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Archives of Pathology & Laboratory... Dec 2019With widespread screening for colorectal cancer, the number of early-stage colorectal cancers is increasing. Local excision of pT1 tumors is associated with considerably... (Review)
Review
CONTEXT.—
With widespread screening for colorectal cancer, the number of early-stage colorectal cancers is increasing. Local excision of pT1 tumors is associated with considerably less morbidity and mortality, but this must be weighed against risk of lymph node metastases.
OBJECTIVE.—
To understand histologic prognostic factors associated with adverse outcome in malignant polyps.
DATA SOURCES.—
Pertinent literature regarding histologic features of prognostic significance in malignant polyps and low-stage colorectal carcinomas is summarized and our institute's cases are used to highlight these histologic features.
CONCLUSIONS.—
Poor prognostic factors for malignant polyps include high tumor grade, presence of lymphovascular invasion, tumor less than 1 mm from resection margin, submucosal invasion deeper than 1 mm, and high tumor budding. These features should be assessed by the pathologist and communicated to the clinical team in order to allow proper management.
Topics: Adenocarcinoma; Adenomatous Polyps; Colorectal Neoplasms; Humans
PubMed: 31509454
DOI: 10.5858/arpa.2019-0291-RA -
BMC Gastroenterology Feb 2022Gastric polyps (GPs) are usually asymptomatic lesions of the upper gastrointestinal tract observed in 1-3% of esophagogastroduodenoscopies (EGD). Most GPs are benign....
BACKGROUND/AIMS
Gastric polyps (GPs) are usually asymptomatic lesions of the upper gastrointestinal tract observed in 1-3% of esophagogastroduodenoscopies (EGD). Most GPs are benign. The aim of this study was to precise the frequency of different types of gastric polyps in our population, and to analyze their possible association with other factors.
MATERIALS AND METHODS
A total of 18,496 consecutive patients undergoing EGD over a 10-year period (between 2007 and 2018) in a tertiary hospital were retrospectively reviewed. Eighty-six patients diagnosed with gastric polyps were analysed. Demographics, medical history of the patients, and indication for gastroscopy were collected. Morphological, histological characteristics of polyps, and therapeutic management data were also collected.
RESULTS
GPs were found in 86 out of 18,496 (0.46%) reviewed EGD, corresponding to a total of 141 polyps. There were 64 female (74.4%) and 22 male patients (25.6%) with a sex ratio (M/F) of 0.34. The average age was 58.1 years. One hundred and forty one polyps were included, and histopathology was obtained on 127 GPs. The most common location was the fundus (59.6%) and 48.9% were smaller than 5 mm. The polyp was unique in 75.6% of cases. According to Paris classification, 80% of the polyps were sessile (Is). Hyperplastic polyps were the most common (55.9%), followed by sporadic fundic gland polyps observed in 23 patients (18.1%), 7 (5.5%) were adenomas and 4 (3.1%) were neuroendocrine tumors type 1. The following factors were associated with hyperplastic polyps: anemia (p = 0.022), single polyp (p = 0.025) and size ≥ 5 mm (p = 0.048). Comparing hyperplastic polyps' biopsies to resected polyps, no difference was found in the evolutionary profile of the 2 groups. A size less than 10 mm (p = 0.013) was associated with fundic gland polyps. Sixty polyps (47.2%) were treated by cold forceps, 19 (15%) treated by a mucosal resection and 15 (11.8%) with diathermic snare. Five procedural bleeding incidents were observed (3.9%). Only the use of anticoagulant treatment was associated with a high bleeding risk (p = 0.005). The comparative histological study between specimens of biopsied GPs and endoscopic polypectomy led to an overall agreement of 95.3%.
CONCLUSION
In our study, the GPs frequency was 0.36%. Hyperplastic polyps and fundic gland are the most common in our country. The high frequency of Helicobacter pylori infection in our patients and in our area may explain the high frequency of HP.
Topics: Adenomatous Polyps; Female; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Polyps; Retrospective Studies; Stomach Neoplasms
PubMed: 35183117
DOI: 10.1186/s12876-022-02154-8 -
PloS One 2019Computer-aided polyp detection in gastric gastroscopy has been the subject of research over the past few decades. However, despite significant advances, automatic polyp... (Clinical Trial)
Clinical Trial
Computer-aided polyp detection in gastric gastroscopy has been the subject of research over the past few decades. However, despite significant advances, automatic polyp detection in real time is still an unsolved problem. In this paper, we report on a convolutional neural network (CNN) for polyp detection that is constructed based on Single Shot MultiBox Detector (SSD) architecture and which we call SSD for Gastric Polyps (SSD-GPNet). To take full advantages of feature maps' information from the feature pyramid and to acquire higher accuracy, we re-use information that is abandoned by Max-Pooling layers. In other words, we reuse the lost data from the pooling layers and concatenate that data as extra feature maps to contribute to classification and detection. Meanwhile, in the feature pyramid, we concatenate feature maps of the lower layers and feature maps that are deconvolved from upper layers to make explicit relationships between layers and to effectively increase the number of channels. The results show that our enhanced SSD for gastric polyp detection can realize real-time polyp detection with 50 frames per second (FPS) and can improve the mean average precision (mAP) from 88.5% to 90.4%, with only a little loss in time-performance. And the further experiment shows that SSD-GPNet has excellent performance in improving polyp detection recalls over 10% (p = 0.00053), especially in small polyp detection. This can help endoscopic physicians more easily find missed polyps and decrease the gastric polyp miss rate. It may be applicable in daily clinical practice to reduce the burden on physicians.
Topics: Adenomatous Polyps; Female; Gastroscopy; Humans; Image Processing, Computer-Assisted; Male; Neural Networks, Computer; Stomach Neoplasms
PubMed: 30908513
DOI: 10.1371/journal.pone.0214133 -
World Journal of Gastroenterology Sep 2017To determine the inter-observer variability for colon polyp morphology and to identify whether education can improve agreement among observers.
AIM
To determine the inter-observer variability for colon polyp morphology and to identify whether education can improve agreement among observers.
METHODS
For purposes of the tests, we recorded colonoscopy video clips that included scenes visualizing the polyps. A total of 15 endoscopists and 15 nurses participated in the study. Participants watched 60 video clips of the polyp morphology scenes and then estimated polyp morphology (pre-test). After education for 20 min, participants performed a second test in which the order of 60 video clips was changed (post-test). To determine if the effectiveness of education was sustained, four months later, a third, follow-up test was performed with the same participants.
RESULTS
The overall Fleiss' kappa value of the inter-observer agreement was 0.510 in the pre-test, 0.618 in the post-test, and 0.580 in the follow-up test. The overall diagnostic accuracy of the estimation for polyp morphology in the pre-, post-, and follow-up tests was 0.662, 0.797, and 0.761, respectively. After education, the inter-observer agreement and diagnostic accuracy of all participants improved. However, after four months, the inter-observer agreement and diagnostic accuracy of expert groups were markedly decreased, and those of beginner and nurse groups remained similar to pre-test levels.
CONCLUSION
The education program used in this study can improve inter-observer agreement and diagnostic accuracy in assessing the morphology of colon polyps; it is especially effective when first learning endoscopy.
Topics: Adenomatous Polyps; Clinical Competence; Colon; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Education, Medical, Continuing; Humans; Observer Variation; Quality Improvement; Republic of Korea; Time Factors; Video Recording
PubMed: 28974894
DOI: 10.3748/wjg.v23.i34.6281 -
Obesity (Silver Spring, Md.) Jun 2008Obesity and insulin resistance are associated with the risk of colon cancer. Adenomatous colonic polyps are precancerous lesions of colon cancer. We investigated whether...
Obesity and insulin resistance are associated with the risk of colon cancer. Adenomatous colonic polyps are precancerous lesions of colon cancer. We investigated whether BMI and the metabolic syndrome are associated with the presence of adenomatous colonic polyps in Korean men. Anthropometric measurements, metabolic risk factors, and colonoscopic pathologic findings were assessed in 1,898 men who underwent routine colonoscopy at the Health Promotion Center of Asan Medical Center in 2005. The modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and International Diabetes Federation (IDF) criteria were used for the definition of the metabolic syndrome. Multiple logistic regression analysis was used to evaluate the association between BMI and the metabolic syndrome and adenomatous polyps. Compared with men in the 1st quintile of the BMI, the adjusted odds ratio (OR) and 95% confidence interval (CI) for adenomatous polyps in men in the 2nd, 3rd, 4th, and 5th quintiles of the BMI were 1.55 (1.10-2.19), 1.57 (1.10-2.24), 1.94 (1.34-2.81), and 1.99 (1.31-3.01), respectively (P for trend <0.0001). Men with triglycerides (TGs) > or = 150 mg/dl were significantly more likely to have adenomatous polyps than were men with TG <150 mg/dl (OR 1.29; 95% CI 1.03-1.62). As a function of the number of metabolic risk factors, the ORs for adenomatous polyps were 1.41 (1.03-1.93), 1.52 (1.08-2.12), 1.46 (1.01-2.12), and 1.77 (1.08-2.90) for 1, 2, 3, and > or = 4 risk factors, respectively (P for trend <0.05). Adenomatous colonic polyps were significantly associated with increased BMI levels. Subjects with even one component of the metabolic syndrome had a significantly higher risk for developing adenomatous polyps compared to those subjects without any component in Korean men.
Topics: Adenomatous Polyps; Body Mass Index; Colonic Polyps; Health Surveys; Humans; Incidence; Korea; Logistic Models; Male; Metabolic Syndrome; Middle Aged; Risk Factors; Triglycerides
PubMed: 18388894
DOI: 10.1038/oby.2008.216 -
Head and Neck Pathology Sep 2008Respiratory epithelial adenomatoid hamartoma (REAH) is an uncommon lesion of the upper aerodigestive tract first described by Wenig and Heffner in 1995 as prominent... (Review)
Review
Respiratory epithelial adenomatoid hamartoma (REAH) is an uncommon lesion of the upper aerodigestive tract first described by Wenig and Heffner in 1995 as prominent glandular proliferations lined by ciliated respiratory epithelium originating from the surface epithelium. The entity is seen most often in male adults. Clinically the lesion presents as a polypoid mass, often in one or both nasal cavities, though other locations have been described. While REAH is benign, awareness and recognition of the lesion is important because it can be easily confused grossly and microscopically with more threatening tumors such as inverted papilloma and sinonasal carcinoma. The literature of REAH is reviewed with detail paid to the histologic diagnosis. The clinical presentation, radiologic findings, and differential diagnosis are also described.
Topics: Adenomatous Polyps; Biomarkers; Epithelial Cells; Female; Hamartoma; Humans; Loss of Heterozygosity; Male; Respiratory Mucosa; Respiratory Tract Diseases
PubMed: 20614315
DOI: 10.1007/s12105-008-0064-3 -
Asian Pacific Journal of Cancer... 2015The C1561T variant of the glutamate carboxypeptidase II (GCPII) gene is critical for natural methylfolylpolyglutamte (methylfolate) absorption, and has been associated...
BACKGROUND
The C1561T variant of the glutamate carboxypeptidase II (GCPII) gene is critical for natural methylfolylpolyglutamte (methylfolate) absorption, and has been associated with perturbations in folate metabolism and disease susceptibility. However, little is known on C1561T-GCPII as a risk factor for colorectal cancer. Therefore, this study examined whether C1561T-GCPII influences folate metabolism and adenomatous polyp occurrence.
MATERIALS AND METHODS
164 controls and 38 adenomatous polyp cases were analysed to determine blood folate and plasma homocysteine (Hcy) level, dietary intake of natural methylfolate, synthetic pteroylglutamic acid (PteGlu), vitamin C and C1561T-GCPII genotype.
RESULTS
In controls and cases, 7.3 and 18.4 percent of subjects respectively, were found to have the CT genotype, increasing the risk for adenomatous polyp occurrence 2.86 times (95% CI:1.37-8.0, p=0.035). Total dietary folate, methylfolate and PteGlu intake and the level of erythrocyte folate and plasma Hcy did not predict the occurrence of an adenomatous polyp. However, dietary natural vitamin C intake was associated with adenomatous polyp risk within C1561T-GCPII CT genotype subjects (p=0.037).
CONCLUSIONS
The findings suggest that C1561T-GCPII variation may be associated with risk for adenomatous polyp, and vitamin C may modify risk by interacting with the variant gene, its expression product and/or folate substrates.
Topics: Adenomatous Polyps; Adult; Aged; Aged, 80 and over; Ascorbic Acid; Case-Control Studies; Colorectal Neoplasms; Diet; Folic Acid; Genotype; Glutamate Carboxypeptidase II; Homocysteine; Humans; Middle Aged; Polymorphism, Single Nucleotide; Pteroylpolyglutamic Acids; Risk Factors; Tetrahydrofolates; Vitamins
PubMed: 26028103
DOI: 10.7314/apjcp.2015.16.10.4383 -
Gastrointestinal Endoscopy Dec 2021Colorectal cancer is a leading cause of death. Colonoscopy is the criterion standard for detection and removal of precancerous lesions and has been shown to reduce...
BACKGROUND AND AIMS
Colorectal cancer is a leading cause of death. Colonoscopy is the criterion standard for detection and removal of precancerous lesions and has been shown to reduce mortality. The polyp miss rate during colonoscopies is 22% to 28%. DEEP DEtection of Elusive Polyps (DEEP) is a new polyp detection system based on deep learning that alerts the operator in real time to the presence and location of polyps. The primary outcome was the performance of DEEP on the detection of elusive polyps.
METHODS
The DEEP system was trained on 3611 hours of colonoscopy videos derived from 2 sources and was validated on a set comprising 1393 hours from a third unrelated source. Ground truth labeling was provided by offline gastroenterologist annotators who were able to watch the video in slow motion and pause and rewind as required. To assess applicability, stability, and user experience and to obtain some preliminary data on performance in a real-life scenario, a preliminary prospective clinical validation study was performed comprising 100 procedures.
RESULTS
DEEP achieved a sensitivity of 97.1% at 4.6 false alarms per video for all polyps and of 88.5% and 84.9% for polyps in the field of view for less than 5 and 2 seconds, respectively. DEEP was able to detect polyps not seen by live real-time endoscopists or offline annotators in an average of .22 polyps per sequence. In the clinical validation study, the system detected an average of .89 additional polyps per procedure. No adverse events occurred.
CONCLUSIONS
DEEP has a high sensitivity for polyp detection and was effective in increasing the detection of polyps both in colonoscopy videos and in real procedures with a low number of false alarms. (Clinical trial registration number: NCT04693078.).
Topics: Adenomatous Polyps; Artificial Intelligence; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Humans; Prospective Studies
PubMed: 34216598
DOI: 10.1016/j.gie.2021.06.021 -
Digestion 2019Colorectal cancers (CRCs) develop through the accumulation of genetic and epigenetic alterations of oncogenes and tumor suppressor genes. In addition to the... (Review)
Review
BACKGROUND
Colorectal cancers (CRCs) develop through the accumulation of genetic and epigenetic alterations of oncogenes and tumor suppressor genes. In addition to the well-characterized adenoma-carcinoma sequence, the serrated neoplasia pathway is now recognized as an alternative pathway for CRC development.
SUMMARY
Through analysis of the colonoscopic, pathological, and molecular features of colorectal tumors, we identified a novel microsurface structure characteristic of serrated lesions. The Type II-Open (Type II-O) pit pattern is highly specific to sessile serrated adenoma/polyps (SSA/Ps), and Type-II-O-positive tumors frequently exhibit v-raf murine sarcoma viral oncogene homolog B1 (BRAF) mutation and 5'-C-phosphate-G-3' (CpG) island hypermethylation. By screening DNA methylation associated with the development of serrated lesions, we detected methylation of secreted protein acidic and rich in cysteine (SPARC)-related modular calcium binding 1 (SMOC1) in traditional serrated adenomas (TSAs). Epigenetic silencing of SMOC1 is prevalent among TSAs but it is rarely observed in SSA/Ps, which suggests SMOC1 could be a useful diagnostic marker of serrated lesions. We also searched for epigenetic alterations associated with the growth pattern of colorectal tumors and found that methylation of neurotensin receptor 1 is associated with lateral and non-invasive tumor growth. Key Message: Through the summarized studies, we have been able to identify novel morphological and molecular features that could contribute to a better understanding of colorectal tumors and to improved clinical diagnosis.
Topics: Adenoma; Adenomatous Polyps; Carcinogenesis; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; CpG Islands; DNA Methylation; Epigenesis, Genetic; Humans; Osteonectin; Proto-Oncogene Proteins B-raf
PubMed: 30554192
DOI: 10.1159/000494410 -
World Journal of Gastroenterology Jan 2016Nonampullary duodenal adenomas are relatively common in familial adenomatous polyposis (FAP), but nonampullary sporadic duodenal adenomas (SDAs) are rare. Emerging... (Review)
Review
Nonampullary duodenal adenomas are relatively common in familial adenomatous polyposis (FAP), but nonampullary sporadic duodenal adenomas (SDAs) are rare. Emerging evidence shows that duodenal adenomas, regardless of their anatomic location and whether they are sporadic or FAP-related, share morphologic and molecular features with colorectal adenomas. The available data suggest that duodenal adenomas develop to duodenal adenocarcinomas via similar mechanisms. The optimal approach for management of duodenal adenomas remains to be determined. The techniques for endoscopic resection of duodenal adenoma include snare polypectomy, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and argon plasma coagulation ablation. EMR may facilitate removal of large duodenal polyps. Although several studies have reported cases of successful ESD for duodenal adenomas, the procedure is technically difficult to perform safely because of the anatomical properties of the duodenum. Although current clinical practice recommends endoscopic resection of all large duodenal adenomas in patients with FAP, endoscopic treatment is usually insufficient to guarantee a polyp-free duodenum. Surgery is indicated for FAP patients with severe polyposis or nonampullary SDAs or FAP-related polyps not amenable to endoscopic resection. Further studies are needed to develop newer endoscopic techniques to guide diagnostic and therapeutic decisions for future management of nonampullary duodenal adenomas.
Topics: Adenomatous Polyps; Dissection; Duodenal Neoplasms; Duodenoscopy; Humans; Intestinal Polyps; Pancreaticoduodenectomy; Postoperative Complications; Predictive Value of Tests; Treatment Outcome
PubMed: 26811631
DOI: 10.3748/wjg.v22.i2.853