Deep learning identifies inflamed fat as a risk factor for lymph node metastasis in early colorectal cancer.

The spread of early-stage (T1 and T2) adenocarcinomas to locoregional lymph nodes is a key event in disease progression of colorectal cancer (CRC). The cellular mechanisms behind this event are not completely understood and existing predictive biomarkers are imperfect. Here, we used an end-to-end deep learning algorithm to identify risk factors for lymph node metastasis (LNM) status in digitized histopathology slides of the primary CRC and its surrounding tissue. In two large population-based cohorts, we show that this system can predict the presence of more than one LNM in pT2 CRC patients with an area under the receiver operating curve (AUROC) of 0.733 (0.67-0.758) and patients with any LNM with an AUROC of 0.711 (0.597-0.797). Similarly, in pT1 CRC patients, the presence of more than one LNM or any LNM was predictable with an AUROC of 0.733 (0.644-0.778) and 0.567 (0.542-0.597), respectively. Based on these findings, we used the deep learning system to guide human pathology experts towards highly predictive regions for LNM in the whole slide images. This hybrid human observer and deep learning approach identified inflamed adipose tissue as the highest predictive feature for LNM presence. Our study is a first proof of concept that artificial intelligence (AI) systems may be able to discover potentially new biological mechanisms in cancer progression. Our deep learning algorithm is publicly available and can be used for biomarker discovery in any disease setting. © 2021 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Dynamic contrast-enhanced EUS for quantification of tumor perfusion in colonic cancer: a prospective cohort study.

BACKGROUND AND AIMS: Dynamic contrast-enhanced EUS (CE-EUS) for quantification of perfusion in colonic tumors has not previously been reported in the literature. The aim of this study was to investigate correlations between perfusion parameters and vessel density assessed by immunohistochemical staining with antibodies toward CD31 and CD105. METHODS: We conducted a prospective clinical study of 28 patients with left-sided colonic adenocarcinoma who underwent CE-EUS and left-sided hemicolectomy within 2 weeks. CE-EUS recordings were analyzed in 2 regions of interest: the entire tumor and the most enhanced area. Immunohistochemical staining with CD31 and CD105 was performed on tumor tissue sections. The slides were manually scanned for highly vascularized areas, and counting of vessels was performed in hotspots within the tumor and invasive front. New vasculature was assessed by CD105. Associations between CE-EUS and CD31 and CD105 were investigated using Spearman correlation. RESULTS: We found significant P values for the correlation between CD31 and rise time (rho = .603 [95% confidence interval (95% CI), .238-.816]; P = .001) in tumor tissue and for the correlation between CD31 and rise time (rho = .50 [95% CI, .201-.695]; P = .008) and fall time (rho = .52 [95% CI, .204-.723]; P = .006) corresponding to the invasive front. We found no correlations between perfusion values evaluated by CE-EUS and CD105. CONCLUSIONS: Our results show a significant correlation for vessel density evaluated by CD31 and perfusion parameters evaluated by CE-EUS. This may be the first step toward using real-time CE-EUS for monitoring antiangiogenic therapies in colonic cancer. (Clinical trial registration number: NCT02324023.).

[Endoscopic ultrasonography in tumour staging of colonic cancer].

Tumour staging of colonic cancer has become increasingly important due to advancements in minimally invasive surgical techniques and potential benefits of neoadjuvant treatments for advanced but operable tumours. Selection of patients for the latter is based on CT-scans although the staging quality of this image modality is widely debated. Endoscopic ultrasonography (EUS) has not routinely been used for staging colonic cancer. This article presents the current knowledge of EUS for T-staging of colonic cancers and discusses the rationale for its supplement to routine CT-scans in selected patients.

Endoscopic ultrasound for staging of colonic cancer proximal to the rectum: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: Treatment of colonic cancer patients is highly dependent on the depth of tumor invasion (T-stage) as well as the extension of lymph node involvement (N-stage). We aimed to systematically review the accuracy of endoscopic ultrasound (EUS) for staging of colonic cancer proximal to the rectum. PATIENTS AND METHODS: Men and women with colonic adenocarcinomas were included in the study. EUS staging was compared to histopathology as the gold standard. Outcome measures were T- and N-staging accuracies. Articles were searched in PubMed, Web of Science, The Cochrane Library, and EMBASE. RESULTS: Six studies were identified comparing EUS staging of colonic cancer to histopathology. The pooled-staging sensitivity and specificity were 0.90 and 0.98 for T1 tumors, 0.67 and 0.96 for T2 tumors, and 0.97 and 0.83 for T3/T4 tumors, respectively. Sensitivity and specificity for N + disease were 0.59 and 0.78, respectively. CONCLUSIONS: EUS is a feasible method for T-staging of cancers of the colon proximal to the rectum. The accuracy of lymph node staging needs to be verified by prospective multicenter studies including larger patient populations.

[Self-inflicted penetrating stab wound in mentally unstable patient - a clinical approach]. / Abdominal stiklæsion med brillestel hos en patient med psykiatrisk sygdom

A mentally ill 46-year-old woman was admitted to our hospital because of a self-inflicted stab wound to the abdomen. Diagnostic laparoscopy was performed and the peritoneum was found to be intact. She was discharged in good physical health the next day. Local wound exploration could not be performed because of the slim stab wound. Conservative treatment with 12-24 hours of in hospital-observation could be an option, but since the patient presented with abdominal pain, surgery was the treatment of choice in this case.

[Confocal laser endomicroscopy is a new endoscopic technique for diagnosing colorectal neoplasia and inflammatory bowel disease].

Confocal laser endomicroscopy (CLE) is a new endoscopic technique that allows in vivo real time histopathology. The method provides "optical" biopsies, giving the endoscopist the possibility of immediate interpretation and intervention. In colorectal cancer CLE has been used to distinguish neoplastic from non-neoplastic lesions. Lately, CLE has been used to monitor anti-angiogenic therapy by fluorescence labelled antibodies targeted against endothelial markers. The review describes CLE and the potential of the method in relation to colorectal polyps, cancer and inflammatory bowel disease.

[Monitorering and complications by conservative treatment of severe acute pancreatitis]. / Monitorering og komplikationer ved konservativ behandling af svær, akut pankreatitis.

Severe acute pancreatitis (SAP) is associated with a high morbidity and a mortality risk of up to 20%. Although much progress has occurred during the latest couple of years, there are still some major controversies on important issues such as monitoring, fluid therapy, antibiotic treatment, and nutrition. In this article we describe the underlying, pathophysiologic mechanisms responsible for organ failure in SAP, and the rationale for monitoring and conservative treatment of SAP.

[Transabdominal ultrasound examination, contrast-enhanced ultrasound examination and endoscopic ultrasound scanning in the determination of the aetiology and the degree of severity in acute pancreatitis]. / Transabdominal, kontrastforstærket og endoskopisk ultralydskanning til bestemmelse af ætiologi og sværhedsgrad ved akut pankreatitis.

A transabdominal ultrasound examination is part of the standard work-up for patients with acute pancreatitis. Transabdominal ultrasound examination displays a high sensitivity for the detection of gallbladder stones. With the recent introduction of contrast enhancement in ultrasound it has become possible to determine the severity of acute pancreatitis. Endoscopic ultrasound has shown a high sensitivity in the diagnosis of stones in the common bile duct and is an important peroperative surgical tool in endoscopic transgastric necrosectomi as well.

Cytokines and organ failure in acute pancreatitis: inflammatory response in acute pancreatitis.

OBJECTIVES: We aimed at synchronously examining the early time course of 4 proinflammatory cytokines as predictive factors for development of organ failure in patients with acute pancreatitis (AP). METHODS: Interleukin (IL) 6, IL-8, IL-18, and tumor necrosis factor α were measured on admission and at days 1, 2, and 14 in 60 patients admitted with first attack of AP. The prediction of single-organ and multiorgan failure from the cytokine profiles was evaluated by receiver operating characteristic analyses. RESULTS: Interleukin 6 and IL-8 levels were significantly higher in patients who developed renal, respiratory, and circulatory failure, as was the case for patients with multiorgan failure. Interleukin 18 levels were significantly elevated in renal and respiratory failure only. Tumor necrosis factor α was significantly elevated in all types of organ failures, except for intestinal failure. CONCLUSIONS: Synchronous measurements of 4 cytokines demonstrated IL-6 and IL-8 to be predictive as early surrogate markers with regard to organ failures in AP. The fact that all of the cytokines were particularly elevated in patients with organ failures calls for evaluation of agents modifying the severe inflammatory response in patients with AP.

[Endoscopic mucosal resection of the colon and rectum]. / Endoskopisk mucosaresektion i colon og rectum.

EMR (endoscopic mucosal resection) is an endoscopic procedure where benign adenomas and superficial carcinomas can be removed from the gastrointestinal tract. The method is an alternative to laparoscopic and open surgery. This paper focuses on lesions of the colon and rectum, presenting the method, techniques, instruments and complications.