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Frontiers in Oncology 2024Scattered, small, dot-like intraepithelial papillary capillary loops (IPCLs) represent type IV epithelial vascularization according to "Ni classification" and are...
BACKGROUND
Scattered, small, dot-like intraepithelial papillary capillary loops (IPCLs) represent type IV epithelial vascularization according to "Ni classification" and are considered to be nonmalignant. According to the European Laryngological Society classification, these loops are malignant vascular changes. This contradiction has high clinical importance; therefore, clarification of the clinical significance of type IV vascularization according to the Ni classification is needed.
METHODS
The study was performed between June 2015 and December 2022. All recruited patients (n = 434) were symptomatic, with macroscopic laryngeal lesions (n = 674). Patients were investigated using the enhanced endoscopic methods of narrow band imaging (NBI) and the Storz Professional Image Enhancement System (IMAGE1 S). The microvascular patterns in the lesions were categorized according to Ni classification from 2011 and all lesions were examined histologically.
RESULTS
A total of 674 lesions (434 patients) were investigated using flexible NBI endoscopy and IMAGE1 S endoscopy. Type IV vascularization was recognized in 293/674 (43.5%) lesions. Among these 293 lesions, 178 (60.7%) were benign (chronic laryngitis, hyperplasia, hyperkeratosis, polyps, cysts, granulomas, Reinkeho oedema and recurrent respiratory papillomatosis); 9 (3.1%) were squamous cell carcinoma; 61 (20.8%) were mildly dysplastic, 29 (9.9%) were moderately dysplastic, 14 (4.8%) were severe dysplastic and 2 (0.7%) were carcinoma in situ. The ability to recognize histologically benign lesions in group of nonmalignant vascular pattern according to Ni (vascularization type I-IV) and distinguish them from precancers and malignancies was with accuracy 75.5%, sensitivity 54.4%, specificity 94.4%, positive predictive value 89.6% and negative predictive value 69.9%.
CONCLUSION
Laryngeal lesions with type IV vascularization as defined by Ni present various histological findings, including precancerous and malignant lesions. Patients with type IV vascularization must be followed carefully and, in case of progression mucosal lesion microlaryngoscopy and excision are indicated.
PubMed: 38333687
DOI: 10.3389/fonc.2024.1222827 -
Research Square Jan 2024Screening colonoscopy detects precancerous polyps, which when resected, prevents colon cancer. Recommendations for surveillance colonoscopy after polypectomy are based...
BACKGROUND
Screening colonoscopy detects precancerous polyps, which when resected, prevents colon cancer. Recommendations for surveillance colonoscopy after polypectomy are based on the U.S. Multi-Society Task Force guidelines (USMSTF).
AIM
to examine provider recommendations based on 2012 and 2020 USMSTF guidelines.
METHODS
A prospective analysis was performed to examine provider recommendations for index screening and surveillance colonoscopy from March 2022 to January 2023. Procedures with unknown histology or unsatisfactory bowel preparation were excluded. We recorded polyp morphology, histology, and subsequent recommendations made by endoscopists, to compare to the USMSTF guidelines.
RESULTS
241 patients were included, with 371 endoscopies reviewed. For index screening colonoscopies, 86%, performed between 2012 and 2020, adhered to 2012 guidelines, while 71%, performed after 2020, adhered to the 2020 guidelines. For surveillance colonoscopies, 62% from 2012 and 2020, and 50% after 2020, adhered to the 2012 and 2020 guidelines, respectively (P < 0.001). For polyp types, recommendations after index colonoscopies showed low-risk adenoma (LRA) had 88% adherence to 2012 guidelines versus 73% adherence to 2020 guidelines. For surveillance colonoscopies, LRA had 73% adherence to 2012 guidelines versus 42% adherence to 2020 guidelines (P < 0.001). Recommendations after index colonoscopy showed high-risk adenoma (HRA) had 79% adherence to 2012 guidelines versus 63% adherence to 2020 guidelines. For surveillance colonoscopies, HRA had 88% adherence to the 2012 guidelines versus 69% adherence to 2020 guidelines (P < 0.001).
CONCLUSIONS
Adherence declined for the introduction of 2020 guidelines and was poorer after 2nd surveillance exams. Increasing the evidence for interval recommendations may increase guideline adherence.
PubMed: 38313272
DOI: 10.21203/rs.3.rs-3870490/v1 -
International Journal of Oncology Mar 2024Gastric cancer ranks as one of the most prevalent cancers worldwide. While the incidence of gastric cancer in Western countries has notably diminished over the past...
Gastric cancer ranks as one of the most prevalent cancers worldwide. While the incidence of gastric cancer in Western countries has notably diminished over the past century, it continues to be a leading cause of cancer‑related mortality on a global scale. The majority of gastric cancers in humans are attributed to chronic infection and the progression of gastric cancer is often preceded by gastritis, atrophy, metaplasia and dysplasia. However, the precise mechanisms underlying the development of gastric cancer remain ambiguous, including the formation of gastric polyps and precancerous lesions. In humans, two types of precancerous metaplasia have been identified in relation to gastric malignancies: Intestinal metaplasia and spasmolytic polypeptide‑expressing metaplasia (SPEM). The role of SPEM in the induction of gastric cancer has gained recent attention and its link with early‑stage human gastric cancer is increasingly evident. To gain insight into SPEM, the present study reviewed the role and research progress of SPEM in gastric cancer.
Topics: Humans; Stomach Neoplasms; Gastric Mucosa; Peptides; Helicobacter Infections; Helicobacter pylori; Precancerous Conditions; Metaplasia; Intercellular Signaling Peptides and Proteins
PubMed: 38299264
DOI: 10.3892/ijo.2024.5621 -
United European Gastroenterology Journal May 2024The primary benefit of post-colorectal cancer (CRC) colonoscopic surveillance is to detect and remove premalignant lesions to prevent metachronous CRC. Current...
BACKGROUND
The primary benefit of post-colorectal cancer (CRC) colonoscopic surveillance is to detect and remove premalignant lesions to prevent metachronous CRC. Current guidelines for long-term colonoscopic surveillance post early age onset CRC (EOCRC) resection are based on limited evidence. The aims of this study were to assess the diagnostic yield of colonoscopic surveillance post-EOCRC resection and identify molecular and clinicopathological risk factors associated with advanced neoplasia.
METHODOLOGY
A retrospective cohort study of prospectively collected data was conducted at St Mark's hospital, London, United Kingdom, for patients diagnosed with EOCRC who underwent at least one episode of post-CRC colonoscopic surveillance between 1978 and 2022. We collected clinicopathological data including tumour molecular status and neoplasia detection rates.
RESULTS
In total, 908 colonoscopic surveillance procedures were performed in 195 patients over 2581.3 person-years of follow-up. The diagnostic yields of metachronous CRC, advanced adenomas and non-advanced adenomas were 1.76%, 3.41% and 22.69% respectively. Sixteen patients (8.21%) developed metachronous CRC, and the majority (87.5%) were detected more than 3 years post index EOCRC diagnosis. Detection of advanced neoplasia was significantly higher in EOCRC patients with Lynch syndrome (26.15%) compared with those in whom Lynch syndrome was excluded (13.13%) (OR, 2.343; 95% CI, 1.014-5.256; p = 0.0349).
CONCLUSIONS
During colonoscopic surveillance post-EOCRC resection, the long-term risk of developing metachronous advanced neoplasia remains high in the context of Lynch syndrome, but this trend is not as clearly evident when Lynch syndrome has been excluded.
Topics: Humans; Colonoscopy; Male; Female; Retrospective Studies; Colorectal Neoplasms; Middle Aged; Adenoma; Risk Factors; Age of Onset; Neoplasms, Second Primary; Adult; Early Detection of Cancer; Aged; Precancerous Conditions
PubMed: 38170450
DOI: 10.1002/ueg2.12516 -
European Journal of Surgical Oncology :... Feb 2024Gallbladder adenoma represents a precancerous lesion of gallbladder cancer. However, distinguishing it from cholesteryl polyps of the gallbladder before surgery is...
BACKGROUND
Gallbladder adenoma represents a precancerous lesion of gallbladder cancer. However, distinguishing it from cholesteryl polyps of the gallbladder before surgery is challenging. Thus, we aimed to comprehensively explore various risk factors contributing to the formation of gallbladder adenoma to facilitate an informed diagnosis and treatment by clinicians.
METHODS
We conducted a retrospective analysis of patients who had undergone cholecystectomy at the Affiliated Hospital of Qingdao University between January 2015 and December 2022. Following postoperative pathological examination, patients were categorized into cholesterol polyp and adenoma groups. We analyzed their baseline characteristics, ultrasound imaging variables, and biochemical data using logistic, lasso, and stepwise regression. Subsequently, we constructed a preoperative prediction model based on the independent risk factors.
RESULTS
Regression analysis of 520 gallbladder polyps and 288 gallbladder adenomas in the model group revealed that age, gallbladder wall thickness, polyp size, echogenicity, pedunculation, and adenosine deaminase (ADA) levels were independent predictors of gallbladder adenoma, all with P < 0.05. Using these indicators, we established a regression equation: Logistic (P) = -5.615 + 0.018 ∗ age - 4.64 ∗ gallbladder wall thickness + 1.811 ∗ polyp size + 2.855 ∗ polyp echo + 0.97∗ pedunculation + 0.092 ∗ ADA. The resulting area under the curve (AUC) value was 0.894 (95 % CI: 0.872-0.917, P < 0.01), with a sensitivity of 89.20 %, specificity of 79.40 %, and overall accuracy of 84.41 % for adenoma detection.
CONCLUSION
Age, polyp size, gallbladder wall thickness, polyp echogenicity, pedunculation, and ADA levels emerge as independent risk factors for gallbladder adenoma.
Topics: Humans; Child, Preschool; Retrospective Studies; Gallbladder Neoplasms; Gallbladder Diseases; Ultrasonography; Adenoma; Polyps
PubMed: 38159390
DOI: 10.1016/j.ejso.2023.107930 -
ACG Case Reports Journal Dec 2023The role of endoscopy in the management of traditionally surgical conditions continues to evolve. Endoscopic techniques, including endoscopic mucosal resection and more...
The role of endoscopy in the management of traditionally surgical conditions continues to evolve. Endoscopic techniques, including endoscopic mucosal resection and more recently endoscopic submucosal dissection, which remove cancerous and precancerous lesions in the gastrointestinal tract, continue to grow in use. In addition, therapeutic endoscopic ultrasound has evolved to include the management of patients with acute cholecystitis. Here, we present an 83-year-old man with acute calculus cholecystitis, who was considered ineligible for cholecystectomy and had a giant duodenal polyp that obstructed the visualization of the duodenal lumen, preventing the successful placement of lumen-apposing metal stents. Volume reduction of a duodenal polyp was performed through epinephrine injection to assist in the successful endoscopic ultrasound-guided gallbladder drainage. Subsequently, the patient underwent elective endoscopic mucosal resection to remove the giant duodenal polyp.
PubMed: 38130478
DOI: 10.14309/crj.0000000000001243 -
Clinical and Translational... Feb 2024The identification of risk factors for precursor lesions of colorectal cancer (CRC) holds great promise in the context of prevention. With this study, we aimed to...
INTRODUCTION
The identification of risk factors for precursor lesions of colorectal cancer (CRC) holds great promise in the context of prevention. With this study, we aimed to identify patient characteristics associated with colorectal polyps (CPs) and polyp features of potential malignant progression. Furthermore, a potential association with gut microbiota in this context was investigated.
METHODS
In this single-center study, a total of 162 patients with CPs and 91 control patients were included. Multiple variables including information on lifestyle, diet, serum parameters, and gut microbiota, analyzed by 16S-rRNA gene amplicon sequencing and functional imputations (Picrust2), were related to different aspects of CPs.
RESULTS
We observed that elevated serum alkaline phosphatase (AP) levels were significantly associated with the presence of high-grade dysplastic polyps. This association was further seen for patients with CRC. Thereby, AP correlated with other parameters of liver function. We did not observe significant changes in the gut microbiota between patients with CP and their respective controls. However, a trend toward a lower alpha-diversity was seen in patients with CRC. Interestingly, AP was identified as a possible clinical effect modifier of stool sample beta diversity.
DISCUSSION
We show for the first time an increased AP in premalignant CP. Furthermore, AP showed a significant influence on the microbial composition of the intestine. Relatively elevated liver enzymes, especially AP, may contribute to the detection of precancerous dysplastic or neoplastic changes in colorectal lesions. The association between elevated AP, premalignant CP, and the microbiome merits further study.
Topics: Humans; Colorectal Neoplasms; Colonic Polyps; Bacteria; Feces; Gastrointestinal Microbiome; Hyperplasia
PubMed: 38088370
DOI: 10.14309/ctg.0000000000000660 -
BMJ Open Nov 2023Colorectal adenoma (CRA) is a precancerous lesion for colorectal cancer. Endoscopic resection is the first-line treatment for CRA. However, CRA recurrence rate is high....
INTRODUCTION
Colorectal adenoma (CRA) is a precancerous lesion for colorectal cancer. Endoscopic resection is the first-line treatment for CRA. However, CRA recurrence rate is high. This proposed study aims to determine if Chinese herbal medicine (CHM) reduces CRA recurrence.
METHODS AND ANALYSIS
This project encompasses an observational, registry-based, cohort study and a nested qualitative study. The cohort study aims to include 364 postpolypectomy CRA participants at Guangdong Provincial Hospital of Chinese Medicine (GPHCM), China, with a follow-up phase of up to 1 year. In addition to routine care, these participants will receive a CHM treatment prescribed by experienced Chinese medicine (CM) clinicians. The CHM treatment encompasses CHM products and CHM formulae according to CM syndromes. The primary outcome is CRA recurrence rate at 1 year after enrolment. Secondary outcomes include characteristics of recurrent CRA, incidence of colorectal polyp (except for CRA), incidence of advanced CRA, incidence of colorectal cancer, improvement of gastrointestinal symptoms commonly seen in CRA patients, faecal occult blood test result, lipid level, fasting plasma glucose level, uric acid level, carcinoembryonic antigen, carbohydrate antigen 19-9, quality of life and safety evaluations. Logistic regression analysis will be used to explore the correlation between exposure and outcome. Qualitative interviews will be conducted among approximate 30 CRA patients from the cohort study and 10 CM practitioners in Department of Gastroenterology at GPHCM. Thematic analysis will be used to analyse qualitative data.
ETHICS AND DISSEMINATION
Ethical approval has been obtained from the Human Research Ethics Committee (HREC) of GPHCM (YF2022-320-02) and registered at Royal Melbourne Institute of Technology (RMIT) HREC. The results will be disseminated in peer-reviewed journals and international academic conferences.
TRIAL REGISTRATION NUMBER
ChiCTR2200065713.
Topics: Humans; Cohort Studies; Drugs, Chinese Herbal; Quality of Life; Colorectal Neoplasms; Registries; Adenoma; Adaptor Proteins, Signal Transducing; Observational Studies as Topic
PubMed: 37984951
DOI: 10.1136/bmjopen-2023-073969 -
Journal of Cancer Research and Clinical... Dec 2023Ultrasound imaging is the preferred method for the early diagnosis of endometrial diseases because of its non-invasive nature, low cost, and real-time imaging features....
PURPOSE
Ultrasound imaging is the preferred method for the early diagnosis of endometrial diseases because of its non-invasive nature, low cost, and real-time imaging features. However, the accurate evaluation of ultrasound images relies heavily on the experience of radiologist. Therefore, a stable and objective computer-aided diagnostic model is crucial to assist radiologists in diagnosing endometrial lesions.
METHODS
Transvaginal ultrasound images were collected from multiple hospitals in Quzhou city, Zhejiang province. The dataset comprised 1875 images from 734 patients, including cases of endometrial polyps, hyperplasia, and cancer. Here, we proposed a based self-supervised endometrial disease classification model (BSEM) that learns a joint unified task (raw and self-supervised tasks) and applies self-distillation techniques and ensemble strategies to aid doctors in diagnosing endometrial diseases.
RESULTS
The performance of BSEM was evaluated using fivefold cross-validation. The experimental results indicated that the BSEM model achieved satisfactory performance across indicators, with scores of 75.1%, 87.3%, 76.5%, 73.4%, and 74.1% for accuracy, area under the curve, precision, recall, and F1 score, respectively. Furthermore, compared to the baseline models ResNet, DenseNet, VGGNet, ConvNeXt, VIT, and CMT, the BSEM model enhanced accuracy, area under the curve, precision, recall, and F1 score in 3.3-7.9%, 3.2-7.3%, 3.9-8.5%, 3.1-8.5%, and 3.3-9.0%, respectively.
CONCLUSION
The BSEM model is an auxiliary diagnostic tool for the early detection of endometrial diseases revealed by ultrasound and helps radiologists to be accurate and efficient while screening for precancerous endometrial lesions.
Topics: Humans; Female; Uterine Diseases; Computer Simulation; Hospitals; Hyperplasia; Physicians; Precancerous Conditions
PubMed: 37947870
DOI: 10.1007/s00432-023-05467-7