[Colorectal cancer screening with virtual colonography]. / Screening des Kolonkarzinoms mit virtueller Kolographie.

BACKGROUND: Since 2003, a decline in the age-standardized incidence rates of colorectal cancer (CRC) has been observed in Germany. Nonetheless, one in eight cancer cases still affects the colon or rectum. The prognosis has improved, with the relative 5­year survival rate for CRC being approximately 65%. METHODS: This positive trend is probably a result of preventive measures introduced over the last 20 years. This could be further improved, however, as CRC can not only be detected early but in almost all cases also prevented through the identification of benign precursors. Less than half of all eligible individuals participate in screening via colonoscopy. This implies that further, possibly even imaging, screening test methods should be explored and offered. Studies have reported that virtual colonography techniques have a comparable accuracy to endoscopy of about 90% for polyp sizes larger than 5 mm. The data for computed tomography (CT) is more extensive than for magnetic resonance imaging (MRI). CONCLUSION: Significant challenges are posed however by the fact that in Germany CT colonography (CTC) is not considered a viable screening option due to radiation protection concerns, and MRI screening is not an established screening method. Radiologists should be familiar with classification using the CT Colonography Reporting and Data System (C-RADS), which uses criteria such as CT density, morphology, size, and location for classification. C­RADS classification follows the categories: C0 (inadequate study), C1 (normal), C2a (indeterminate), C2b (benign), C3 (suspicious), and C4 (malignant), as well as extracolonic categories E1/2 (no clinically significant findings), E3 (likely insignificant findings), and E4 (likely significant findings).

Trends in Colorectal Cancer Screening from the National Health Interview Survey: Analysis of the Impact of Different Modalities on Overall Screening Rates.

Colorectal cancer is the second leading cause of cancer-related mortality in adults in the United States. Despite compelling evidence of improved outcomes in colorectal cancer, screening rates are not optimal. This study aimed to characterize colorectal cancer screening trends over the last two decades and assess the impact of various screening modalities on overall colorectal cancer screening rates. Using National Health Interview Survey data from 2005 to 2021, we examined colorectal cancer screening [colonoscopy, multitarget stool DNA (mt-sDNA), fecal occult blood test (FOBT)/fecal immunochemical test, sigmoidoscopy, CT colonography] rates among adults ages 50-75 years (n = 85,571). A pseudo-time-series cross-sectional (pseudo-TSCS) analysis was conducted including a random effects generalized least squares regression model to estimate the relative impact of each modality on changes in colorectal cancer screening rates. Among 50 to 75 year olds, the estimated colorectal cancer screening rate increased from 47.7% in 2005 to 69.9% in 2021, with the largest increase between 2005 and 2010 (47.7%-60.7%). Rates subsequently plateaued until 2015 but increased from 63.5% in 2015 to 69.9% in 2018. This was primarily driven by the increased use of mt-sDNA (2.5% in 2018 to 6.6% in 2021). Pseudo-TSCS analysis results showed that mt-sDNA contributed substantially to the increase in overall screening rates (77.3%; P < 0.0001) between 2018 and 2021. While colorectal cancer screening rates increased from 2005 to 2021, they remain below the 80% goal. The introduction of mt-sDNA, a noninvasive screening test may have improved overall rates. Sustained efforts are required to further increase screening rates to improve patient outcomes and offering a range of screening options is likely to contribute to achieving this goal. PREVENTION RELEVANCE: This retrospective study highlights the importance of convenient stool-based colorectal cancer screening options to achieve the national goal of 80% for overall colorectal cancer screening rates. Empowering screening-eligible individuals with a choice for their colorectal cancer screening tests is imperative.

Bowel Preparation Burden, Rectal Pain and Abdominal Discomfort: Perspective of Participants Undergoing CT Colonography and Colonoscopy.

OBJECTIVE: This study aimed to evaluate bowel preparation burden, rectal pain and abdominal discomfort levels and to determine the association between demographic characteristics and those levels among participants undergoing CT colonography and colonoscopy. METHODS: A cross-sectional survey was conducted in eligible Thai citizens who consented to participate all four visits of a free colorectal cancer screening protocol. Three levels (mild, moderate and severe) of burden, pain and discomfort were used to ask the perspective of participants at the final visit, one week after undergoing those two procedures. RESULTS: Data from 1,271 participants completed for analyses - females 815 (64.1%), males 456 (35.9%). The majority of participants experienced mild burden, pain and discomfort. Association between characteristic groups and burden levels differed regarding own income, chronic disease and laxative. Between characteristic groups and pain and discomfort levels differed regarding own income and chronic disease. Participants without their own income rated severe burden lower than those who had (p<0.001), but those without chronic disease rated moderate burden lower than who had (p=0.003). Participants prepared bowel with spilt-dose of PEG rated moderate burden higher than those who prepared with NaP (p<0.001). Participants undergoing CT colonography without their own income and presenting no chronic disease faced severe rectal pain lower than those who had (p<0.001 and p=0.04). Participants without their own income rated moderate and severe abdominal discomfort lower than those who had (p<0.01 and p=0.008). Participants undergoing colonoscopy without their own income and no chronic diseases faced severe rectal pain lower than those who had (p<0.001 and p=0.007). Participants without their own income and no chronic disease rated severe abdominal discomfort lower than those who had (p<0.001 and p=0.005). CONCLUSION: Evaluating the perspectives of customers alongside quality improvement and innovation to reduce unpleasant experiences remains needed in CT colonography and colonoscopy to promote CRC screening.

Recent American College of Physicians Guidance Statement for Screening Average-risk, Asymptomatic Adults for Colorectal Cancer.

The American College of Physicians (ACP) update of their standing guidance statement for colorectal-cancer screening in asymptomatic average-risk adults was recently published to assist clinicians with implementing evidence-based patient care. After assessing existing guideline literature, the ACP recommended five actions: consider not screening adults ages 45 to 49 years; stop screening adults older than 75 years; discuss benefits, harms, costs, availability, frequency, and patient values/preferences with patients prior to choosing a screening method; and when choosing, recommend biennial rather than annual use of a fecal immunochemical test or a guaiac fecal occult blood test and avoid recommending computed tomography colonography or stool DNA tests. While the ACP guidelines are rigorous, well-intended, and considerate of patients' input, their greatest impact may result from highlighting the need for researchers to help frontline clinicians to describe the risk, costs, and benefits/harms of various colorectal-cancer screening strategies in an effective, yet time-efficient, manner given the all-too-brief annual patient encounters. In the United States, reimbursement is still dependent on U.S. Preventive Services Task Force recommendations which are somewhat more liberal in contrast to the ACP's approach which strongly favors randomized, controlled trial evidence to guide the delivery of prevention and screening services to asymptomatic average-risk patients.

Natural History of Colorectal Polyps Undergoing Longitudinal in Vivo CT Colonography Surveillance.

Background The natural history of colorectal polyps is not well characterized due to clinical standards of care and other practical constraints limiting in vivo longitudinal surveillance. Established CT colonography (CTC) clinical screening protocols allow surveillance of small (6-9 mm) polyps. Purpose To assess the natural history of colorectal polyps followed with CTC in a clinical screening program, with histopathologic correlation for resected polyps. Materials and Methods In this retrospective study, CTC was used to longitudinally monitor small colorectal polyps in asymptomatic adult patients from April 1, 2004, to August 31, 2020. All patients underwent at least two CTC examinations. Polyp growth patterns across multiple time points were analyzed, with histopathologic context for resected polyps. Regression analysis was performed to evaluate predictors of advanced histopathology. Results In this study of 475 asymptomatic adult patients (mean age, 56.9 years ± 6.7 [SD]; 263 men), 639 unique polyps (mean initial diameter, 6.3 mm; volume, 50.2 mm3) were followed for a mean of 5.1 years ± 2.9. Of these 639 polyps, 398 (62.3%) underwent resection and histopathologic evaluation, and 41 (6.4%) proved to be histopathologically advanced (adenocarcinoma, high-grade dysplasia, or villous content), including two cancers and 38 tubulovillous adenomas. Advanced polyps showed mean volume growth of +178% per year (752% per year for adenocarcinomas) compared with +33% per year for nonadvanced polyps and -3% per year for unresected, unretrieved, or resolved polyps (P < .001). In addition, 90% of histologically advanced polyps achieved a volume of 100 mm3 and/or volume growth rate of 100% per year, compared with 29% of nonadvanced and 16% of unresected or resolved polyps (P < .001). Polyp volume-to-diameter ratio was also significantly greater for advanced polyps. For polyps observed at three or more time points, most advanced polyps demonstrated an initial slower growth interval, followed by a period of more rapid growth. Conclusion Small colorectal polyps ultimately proving to be histopathologically advanced neoplasms demonstrated substantially faster growth and attained greater overall size compared with nonadvanced polyps. Clinical trial registration no. NCT00204867 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Dachman in this issue.

Prognostic impact of extramural venous invasion detected by contrast-enhanced CT colonography in colon cancer.

BACKGROUND: The impact of computed tomography (CT)-detected extramural venous invasion on the recurrence of colon cancer is not fully understood. The aim of this study was to investigate the clinical significance of extramural venous invasion diagnosed before surgery by contrast-enhanced CT colonography using three-dimensional multiplanar reconstruction images. METHODS: Patients with colon cancer staged greater than or equal to T2 and/or stage I-III who underwent contrast-enhanced CT colonography between 2013 and 2018 at the National Cancer Center Hospital in Japan were retrospectively investigated for CT-detected extramural venous invasion. Inter-observer agreement for the detection of CT-detected extramural venous invasion was evaluated and Kaplan-Meier survival curves were plotted for recurrence-free survival using CT-TNM staging and CT-detected extramural venous invasion. Preoperative clinical variables were analysed using Cox regression for recurrence-free survival. RESULTS: Out of 922 eligible patients, 544 cases were analysed (50 (9.2 per cent) were diagnosed as positive for CT-detected extramural venous invasion and 494 (90.8 per cent) were diagnosed as negative for CT-detected extramural venous invasion). The inter-observer agreement for CT-detected extramural venous invasion had a κ coefficient of 0.830. The group positive for CT-detected extramural venous invasion had a median follow-up of 62.1 months, whereas the group negative for CT-detected extramural venous invasion had a median follow-up of 60.7 months. When CT-TNM stage was stratified according to CT-detected extramural venous invasion status, CT-T3 N(-)extramural venous invasion(+) had a poor prognosis compared with CT-T3 N(-)extramural venous invasion(-) and CT-stage I (5-year recurrence-free survival of 50.6 versus 89.3 and 90.1 per cent respectively; P < 0.001). In CT-stage III, the group positive for CT-detected extramural venous invasion also had a poor prognosis compared with the group negative for CT-detected extramural venous invasion (5-year recurrence-free survival of 52.0 versus 78.5 per cent respectively; P = 0.003). Multivariable analysis revealed that recurrence was associated with CT-T4 (HR 3.10, 95 per cent c.i. 1.85 to 5.20; P < 0.001) and CT-detected extramural venous invasion (HR 3.08, 95 per cent c.i. 1.90 to 5.00; P < 0.001). CONCLUSION: CT-detected extramural venous invasion was found to be an independent predictor of recurrence and could be used in combination with preoperative TNM staging to identify patients at high risk of recurrence.

CT Colonography Reporting and Data System (C-RADS): Version 2023 Update.

The CT Colonography Reporting and Data System (C-RADS) has withstood the test of time and proven to be a robust classification scheme for CT colonography (CTC) findings. C-RADS version 2023 represents an update on the scheme used for colorectal and extracolonic findings at CTC. The update provides useful insights gained since the implementation of the original system in 2005. Increased experience has demonstrated confusion on how to classify the mass-like appearance of the colon consisting of soft tissue attenuation that occurs in segments with acute or chronic diverticulitis. Therefore, the update introduces a new subcategory, C2b, specifically for mass-like diverticular strictures, which are likely benign. Additionally, the update simplifies extracolonic classification by combining E1 and E2 categories into an updated extracolonic category of E1/E2 since, irrespective of whether a finding is considered a normal variant (category E1) or an otherwise clinically unimportant finding (category E2), no additional follow-up is required. This simplifies and streamlines the classification into one category, which results in the same management recommendation.

Colorectal cancer screening guidelines for average-risk and high-risk individuals: A systematic review.

AIMS: This review aims to summarize the different colorectal cancer guidelines for average-risk and high-risk individuals from various countries. METHODS: A comprehensive literature search regarding guidelines, consensus recommendations, or position statements about colorectal cancer screening published within the last 10 years (1st January 2012 to 27th August 2022), was performed at EBSCOhost, JSTOR, PubMed, ProQuest, SAGE, and ScienceDirect. RESULTS: A total of 18 guidelines were included in this review. Most guidelines recommended screening between 45 and 75 years for average-risk individuals. Recommendations regarding colorectal cancer screening in high-risk individuals were more varied and depended on the risk factor. For high-risk individuals with a positive family history of colorectal cancer or advanced colorectal polyp, screening should begin at age 40. Some frequently suggested screening modalities in order of frequency are colonoscopy, FIT, and CTC. Furthermore, several screening intervals were suggested, including colonoscopy every 10 years for average-risk and every 5-10 years for high-risk individuals, FIT annually in average-risk and every 1-2 years in high-risk individuals, and CTC every five years for all individuals. CONCLUSION: All individuals with average-risk should undergo colorectal cancer screening between 45 and 75. Meanwhile, individuals with higher risks, such as those with a positive family history, should begin screening at age 40. Several recommended screening modalities were suggested, including colonoscopy every 10 years in average-risk and every 5-10 years in high-risk, FIT annually in average-risk and every 1-2 years in high-risk, and CTC every five years.

Screening for colorectal cancer in asymptomatic average-risk adults: a guidance statement from the American College of Physicians (version 2)

The purpose of this updated guidance statement is to guide clinicians on screening for colorectal cancer (CRC) in asymptomatic average-risk adults. The intended audience is all clinicians. The population is asymptomatic adults at average risk for CRC. This updated guidance statement was developed using recently published and critically appraised clinical guidelines from national guideline developers since the publication of the American College of Physicians' 2019 guidance statement, "Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults." The authors searched for national guidelines from the United States and other countries published in English using PubMed and the Guidelines International Network library from 1 January 2018 to 24 April 2023. The authors also searched for updates of guidelines included in the first version of our guidance statement. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument was used to assess the quality of eligible guidelines. Two guidelines were selected for adoption and adaptation by raters on the basis of the highest average overall AGREE II quality scores. The evidence reviews and modeling studies for these 2 guidelines were also used to synthesize the evidence of diagnostic test accuracy, effectiveness, and harms of CRC screening interventions and to develop our guidance statements.

Assessment of Circulating Tumor Cells in Colorectal Cancer as an Adjunctive Non-invasive Diagnostic Method.

BACKGROUND: Colorectal cancer (CRC) is a significant contributor to cancer-related morbidity and mortality. Biopsy remains the gold standard for CRC diagnosis, but invasive testing may not be preferred as an initial diagnostic procedure. Therefore, alternative non-invasive approaches are needed. Circulating tumor cells (CTC) present in the bloodstream have great potential as a non-invasive diagnostic marker for CRC patients. This study aimed to assess the diagnostic potential of CTC in CRC as an adjunctive diagnostic method using a subjective manual identification method and laser capture microdissection at 40x magnification. METHODS: A cross-sectional study was conducted on adult patients suspected to have CRC at Dr. Cipto Mangunkusumo National General Hospital, Jakarta, between November 2020 and March 2021. CTC analysis was performed using the negative selection immunomagnetic method with Easysep™ and the CD44 mesenchymal tumor marker. The identification and quantification of CTC were conducted manually and subjectively, with three repetitions of cell counting per field of view at 40x magnification. RESULTS: Of 80 subjects, 77.5% were diagnosed with CRC, while 7.5% and 15% exhibited adenomatous polyps and inflammatory/hyperplastic polyps, respectively. The diagnostic analysis of CTC for detecting CRC (compared to polyps) using a CTC cutoff point of >1.5 cells/mL suggested sensitivity, specificity, and positive predictive value (PPV) of 50%, 88.89%, and 93.94%. Additionally, the negative predictive value (NPV), as well as the positive and negative likelihood ratio (PLR and NLR) were 34.04%, 4.5, and 0.56, respectively. The subjective manual identification and quantification of CTC were performed at 40x magnification using laser capture microdissection. CONCLUSION: This study assessed the diagnostic potential of CTC examination in CRC as an adjunctive diagnostic method using the subjective manual identification method and laser capture microdissection at 40x magnification. Despite the limitations associated with subjective cell counting, the results showed 50% sensitivity and 88.89% specificity in diagnosing CRC. Further studies are needed to optimize the manual identification process and validate the clinical utility of CTC analysis in CRC patients.

Computed Tomography Colonography as a Sensible Option for Colorectal Cancer Screening: Evidence Based on Metanalysis / Colonografia por tomografia computadorizada como uma opção sensível para o rastreamento do câncer colorretal: Evidências baseadas em metanálise

Abstract Objective This metanalysis aimed to evaluate the sensitivity and specificity of computed tomography colonography in colorectal polyp detection. Methods A literature search was performed in the PubMed and Web of Science databases. Results A total of 1,872 patients (males 57.2%, females 42.8%) aged 49 to 82 years old (mean age 59.7 ± 5.3 years) were included in this metanalysis. The estimated sensitivity of computed tomography colonography was 88.4% (46.3-95.7%, coefficient of variation [CV]=28.5%) and the estimated specificity was 73.6% (47.4-100.0%, CV=37.5%). For lesions up to 9mm, the sensitivity was 82.5% (62.0-99.9%, CV =25.1%) and the specificity was 79.2% (32.0-98.0%, CV=22.9%). For lesions>9mm, the sensitivity was 90.2% (64.0-100.0%, CV=7.4%) and the specificity was 94.7% (80.0-100.0%, CV=6.2%). No statistically significant differences in sensitivity according to the size of the lesion were found (p=0.0958); however, the specificity was higher for lesions>9mm (p<0.0001). Conclusions Most of the studies analyzed in the present work were conducted before 2010, which is about a decade after computed tomography colonography started being indicated as a screening method by European and American guidelines. Therefore, more studies aimed at analyzing the technique after further technological advancements are necessary, which could lead to the development of more modern devices.

Resumo Objetivo Esta meta-análise teve como objetivo avaliar a sensibilidade e especificidade da colonografia por tomografia computadorizada na detecção de pólipos colorretais. Métodos Foi realizada uma pesquisa bibliográfica nas bases de dados da PubMed e da Web of Science. Resultados Um total de 1.872 pacientes, 57,2% homens e 42,8% mulheres, com idades entre 49 a 82 anos de idade (média de 59,7 ± 5,3 anos) foram incluídos nesta meta análise. A sensibilidade da colonografia por tomografia computadorizada foi estimada em 88,4% (46,3-95,7%; coeficiente de variância [CV]=28,5%) e a especificidade em 73,6% (47,4%-100,0%; CV=37,5%). Para lesões de até 9mm, a sensibilidade foi de 82,5% (62,0-99,9%; CV=25,1%) e a especificidade de 79,2% (32,0-98,0%; CV=22,9%). Para lesõesmaiores que 9mm, a sensibilidade foi de 90,2% (64,0-100,0%; CV=7,4%) e a especificidade de 94,7% (80,0-100,0%; CV=6,2%). Não houve diferença estatisticamente significante entre as sensibilidades por tamanho da lesão (p=0,0958), porém a especificidade foi maior em lesões acima de 9mm (p<0,0001). Conclusão A maioria dos estudos analisados no presente trabalho foi realizada antes de 2010, cerca de uma década depois que a colonografia por tomografia computadorizada passou a ser indicada como método de triagem pelas diretrizes europeias e americanas. Portanto, são necessários mais estudos com o objetivo de analisar a técnica apósmaiores avanços tecnológicos, o que poderia levar ao desenvolvimento de dispositivos mais modernos.

Dentin Thickness of Pulp Chamber Floor in Primary Molars: Evaluation by Cone-Beam Computed Tomography

ABSTRACT Objective: Use cone-beam computed tomography (CBCT) images to evaluate the dentin thickness of the pulp chamber floor in primary molars. Material and Methods: Cross-sectional study, conducted with CBCT images of teeth of children. Primary molars with preserved pulp chamber floor were included. The dentin thickness of the pulp chamber floor in the primary molars was measured linearly in CBCT cross-sections. Data were descriptively analyzed and the Mann-Whitney test was applied (p<0.05). Results: 27 CBCT exams and 123 primary molars of children aged 4 to 13 years were analyzed; the majority was female (52.0%). In maxillary molars, the median dentin thickness was 1.50 (0.6-2.2) mm in the first and 1.65 (0.6-2.3) mm in the second (p=0.049) molars. In mandibular molars, the median was 1.20 (0.3-1.7) mm in the first and 1.60 (1.0-2.2) mm in the second (p<0.001) molars. Children aged 4 to 8 years showed less dentin thickness (p<0.001). Conclusion: The median dentin thickness of the pulp chamber floor in primary molars was 1.50 mm, ranging from 0.3 to 2.3 mm. Less dentin thickness was associated with younger children, teeth in the mandibular arch, and first molars.

Colonoscopía virtual de screening de cáncer colorrectal en pacientes con enfermedad diverticular / Virtual colonoscopy for colorectal cancer screening in patients with diverticular disease

CONTEXTO: El cáncer colorrectal (CCR) es un problema de salud pública en todo el mundo y particularmente em nuestro país, dada su elevada incidencia. En Argentina, según las estimaciones de incidencia del Observatorio Global de Cáncer de la OMS se estimaron 15.692 casos nuevos para el año 2018 en ambos sexos, concentrando el 13% del total de tumores, siendo el segundo cáncer más frecuente, por detrás del cáncer de mama en mujeres y el cáncer de próstata en hombres. En Argentina el CCR es el segundo cáncer de mayor mortalidad (luego del cáncer de pulmón), con más de 7.000 fallecimientos anuales. TECNOLOGÍA: La colonoscopía tomográfica computarizada, también conocida como colonoscopía virtual, fue desarrollada como un método mínimamente invasivo para examinar el colon.5 Se ha sugerido el uso de esta prueba para la detección de anomalías en el colon y el recto como por ejemplo, CCR y pólipos. Esta tecnología implica el uso de tomografía computarizada helicoidal (TC) e imágenes generadas por computadora para producir imágenes bidimensionales y tridimensionales (3D) de alta resolución del colon y el recto. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca del desempeño diagnóstico, la eficacia, seguridad y aspectos relacionados a las políticas de cobertura del uso de colonoscopia virtual para screening de CCR en pacientes con enfermedad diverticular. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y políticas de cobertura de diferentes sistemas de salud. RESULTADOS: Se incluyeron cuatro RS, un ECA, seis GPC, dos informes de ETS, una RS de evaluaciones económicas, y 12 informes de políticas de cobertura de CTC en screening de CCR en pacientes con enfermedad diverticular. CONCLUSIONES: No se encontraron estudios que comparen de forma directa la utilización de colonoscopía virtual por tomografía computarizada contra otros métodos diagnósticos (excluyendo enema de bario de doble contraste) para el screening de cáncer colorrectal en pacientes con enfermedad diverticular. La decisión del método a utilizar podría basarse en consideraciones clínicas y preferencia de los pacientes y cuestiones como la accesibilidad a las diferentes modalidades de cribado. Se encontró evidencia de moderada calidad que sugiere que la colonoscopía virtual tiene uma sensibilidad superior al enema de bario de doble contraste en el screening de cáncer colorrectal em la población general y podría inferirse que también la tendría en pacientes con enfermedad diverticular. Financiadores públicos y privados de países de altos ingresos cubren el uso de colonoscopía virtual en el screening de cáncer colorrectal en pacientes con antecedentes de videocolonoscopía incompleta o en los que la videocolonoscopía se encuentra contraindicada. Esta tecnología no es mencionada en el Programa Médico Obligatorio ni es reintegrada por el Sistema Único de Reintegro de la Argentina. Esta tecnología se encuentra recomendada por guías de práctica clínica como técnica de screening de cáncer colorrectal y en Argentina el Instituto Nacional del Cáncer la recomienda como uma alternativa válida para el tamizaje luego de una videocolonoscopía incompleta.

¿Cómo pueden contribuir los radiólogos a mejorar la detección sistemática del cáncer colorrectal? / How can radiologists be helpful in improving colo-rectal cancer screening?

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Revisión de métodos computacionales de detección y clasificación de pólipos en imagen de colonoscopia / Review of computational methods for the detection and classification of polyps in colonoscopy imaging

El diagnóstico asistido por computador (DAC) constituye una herramienta con gran potencial para ayudar a los endoscopistas en las tareas de detección y clasificación histológica de los pólipos colorrectales. En los últimos años se han descrito diferentes tecnologías y ha aumentado la evidencia sobre su potencial utilidad, lo que ha generado grandes expectativas en las sociedades científicas. Sin embargo, la mayoría de estos trabajos son retrospectivos y utilizan imágenes de diferente calidad y características que son analizadas off-line. En esta revisión se pretende familiarizar a los gastroenterólogos con los métodos computacionales y las particularidades de la imagen endoscópica con impacto en el análisis del procesamiento de imágenes. Finalmente, se exponen las bases de datos de imágenes disponibles de forma pública que son necesarias para poder comparar y confirmar los resultados obtenidos con diferentes métodos

Computer-aided diagnosis (CAD) is a tool with great potential to help endoscopists in the tasks of detecting and histologically classifying colorectal polyps. In recent years, different technologies have been described and their potential utility has been increasingly evidenced, which has generated great expectations among scientific societies. However, most of these works are retrospective and use images of different quality and characteristics which are analysed off line. This review aims to familiarise gastroenterologists with computational methods and the particularities of endoscopic imaging, which have an impact on image processing analysis. Finally, the publicly available image databases, needed to compare and confirm the results obtained with different methods, are presented

Patología del recto: hallazgos en la colonografía-TC / TC Rectal Pathology: Findings at CT-Colonography

Objetivo: Revisar el espectro de la patología rectal benigna y maligna, sus hallazgos en la colonografía-TC (CTC) y su manejo. Conclusión: Aunque la CTC no es la herramienta de primera elección para el estudio de la patología rectal, está indicada en casos de colonoscopia óptica incompleta o contraindicada. Las lesiones rectales pueden pasar desapercibidas por la dificultad que representa la valoración de esta área anatómica, y por ello es necesaria una excelente preparación y distensión, la insuflación moderada del balón y una navegación cuidadosa en 2D y 3D con conocimiento del espectro de la patología rectal y su semiología en CTC

Objective: To review the spectrum of benign and malignant rectal diseases, their findings on CT colonography, and their management. Conclusion: Although CT colonography is not the first choice for the study of rectal disease, it is indicated in cases where optical colonoscopy is contraindicated or cannot be completed. Rectal lesions can go undetected because this anatomic area is difficult to evaluate; for this reason, it is essential to ensure optimal preparation and distension, moderate balloon insufflation, and careful 2D and 3D navigation with knowledge of the spectrum of rectal disease and its CT colonography signs