020.06.015 -
Head & Neck Sep 2023In this systematic review, we aimed to evaluate the clinicopathological profile of sclerosing polycystic adenoma (SPA). PubMed, Scopus, EMBASE, Lilacs, Web of Science,... (Review)
Review
In this systematic review, we aimed to evaluate the clinicopathological profile of sclerosing polycystic adenoma (SPA). PubMed, Scopus, EMBASE, Lilacs, Web of Science, and gray literature were searched to access cases of SPA in salivary glands. One hundred and thirty cases of SPA were found across 61 selected articles. SPA affected mainly the parotid gland of adults with a mean age of 44.6 years old, with a slight preference for females. The lesion was usually presented as a painless firm mass with a long period of evolution. Histologically, they are well-delimitated lesions composed of acinar and ductal elements with a variety of cytomorphologic features surrounded by a densely collagenized stroma. PI3K was the most common gene mutation related to SPA. SPA is a benign condition that mainly affects the parotid gland of female patients and it is usually treated by surgical resection with a good prognosis.
Topics: Adult; Humans; Female; Parotid Gland; Adenoma; Sclerosis
PubMed: 37403748
DOI: 10.1002/hed.27435 -
Clinical Gastroenterology and... Apr 2021The incidence and mortality of early-onset colorectal cancer (CRC) are increasing. Adenoma detection, removal, and subsequent endoscopic surveillance might modify risk... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND & AIMS
The incidence and mortality of early-onset colorectal cancer (CRC) are increasing. Adenoma detection, removal, and subsequent endoscopic surveillance might modify risk of CRC diagnosed before age 50 years (early-onset CRC). We conducted a systematic review of young-onset adenoma (YOA) prevalence, associated risk factors, and rate of metachronous advanced neoplasia after YOA diagnosis.
METHODS
We performed a systematic search of multiple electronic databases through February 12, 2019 and identified studies of individuals 18 to 49 years old that reported prevalence of adenoma, risk factors for adenoma, and/or risk for metachronous advanced neoplasia. Summary estimates were derived using random effects meta-analysis, when feasible.
RESULTS
The pooled overall prevalence of YOA was 9.0% (95% CI, 7.1%-11.4%), based on 24 studies comprising 23,142 individuals. On subgroup analysis, the pooled prevalence of YOA from autopsy studies was 3.9% (95% CI, 1.9%-7.6%), whereas the prevalence from colonoscopy studies was 10.7% (95% CI, 8.5%-13.5). Only advancing age was identified as a consistent risk factor for YOA, based on 4 studies comprising 78,880 individuals. Pooled rate of metachronous advanced neoplasia after baseline YOA diagnosis was 6.0% (95% CI, 4.1%-8.6%), based on 3 studies comprising 1493 individuals undergoing follow-up colonoscopy, with only 1 CRC case reported. Overall, few studies reported metachronous advanced neoplasia and no studies evaluated whether routine surveillance colonoscopy decreases risk of CRC.
CONCLUSIONS
In a systematic review, we estimated the prevalence of YOA to be 9% and to increase with age. Risk for metachronous advanced neoplasia after YOA diagnosis is estimated to be 6%. More research is needed to understand the prevalence, risk factors, and risk of CRC associated with YOA.
Topics: Adenoma; Adolescent; Adult; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Humans; Middle Aged; Prevalence; Risk Factors; Young Adult
PubMed: 32428708
DOI: 10.1016/j.cgh.2020.04.092 -
Annals of Oncology : Official Journal... Jun 2017Colorectal adenomas are known as precursors for the majority of colorectal carcinomas. While weight gain during adulthood has been identified as a risk factor for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Colorectal adenomas are known as precursors for the majority of colorectal carcinomas. While weight gain during adulthood has been identified as a risk factor for colorectal cancer, the association is less clear for colorectal adenomas. We conducted a systematic review and meta-analysis to quantify the evidence on this association.
METHODS
We searched Medline up to September 2016 to identify observational (prospective, cross-sectional and retrospective) studies on weight gain during adulthood and colorectal adenoma occurrence and recurrence. We conducted meta-analysis on high weight gain versus stable weight, linear and non-linear dose-response meta-analyses to analyze the association. Summary odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using a random effects model.
RESULTS
For colorectal adenoma occurrence, the summary OR was 1.39 (95% CI: 1.17-1.65; I2: 43%, N = 9 studies, cases = 5507) comparing high (midpoint: 17.4 kg) versus stable weight gain during adulthood and with each 5 kg weight gain the odds increased by 7% (2%-11%; I2: 65%, N = 7 studies). Although there was indication of non-linearity (Pnon-linearity < 0.001) there was an increased odds of colorectal adenoma throughout the whole range of weight gain. Three studies were identified investigating the association between weight gain and colorectal adenoma recurrence and data were limited to draw firm conclusions.
CONCLUSIONS
Even a small amount of adult weight gain was related to a higher odds of colorectal adenoma occurrence. Our findings add to the benefits of weight control in adulthood regarding colorectal adenoma occurrence, which might be relevant for early prevention of colorectal cancer.
Topics: Adenoma; Adult; Colorectal Neoplasms; Female; Humans; Male; Middle Aged; Weight Gain
PubMed: 28327995
DOI: 10.1093/annonc/mdx080 -
Computational Intelligence and... 2022The first-line treatment for patients with any type of pituitary adenoma is trans-sphenoidal surgery. Considering the prevalence of the condition globally, the treatment... (Meta-Analysis)
Meta-Analysis Review
Recurrence Rate and Exploration of Clinical Factors after Pituitary Adenoma Surgery: A Systematic Review and Meta-Analysis based on Computer Artificial Intelligence System.
BACKGROUND
The first-line treatment for patients with any type of pituitary adenoma is trans-sphenoidal surgery. Considering the prevalence of the condition globally, the treatment is quite common. The recurrence of pituitary adenoma is a recognized occurrence in the medical field; however, there is limited comprehensive research and analysis of the predictive factors of recurrence rates and the clinical factors impacting relapse rates. Identifying the recurrence rates of pituitary adenomas and the clinical factors associated with them could help increase the remission rate by increasing focus on the specific aspects for early diagnosis and improved treatment.
OBJECTIVE
The objective of the current systematic review and meta-analysis is to assess the recurrent rates based on previous studies and to explore the clinical factors after pituitary surgery.
METHODS
A search was performed on PubMed, APA PsycINFO, Scopus, CENTRAL, and Google Scholar databases for English articles published from 1 January 2010 to 1 August 2022. Systematic reviews, meta-analysis, evidence syntheses, editorials, commentaries, preclinical studies, abstracts, theses, and preprints were excluded. Meta XL statistical software was used to conduct a prevalence meta-analysis.
RESULTS
PubMed, PsycINFO, and Medline databases were searched. All of the articles were written between 2012 and 2022. In the beginning, 612 items were recognized. After removing duplicates and analyzing the remaining articles in terms of inclusion and exclusion criteria, 31 articles remained.
CONCLUSION
There is a relationship between recurrence rates and the follow-up period. There were conflicting results about the clinical factors after pituitary adenoma surgery, specifically age and tumor size. Some included studies that there was an association between macroadenomas and high recurrence rates. No study reported that gender was a clinical factor affecting pituitary adenoma surgery outcomes or the recurrence rate. Studies also reported that there was a correlation between the remnant tumor factor and the recurrence rates; adenoma remnants after surgery increased the risk of recurrence rates for patients.
Topics: Humans; Pituitary Neoplasms; Artificial Intelligence; Adenoma; Computers
PubMed: 36275975
DOI: 10.1155/2022/6002672 -
European Journal of Gastroenterology &... Dec 2017The WHO published a new classification of colonic polyps in 2010, including the group of serrated polyps, which can be divided into hyperplastic polyps (HP), traditional... (Meta-Analysis)
Meta-Analysis Review
The WHO published a new classification of colonic polyps in 2010, including the group of serrated polyps, which can be divided into hyperplastic polyps (HP), traditional serrated adenomas, and sessile serrated adenomas (SSA) or polyps. To assess the rate of re-diagnosis of HP to SSA and to look for possible predictors for changing the diagnosis. English Medical literature searches were performed for 'reassessment' OR 'reclassification' AND 'hyperplastic polyp' OR 'sessile serrated adenoma' till 31 January 2017. PRISMA guidelines for systematic reviews were followed. Studies that included a precise re-diagnosis of HP into SSA were included. We also looked for predictors of SSA diagnosis such as polyp location and size, patient sex and age, and synchronous advanced adenoma. Altogether, we found 220 eligible studies; 212 were excluded as they did not fulfill the inclusion criteria and we were left with eight studies including 2625 patients. The odds ratio for the number of polyps with changed pathological diagnosis from HP to SSA was 0.112 with 95% confidence interval (CI): 0.099-0.126 (P<0.0001) or 11.2%. Heterogeneity between studies was significant with Q=199.4, d.f. (Q)=9, P<0.0001, and I=95.486%. The odds ratio for changing the pathological diagnosis from HP to SSA for polyp proximal location and polyp size more than 5 mm were 4.401, 95% CI: 2.784-6.958, P<0.0001, and 8.336, 95% CI: 4.963-15.571, P<0.0001, respectively. Endoscopists and pathologists should be aware of the SSA diagnosis when finding HPs larger than 5 mm in the right colon. The diagnosis of HP in these cases should be reassessed by experienced gastrointestinal pathologists.
Topics: Adenoma; Colon; Colonic Neoplasms; Colonic Polyps; Humans; Hyperplasia
PubMed: 29049128
DOI: 10.1097/MEG.0000000000000994 -
Journal of Investigative Medicine : the... Aug 2023The therapeutic response heterogeneity in acromegaly persists, despite the medical-surgical advances of recent years. Thus, personalized medicine implementation, which... (Review)
Review
The therapeutic response heterogeneity in acromegaly persists, despite the medical-surgical advances of recent years. Thus, personalized medicine implementation, which focuses on each patient, is justified. Metabolomics would decipher the molecular mechanisms underlying the therapeutic response heterogeneity. Identification of altered metabolic pathways would open new horizons in the therapeutic management of acromegaly. This research aimed to evaluate the metabolomic profile in acromegaly and metabolomics' contributions to understanding disease pathogenesis. A systematic review was carried out by querying four electronic databases and evaluating patients with acromegaly through metabolomic techniques. In all, 21 studies containing 362 patients were eligible. Choline, the ubiquitous metabolite identified in growth hormone (GH)-secreting pituitary adenomas (Pas) by in vivo magnetic resonance spectroscopy (MRS), negatively correlated with somatostatin receptors type 2 expression and positively correlated with magnetic resonance imaging T2 signal and Ki-67 index. Moreover, elevated choline and choline/creatine ratio differentiated between sparsely and densely granulated GH-secreting PAs. MRS detected low hepatic lipid content in active acromegaly, which increased after disease control. The panel of metabolites of acromegaly deciphered by mass spectrometry (MS)-based techniques mainly included amino acids (especially branched-chain amino acids and taurine), glyceric acid, and lipids. The most altered pathways in acromegaly were the metabolism of glucose (particularly the downregulation of the pentose phosphate pathway), linoleic acid, sphingolipids, glycerophospholipids, arginine/proline, and taurine/hypotaurine. Matrix-assisted laser desorption/ionization coupled with MS imaging confirmed the functional nature of GH-secreting PAs and accurately discriminated PAs from healthy pituitary tissue.
Topics: Humans; Acromegaly; Growth Hormone-Secreting Pituitary Adenoma; Magnetic Resonance Imaging; Metabolomics; Adenoma
PubMed: 37139720
DOI: 10.1177/10815589231169452 -
International Journal of Surgery... Jul 2015Pleomorphic adenoma (PA) is the commonest benign neoplasm of salivary glands.(1) PA can undergo malignant transformation to ex-pleomorphic adenoma (2,3) but rarely, can... (Review)
Review
BACKGROUND
Pleomorphic adenoma (PA) is the commonest benign neoplasm of salivary glands.(1) PA can undergo malignant transformation to ex-pleomorphic adenoma (2,3) but rarely, can metastasise without malignant transformation.(4,5) Metastasising pleomorphic adenoma (MPA) is a rare malignant tumour which, histologically, is indistinguishable from PA yet produces secondary tumours in distant sites.(6,7,8) OBJECTIVE: Our aim is to review the literature for all reported cases of MPA and create a virtual series. The age and location of primary tumour with the location and time to metastasise will be reviewed. The prognosis and treatment options will be explored.
METHOD
We conducted a PUBMED search with a combination of keywords: metastasizing/metastasising AND pleomorphic adenoma OR mixed tumour. An author's own case has also been included.
RESULTS
Between 1942 and 2014 there were 80 case reports included in the review, plus the authors own case. Mean age at diagnosis of MPA was 49.5 years (range 11-83). Male-to-female ratio was 34:46. The mean time between PA and MPA was 14.9 years (range 0-51), with three cases reporting simultaneous presentation. 72.8% (n = 59) of cases reported PA local recurrence prior to MPA. The three most common sites for MPA were: bone 36.6% (n = 28), lung 33.8% (n = 26) and neck lymph nodes 20.1% (n = 17). Survival was poorly reported, but 41 (80.4%) were alive at 1-year.
CONCLUSION
Benign MPA is rare. Metastasis occurs years after the initial PA and is associated with multiple local recurrences. Histologically, MPA retain their benign nature yet demonstrate malignant behaviour.
Topics: Adenoma, Pleomorphic; Humans; Neoplasm Metastasis; Prognosis; Salivary Gland Neoplasms
PubMed: 25958295
DOI: 10.1016/j.ijsu.2015.04.084 -
Frontiers in Endocrinology 2022Pasireotide (PAS) is a novel somatostatin receptor ligands (SRL), used in controlling hormonal hypersecretion in both acromegaly and Cushing's Disease (CD). In previous... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Pasireotide (PAS) is a novel somatostatin receptor ligands (SRL), used in controlling hormonal hypersecretion in both acromegaly and Cushing's Disease (CD). In previous studies and meta-analysis, first-generation SRLs were reported to be able to induce significant tumor shrinkage only in somatotroph adenomas. This systematic review and meta-analysis aim to summarize the effect of PAS on the shrinkage of the pituitary adenomas in patients with acromegaly or CD.
MATERIALS AND METHODS
We searched the Medline database for original studies in patients with acromegaly or CD receiving PAS as monotherapy, that assessed the proportion of significant tumor shrinkage in their series. After data extraction and analysis, a random-effect model was used to estimate pooled effects. Quality assessment was performed with a modified Joanna Briggs's Institute tool and the risk of publication bias was addressed through Egger's regression and the three-parameter selection model.
RESULTS
The electronic search identified 179 and 122 articles respectively for acromegaly and CD. After study selection, six studies considering patients with acromegaly and three with CD fulfilled the eligibility criteria. Overall, 37.7% (95%CI: [18.7%; 61.5%]) of acromegalic patients and 41.2% (95%CI: [22.9%; 62.3%]) of CD patients achieved significant tumor shrinkage. We identified high heterogeneity, especially in acromegaly (I of 90% for acromegaly and 47% for CD), according to the low number of studies included.
DISCUSSION
PAS treatment is effective in reducing tumor size, especially in acromegalic patients. This result strengthens the role of PAS treatment in pituitary adenomas, particularly in those with an invasive behavior, with progressive growth and/or extrasellar extension, with a low likelihood of surgical gross-total removal, or with large postoperative residual tissue.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022328152, identifier CRD42022328152.
Topics: ACTH-Secreting Pituitary Adenoma; Acromegaly; Adenoma; Humans; Pituitary ACTH Hypersecretion; Pituitary Neoplasms; Somatostatin
PubMed: 35846311
DOI: 10.3389/fendo.2022.935759 -
World Neurosurgery Apr 2020In pituitary tumors, the presence of residual tumor after transsphenoidal surgery and recurrence of the tumor after resection are frequent, and the best treatment is not... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In pituitary tumors, the presence of residual tumor after transsphenoidal surgery and recurrence of the tumor after resection are frequent, and the best treatment is not well established. The effects and complications of stereotactic radiosurgery have not been extensively studied.
OBJECTIVE
We aimed to reveal the effect of stereotactic radiosurgery on residual and recurrent adenomas.
METHODS
A systematic review of the literature in the MEDLINE/PubMed, Cochrane Central Database, and Google Scholar was conducted using the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search was structured according to the PICOT (i.e., Participants, types of Interventions, Comparator between the treatments, types of Outcome measures, and Follow-up [Time of duration]) strategy. The methodologic quality assessment (risk of bias) was performed according to the Methodological Index for Non-Randomized Studies scale. The studies were grouped and analyzed after data extraction using the software "R".
RESULTS
Twenty-six articles including 2315 patients were analyzed, with an average follow-up duration of 57.8 months and mean radiation marginal dose of 19.6 Gy. The overall tumor control rate was 95%, tumor reduction rate was 46%, and hormonal control rate was 67%. The side effects were evaluated.
CONCLUSIONS
Stereotactic radiosurgery was efficient in residual or recurrence tumor control, with few side effects, and is recommended for treating residual or recurrent tumors, both secreting and nonsecreting tumors. A limitation of this study is that there were no randomized trials included in the synthesis.
Topics: Adenoma; Humans; Neoplasm Recurrence, Local; Neoplasm, Residual; Pituitary Neoplasms; Radiosurgery; Treatment Outcome
PubMed: 31899390
DOI: 10.1016/j.wneu.2019.11.041