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1.
South Med J ; 114(4): 199-206, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33787931

RESUMO

OBJECTIVES: Endoscopic mucosal resection (EMR) is an alternative to surgery for the treatment of large laterally spreading lesions. Residual or recurrent adenoma is a major limitation. This study aimed to quantify early and late recurrences and to assess its associated risk factors. METHODS: The study was a single-center, multiendoscopist, longitudinal study conducted between January 1, 2013 and April 26, 2017. A total of 480 patients with 500 polyps who underwent an endoscopic resection were included. Surveillance colonoscopy (SC) was performed at 4 to 6 months (SC1) and 16 to 18 months (SC2). RESULTS: At SC1, early recurrence was noted in 77 of 354 (21.8%) lesions; 76 (98.7%) were treated endoscopically. The remaining 277 of 354 (78.2%) lesions had no recurrence at SC1; only 41 lesions (15%) were followed up at SC2. Recurrence at SC2 was found in 4 lesions (9.8%), all of which were treated endoscopically. Lesion size >40 mm was associated with recurrence. Recurrence at both SC1 and SC2 was successfully treated endoscopically in 78 of 81 lesions (96.3%). CONCLUSIONS: EMR is an effective, minimally invasive technique for the treatment of large laterally spreading lesions. Although recurrence is a concern, its risk is low (21.8% on SC1 and 9.8% on SC2) and was managed endoscopically in 96.3% cases on follow-up endoscopy.


Assuntos
Adenoma/cirurgia , Neoplasias do Colo/cirurgia , Pólipos do Colo/cirurgia , Ressecção Endoscópica de Mucosa , Recidiva Local de Neoplasia/epidemiologia , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/patologia , Pólipos do Colo/diagnóstico por imagem , Pólipos do Colo/patologia , Colonoscopia , Ressecção Endoscópica de Mucosa/métodos , Feminino , Seguimentos , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/etiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
2.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(1): 75-80, 2021 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-33461256

RESUMO

Objective: Serrated adenoma is recognized as a precancerous lesion of colorectal cancer, and the serrated pathway is considered as an important pathway that can independently develop into colorectal cancer. However, little is known about the related risk factors of carcinogenesis of serrated adenoma. The purpose of this study was to analyze the distribution characteristics and potential malignant factors of serrated adenoma in the colon and rectum. Methods: A retrospective case-control study was conducted to collect the clinical data of patients with serrated adenoma who underwent colonoscopy and were pathologically diagnosed in the Cancer Hospital of Chinese Academy of Medical Sciences from April 2017 to July 2019, and exclude patients with two or more pathological types of lesions. The clinical characteristics of serrated adenoma were summarized, and univariate and logistic multivariate regression analysis was conducted to explore the influencing factors for serrated adenoma to develop malignant transformation. Results: Among 28 730 patients undergoing colonoscopy, 311 (1.08%) were found with 372 serrated adenomas, among which 22 (5.9%) were sessile serrated adenomas/polyps, 84 (22.6%) were traditional serrated adenomas, and 266 (71.5%) were unclassified serrated adenomas according to WHO classification. The pathological results showed that 106 (28.5%) lesions were non-dysplasia, 228 (61.3%) lesions were low grade intraepithelial neoplasia, and 38 (10.2%) lesions were high grade intraepithelial neoplasia or cancer. There were 204 (54.8%) lesions with long-axis diameter <10 mm and 168 (45.2%) lesions with length long-axis ≥ 10 mm. 238 (64.0%) lesions were found in the left side colon and rectum and 134 (36.0%) lesions in the right side colon. Gross classification under endoscopy: 16 flat type lesions (4.3%), 174 sessile lesions (46.8%), 117 semi-pedunculated lesions (31.5%), 59 pedunculated lesions (15.9%). Narrow-band imaging international colorectal endoscopic (NICE) classification: 85 (22.8%) type I lesions, 280 (75.3%) type II lesions, 4 (1.1%) type III lesions. Univariate analysis showed that lesion size, lesion location, lesion site and different WHO classifications were associated with malignant transformation of colorectal serrated adenoma (all P<0.05). For the serrated adenomas with different NICE classifications, there were statistically significant differences in the distribution of malignant lesions among groups (P=0.001). Multivariate analysis showed that the long-axis diameter of the lesion ≥10 mm (OR=6.699, 95% CI: 2.843-15.786) and the lesion locating in the left side colorectum (OR=2.657, 95% CI: 1.042-6.775) were independent risk factors for malignant transformation. Conclusions: Serrated adenomas mainly locate in the left side colon and rectum, and are prone to malignant transformation when the lesions are ≥10 mm in long-axis diameter or left-sided.


Assuntos
Adenoma , Pólipos Adenomatosos/patologia , Pólipos do Colo , Neoplasias Colorretais , Lesões Pré-Cancerosas/patologia , Adenoma/patologia , Pólipos Adenomatosos/diagnóstico , Carcinogênese , Estudos de Casos e Controles , Pólipos do Colo/diagnóstico , Pólipos do Colo/patologia , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/patologia , Progressão da Doença , Humanos , Lesões Pré-Cancerosas/diagnóstico , Estudos Retrospectivos , Fatores de Risco
3.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504521

RESUMO

Mastocytosis is a rare group of disorders that presents with heterogenous phenotypes depending on the organ system involved. In the absence of cutaneous involvement-mast cell aggregates that may present as papules, nodules or plaques-classically associated with indolent systemic mastocytosis (SM), the diagnosis of this rare condition is particularly challenging. When localised to the gastrointestinal (GI) tract, symptoms of indolent SM are often non-specific and mimic common conditions such as inflammatory bowel disease or irritable bowel syndrome. Diagnosis may be suspected by clinical presentation, but biopsy with histopathological analysis is necessary to confirm. We present a rare case of indolent SM without cutaneous features. In the absence of typical cutaneous features, indolent SM should be considered in the differential diagnosis of a patient with persistent GI symptoms refractory to medical treatment, as failure to do so can lead to delay in the appropriate diagnosis and treatment.


Assuntos
Pólipos do Colo/patologia , Mastocitose Sistêmica/patologia , Doenças do Colo/diagnóstico , Doenças do Colo/patologia , Pólipos do Colo/diagnóstico , Pólipos do Colo/cirurgia , Colonoscopia , Feminino , Humanos , Mastocitose Sistêmica/diagnóstico , Pessoa de Meia-Idade
5.
Z Gastroenterol ; 58(10): 955-959, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33036049

RESUMO

Colonoscopy is effective in the prevention and screening of colorectal cancer. Whether terminal ileal (TI) intubation is required during conventional colonoscopy and whether it offers clinical benefits with respect to polyp detection rate (PDR) remain unclear. This retrospective study included patients who underwent colonoscopy at our hospital between July 1, 2018 and April 20, 2019. The positive findings and time for TI intubation were recorded. Univariate and multivariate analyses were performed to identify factors associated with PDR. There were 1675 patients with cecal intubation colonoscopy, including 994 (59 %) with TI intubation and 8 (1 %) with intestinal disease. The mean time for TI intubation was 40 seconds (3-338), and the mean time from cecal intubation to arrival at the deep part of TI mucosa was 24 seconds (2-118). The overall PDR was 27 %. On multivariable analysis, age > 50 years [95 % confidence interval (CI) 2.837-4.590], male sex (95 %CI, 0.406-0.649), presence of symptoms (abdominal symptoms vs. asymptomatic, 95 % CI, 1.146-2.468; stool changes vs. asymptomatic, 95 % CI, 1.070-1.834), and non-TI intubation (95 % CI, 1.040-1.648) were independent predictors of higher PDR. Trend analysis indicated decreasing trend of PDR among non-TI intubation group, 0-5 cm TI intubation group, and > 5 cm TI intubation group (30 % vs. 27 % vs. 24 %, respectively; p < 0.05). TI intubation is necessary to identify small bowel disease among a designated population, but it was not suggested to be routinely performed as part of colonoscopy, owing to limited positive intestinal findings, extra time requirement, and possible PDR worsening.


Assuntos
Pólipos do Colo/patologia , Colonoscopia/métodos , Intubação Intratraqueal , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Íleo , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Medicine (Baltimore) ; 99(40): e22581, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019473

RESUMO

RATIONALE: Angiosarcoma is a highly invasive tumour with a low incidence rate but high rates of local recurrence and distant metastasis and a poor prognosis. Understanding the endoscopic characteristics of angiosarcoma will help with early diagnosis and treatment of this disease. PATIENT CONCERNS: The patient was a 77-year-old female who was admitted to the hospital due to recurring melena for 3 months. Outpatient gastroscopy showed that the patient had multiple gastric erosions. Colonoscopy revealed the presence of multiple protruding lesions in the colon and multiple rectal polyps. Pathological biopsy indicated that the patient had a tubular adenoma, which was removed by endoscopic resection. DIAGNOSES: Postsurgical pathologic assessment suggested that the histological subtype was epithelioid angiosarcoma. Positron emission tomography-computed tomography (PET-CT) revealed multiple metastases in the lymph nodes and bone. INTERVENTIONS: The patient underwent acid suppression to protect the stomach, fluid supplementation and red blood cell infusion, and subsequently, surgery, radiotherapy and chemotherapy were recommended. The patient's family refused further treatments for the patient and requested discharge. OUTCOMES: The patient refused further treatment and was not followed-up. LESSONS: Colorectal angiosarcoma is an extremely rare and highly malignant tumour, and understanding its endoscopic morphology will help aid in its diagnosis.


Assuntos
Pólipos do Colo/diagnóstico por imagem , Hemangiossarcoma/secundário , Melena/etiologia , Adenoma/cirurgia , Idoso , Biópsia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Pólipos do Colo/patologia , Colonoscopia/métodos , Feminino , Gastroscopia/métodos , Humanos , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Melena/diagnóstico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Neoplasias Retais/patologia , Recusa do Paciente ao Tratamento
7.
Surg Clin North Am ; 100(6): 1079-1089, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33128881

RESUMO

Advanced colonic polypectomy techniques are endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), and they aim at organ preservation with low complication rates. Main goal of endoscopic submucosal dissection (ESD) is to accomplish en-bloc resection that will subsequently allow accurate histopathological evaluation. It consists of injection, circumferential incision, and dissection of the lesion. Steps of the procedure are discussed in detail along with technological advancements.


Assuntos
Pólipos do Colo/cirurgia , Colonoscopia/métodos , Ressecção Endoscópica de Mucosa/métodos , Pólipos do Colo/patologia , Dissecação/métodos , Humanos , Mucosa Intestinal/patologia , Mucosa Intestinal/cirurgia
8.
J Cancer Res Clin Oncol ; 146(11): 2861-2870, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32772171

RESUMO

PURPOSE: IGF-1Ec is an isoform of Insulin-like growth factor 1 (IGF-1) and has recently been identified to be overexpressed in cancers including prostate and neuroendocrine tumours. The aim of this paper is to investigate the expression of IGF-1Ec in colorectal cancer and polyps compared to normal colon tissues and its association with recurrent disease using semi-quantitative immunohistochemistry. METHODS: Immunohistochemistry for IGF-1Ec expression was performed for colorectal cancer, colorectal polyps and normal colonic tissues. The quantification of IGF-1Ec expression was performed with the use of Image J software and the IHC profiler plugin. Following ethics approval from the National Research Ethics Service (Reference 11/LO/1521), clinical information including recurrent disease on follow-up was collected for patients with colorectal cancer. RESULTS: Immunohistochemistry was performed in 16 patients with colorectal cancer and 11 patients with colonic polyps and compared to normal colon tissues and prostate adenocarcinoma (positive control) tissues. Significantly increased expression of IGF-1Ec was demonstrated in colorectal cancer (p < 0.001) and colorectal polyps (p < 0.05) compared to normal colonic tissues. Colonic adenomas with high-grade dysplasia had significantly higher expression of IGF-1Ec compared to low-grade dysplastic adenomas (p < 0.001). Colorectal cancers without lymph node metastases at the time of presentation had significantly higher IGF-1Ec expression compared to lymph node-positive disease (p < 0.05). No correlation with recurrent disease was identified with IGF-1Ec expression. CONCLUSION: IGF-1Ec is significantly overexpressed in colorectal cancer and polyps compared to normal colon tissues offering a potential target to improve colonoscopic identification of colorectal polyps and cancer and intraoperative identification of colorectal tumours.


Assuntos
Pólipos Adenomatosos/diagnóstico , Pólipos do Colo/diagnóstico , Neoplasias Colorretais/diagnóstico , Fator de Crescimento Insulin-Like I/metabolismo , Pólipos Adenomatosos/metabolismo , Pólipos Adenomatosos/patologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Pólipos do Colo/metabolismo , Pólipos do Colo/patologia , Neoplasias Colorretais/metabolismo , Neoplasias Colorretais/patologia , Feminino , Humanos , Imuno-Histoquímica/métodos , Fator de Crescimento Insulin-Like I/análise , Masculino
9.
Niger J Clin Pract ; 23(8): 1048-1053, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32788480

RESUMO

Aims: To describe the clinical characteristics, colonoscopic features, histological findings, dysplasia patterns, and clinical outcome of endoscopically detected colonic polyps in the Saudi population. Methods: This retrospective record review was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, on patients who underwent colonoscopy between 2005 and 2015. Patients with colorectal cancer were excluded. Data were analyzed using SPSS software. Results: Among 211 patients recruited, 66.8% were males and 66.2% were Saudi. Single polyps were detected in 45.5% of cases, while 29.9%, 18%, and 6.6% had 2, 3, and 4 polyps, respectively. Regarding the size, 81%, 17%, and 2% of the polyps were <1 cm, 1-2 cm, and >2 cm, respectively. The endoscopic examination revealed that 16.4% of the polyps were pedunculated, 82.6% were sessile, and 1% were sessile and pedunculated. About 45%, 30%, 21%, and 6.6% of the polyps were located at the rectum/sigmoid, left colon, right colon, and transverse/ascending colon, respectively. Histologically, 68.6% of polyps were adenomatous and 21.3% were non-adenomatous. Mild dysplasia was detected in almost half of the studied sample (42.3%) while moderate and severe grades of dysplasia were demonstrated in 19.2% and 38.5% of the examined polyps. Surgical intervention was required in 8.1% of cases. Conclusion: Single small-sized sessile polyps of adenomatous type and mild dysplasia are the most common polyps in the Saudi population. Sigmoid/rectum is the most common site affected, and the outcome of polyps is generally favorable.


Assuntos
Adenoma/patologia , Colo Ascendente/diagnóstico por imagem , Neoplasias do Colo/patologia , Pólipos do Colo/patologia , Colonoscopia/métodos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Colo Ascendente/patologia , Neoplasias do Colo/epidemiologia , Pólipos do Colo/epidemiologia , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/diagnóstico por imagem , Lesões Pré-Cancerosas/epidemiologia , Estudos Retrospectivos , Arábia Saudita , Distribuição por Sexo
10.
PLoS One ; 15(7): e0235902, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32701949

RESUMO

BACKGROUND: Post-colonoscopy bleeding (PCB) is an important colonoscopy quality indicator that is recommended to be routinely collected by colorectal cancer screening programs and endoscopy quality improvement programs. We created a standardized and reliable definition of PCB and set of rules for attributing the relatedness of PCB to a colonoscopy. METHODS: PCB events were identified from colonoscopies performed at the Forzani & MacPhail Colon Cancer Screening Centre. Existing definitions and relatedness rules for PCB were reviewed by the authors and a draft definition and set of rules was created. The definition and rules were revised after initial testing was performed using a set of 15 bleeding events. Information available for each event included the original endoscopy report and data abstracted from the emergency or inpatient record by a trained research assistant. A validation set of 32 bleeding events were then reviewed to assess their interrater reliability by having three endoscopists and one research assistant complete independent reviews and three endoscopists complete a consensus review. The Kappa statistic was used to measure interrater reliability. RESULTS: The panel classified 28 of 32 events as meeting the definition of PCB and rated 7, 8 and 6 events as definitely, probably and possibly related to the colonoscopy, respectively. The Kappa for the definition of PCB for the three independent reviews was 0.82 (substantial agreement). The Kappa for the attribution of the PCB to the colonoscopy by the three endosocopists was 0.74 (substantial agreement). The research assistant had a high agreement with the panel for both the definition (100% agreement) and application of the causal criteria (kappa 0.95). CONCLUSIONS: A standardized definition of PCB and attribution rules achieved high interrater reliability by endoscopists and a non-endoscopist and provides a template of required data for event adjudication by screening and quality improvement programs.


Assuntos
Colonoscopia/efeitos adversos , Hemorragia/etiologia , Neoplasias do Colo/diagnóstico , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Hemoglobinas/análise , Humanos
11.
Am J Gastroenterol ; 115(7): 980-988, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32618646

RESUMO

Advanced adenomas represent a subset of colorectal polyps that are known to confer an increased risk of colorectal neoplasia to the affected individual and their first-degree relatives (FDRs). Accordingly, professional guidelines suggest earlier and more intensive screening for FDRs of those with advanced adenomas similar to FDRs of those with colorectal cancer (CRC). Although the risk to family members is less clear among patients with advanced serrated polyps, they are often considered in the same category. Unfortunately, there is a growing concern that patients, endoscopists, and primary care providers are unaware of the familial risk associated with these polyps, leaving a wide gap in screening these high-risk individuals. Herein, we propose a standardized language around advanced colorectal polyps and present a detailed review of the literature on associated familial risk. We outline the challenges to implementing the current screening recommendations and suggest approaches to overcome these limitations, including a proposed new colonoscopy quality metric to capture communication of familial CRC risk. Improving screening in these high-risk groups has the potential to substantially reduce the burden of CRC.


Assuntos
Adenoma/genética , Adenoma/patologia , Pólipos do Colo/genética , Pólipos do Colo/patologia , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Programas de Rastreamento/métodos , Colonoscopia , Detecção Precoce de Câncer , Humanos , Risco
12.
Yonsei Med J ; 61(7): 579-586, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32608201

RESUMO

PURPOSE: The impact of changes in body mass index and waist circumference on the development of metachronous colorectal neoplasia (CRN) after polypectomy has rarely been examined. We evaluated the association between changes in overall/abdominal obesity and metachronous CRN risk. MATERIALS AND METHODS: We studied patients who underwent ≥1 adenoma removal and surveillance colonoscopy. Patients were classified into the following four groups based on the changes in overall obesity from index to follow-up colonoscopy: non-obesity persisted (group 1), obesity to non-obesity (group 2), non-obesity to obesity (group 3), and obesity persisted (group 4). Patients were also divided into another four groups based on similar changes in abdominal obesity (groups 5-8). RESULTS: The number of patients in groups 1, 2, 3, and 4 was 5074, 457, 643, and 3538, respectively, and that in groups 5, 6, 7, and 8 was 4229, 538, 656, and 2189, respectively. Group 4 had a significantly higher risk of metachronous CRN compared to groups 1 and 2. However, metachronous advanced CRN (ACRN) risk was not different among groups 1, 2, 3, and 4. Metachronous CRN risk in group 8 (abdominal obesity persisted) was higher than that in groups 5 (non-abdominal obesity persisted) and 7 (non-abdominal obesity to abdominal obesity), and tended to be higher than that in group 6 (abdominal obesity to non-abdominal obesity). Additionally, group 8 had a significantly higher risk of metachronous ACRN compared to groups 5, 6, and 7. CONCLUSION: Changes in obesity affected the metachronous CRN risk. In particular, changes in abdominal obesity affected the metachronous ACRN risk.


Assuntos
Pólipos do Colo/cirurgia , Colonoscopia/métodos , Neoplasias Colorretais/patologia , Segunda Neoplasia Primária/patologia , Obesidade Abdominal/complicações , Obesidade/complicações , Adulto , Índice de Massa Corporal , Pólipos do Colo/epidemiologia , Pólipos do Colo/patologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/etiologia , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Segunda Neoplasia Primária/epidemiologia , Segunda Neoplasia Primária/etiologia , Segunda Neoplasia Primária/cirurgia , Obesidade/epidemiologia , Obesidade Abdominal/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Circunferência da Cintura/fisiologia
13.
Hum Pathol ; 100: 24-37, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32387105

RESUMO

Distinct histomorphologic features of colitis-associated dysplasia (CAD) or neoplastic precursors in inflammatory bowel disease (IBD) have never been clearly identified. In this study, we tried to further explore the differentiating morphologic features of CAD by retrospectively reviewing the lesions that were clearly associated with carcinomas (carcinoma-related lesions) and by comparing between endoscopically nonpolypoid (non-adenoma-like) lesions and polypoid (adenoma-like) lesions and sporadic conventional adenomas found in the noncolitic mucosa and in patients without IBD. Our study results have revealed that (1) precursor lesions related to IBD-associated colorectal carcinomas were almost always nonpolypoid in macroscopic/endoscopic appearance; (2) nearly half of the carcinoma-related lesions and nonpolypoid lesions were similarly nonadenomatous (nonconventional) lesions, largely serrated type, with no or only mild/focal adenomatous dysplasia, and commonly had mixed adenomatous and nonadenomatous features; (3) carcinoma-related and nonpolypoid adenomatous dysplastic lesions frequently showed some peculiar histocytologic features that we observed and described for the first time, including mixed features of inflammatory pseudopolyps or granulation tissue, pleomorphic and disarrayed nuclei, micropapillary or hobnailing surface epithelial cells, and microvesicular or bubbling cytoplasm of dysplastic cells; and (4) polypoid lesions in the colitic mucosa were identical to sporadic adenomas in the noninflamed mucosa and in patients without IBD, and they lacked the aforementioned features. The seemingly distinctive morphologic characteristics that we proposed here, although still not absolutely specific or unique, can be used as the features of inclusion for identifying CAD on endoscopic biopsies when the endoscopy images are not readily available to pathologists and thus to alert clinicians for a closer follow-up.


Assuntos
Pólipos Adenomatosos/patologia , Colo/patologia , Pólipos do Colo/patologia , Neoplasias Colorretais/patologia , Doenças Inflamatórias Intestinais/patologia , Mucosa Intestinal/patologia , Lesões Pré-Cancerosas/patologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
Am J Surg Pathol ; 44(9): 1282-1289, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32384323

RESUMO

Colorectal carcinogenesis in familial adenomatous polyposis (FAP) follows a conventional adenoma-carcinoma sequence. However, previous studies have also reported the occurrence of traditional serrated adenomas (TSAs) in patients with FAP. In the present study, we analyzed the clinicopathologic and molecular features of 37 TSAs from 21 FAP patients. Histologically, the majority of FAP-associated TSAs showed typical cytology and slit-like serration; however, ectopic crypt formation was infrequent. Next-generation sequencing and Sanger sequencing identified KRAS and BRAF V600E mutations in 18 (49%) and 14 (38%) TSAs, respectively. Somatic APC mutations were detected in 26 lesions (84% of analyzed cases). Three lesions had BRAF non-V600E mutations, and 2 of them had a concurrent KRAS mutation. Seven TSAs (19%) were associated with a precursor polyp, 6 with a hyperplastic polyp, and 1 with a sessile serrated lesion, and all of them showed the BRAF V600E mutation. Additional sequencing analysis of 4 TSAs with a precursor polyp showed that the BRAF V600E mutation was shared between the TSA and precursor components, but APC mutations were exclusive to the TSA component in all the analyzed lesions. None of the lesions showed the high CpG island methylation phenotype. These results indicate that FAP-associated TSAs frequently have KRAS or BRAF mutations, similar to sporadic cases, and second-hit somatic APC mutations are commonly involved in their tumorigenesis as in other FAP-associated tumors. Although progression to adenocarcinoma is likely rare, tumorigenesis via the serrated pathway occurs in patients with FAP.


Assuntos
Polipose Adenomatosa do Colo/genética , Biomarcadores Tumorais/genética , Pólipos do Colo/genética , Mutação , Proteínas Proto-Oncogênicas B-raf/genética , Proteínas Proto-Oncogênicas p21(ras)/genética , Polipose Adenomatosa do Colo/patologia , Polipose Adenomatosa do Colo/cirurgia , Adolescente , Adulto , Idoso , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Progressão da Doença , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Adulto Jovem
15.
Cancer Invest ; 38(6): 339-348, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32423246

RESUMO

Data regarding computed tomography colonography, standard optical colonoscopy, and enhanced colonoscopy/histopathology at 1-year after surgery and at 6-month intervals for the next 2 years of 345 patients who faced curative surgery for colorectal cancer were included in this analysis. Computed tomography colonography and standard optical colonoscopy both detected 298 polyps as suspicious. With reference to enhanced colonoscopy/histopathology, sensitivities for the detection of any polyps for computed tomography colonography and standard optical colonoscopy were 0.952 and 0.906, while, accuracies were 0.783 and 0.641, respectively. Computed tomography colonography may be a sensitive and accurate surveillance tool for colorectal cancer patients.


Assuntos
Pólipos do Colo/diagnóstico , Colonografia Tomográfica Computadorizada , Colonoscopia , Neoplasias Colorretais/diagnóstico , Adulto , Idoso , Pólipos do Colo/diagnóstico por imagem , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
16.
JAMA Netw Open ; 3(4): e203398, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32324237

RESUMO

Importance: Histologic classification of colorectal polyps plays a critical role in screening for colorectal cancer and care of affected patients. An accurate and automated algorithm for the classification of colorectal polyps on digitized histopathologic slides could benefit practitioners and patients. Objective: To evaluate the performance and generalizability of a deep neural network for colorectal polyp classification on histopathologic slide images using a multi-institutional data set. Design, Setting, and Participants: This prognostic study used histopathologic slides collected from January 1, 2016, to June 31, 2016, from Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, with 326 slides used for training, 157 slides for an internal data set, and 25 for a validation set. For the external data set, 238 slides for 179 distinct patients were obtained from 24 institutions across 13 US states. Data analysis was performed from April 9 to November 23, 2019. Main Outcomes and Measures: Accuracy, sensitivity, and specificity of the model to classify 4 major colorectal polyp types: tubular adenoma, tubulovillous or villous adenoma, hyperplastic polyp, and sessile serrated adenoma. Performance was compared with that of local pathologists' at the point of care identified from corresponding pathology laboratories. Results: For the internal evaluation on the 157 slides with ground truth labels from 5 pathologists, the deep neural network had a mean accuracy of 93.5% (95% CI, 89.6%-97.4%) compared with local pathologists' accuracy of 91.4% (95% CI, 87.0%-95.8%). On the external test set of 238 slides with ground truth labels from 5 pathologists, the deep neural network achieved an accuracy of 87.0% (95% CI, 82.7%-91.3%), which was comparable with local pathologists' accuracy of 86.6% (95% CI, 82.3%-90.9%). Conclusions and Relevance: The findings suggest that this model may assist pathologists by improving the diagnostic efficiency, reproducibility, and accuracy of colorectal cancer screenings.


Assuntos
Pólipos do Colo/diagnóstico , Pólipos do Colo/patologia , Interpretação de Imagem Assistida por Computador/métodos , Redes Neurais de Computação , Algoritmos , Aprendizado Profundo , Histocitoquímica , Humanos , Sensibilidade e Especificidade
17.
PLoS One ; 15(4): e0231880, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32315365

RESUMO

BACKGROUND: Evidence has shown that deep learning computer aided detection (CADe) system achieved high overall detection accuracy for polyp detection during colonoscopy. AIM: The detection performance of CADe system on non-polypoid laterally spreading tumors (LSTs) and sessile serrated adenomas/polyps (SSA/Ps), with higher risk for malignancy transformation and miss rate, has not been exclusively investigated. METHODS: A previously validated deep learning CADe system for polyp detection was tested exclusively on LSTs and SSA/Ps. 1451 LST images from 184 patients were collected between July 2015 and January 2019, 82 SSA/Ps videos from 26 patients were collected between September 2018 and January 2019. The per-frame sensitivity and per-lesion sensitivity were calculated. RESULTS: (1) For LSTs image dataset, the system achieved an overall per-image sensitivity and per-lesion sensitivity of 94.07% (1365/1451) and 98.99% (197/199) respectively. The per-frame sensitivity for LST-G(H), LST-G(M), LST-NG(F), LST-NG(PD) was 93.97% (343/365), 98.72% (692/701), 85.71% (324/378) and 85.71% (6/7) respectively. The per-lesion sensitivity of each subgroup was 100.00% (71/71), 100.00% (64/64), 98.31% (58/59) and 80.00% (4/5). (2) For SSA/Ps video dataset, the system achieved an overall per-frame sensitivity and per-lesion sensitivity of 84.10% (15883/18885) and 100.00% (42/42), respectively. CONCLUSIONS: This study demonstrated that a local-feature-prioritized automatic CADe system could detect LSTs and SSA/Ps with high sensitivity. The per-frame sensitivity for non-granular LSTs and small SSA/Ps should be further improved.


Assuntos
Adenoma/diagnóstico , Colonoscopia , Neoplasias Colorretais/diagnóstico , Processamento de Imagem Assistida por Computador/métodos , Adenoma/patologia , Pólipos do Colo/patologia , Neoplasias Colorretais/patologia , Aprendizado Profundo , Humanos
19.
Dig Dis Sci ; 65(7): 1951-1953, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32157495

RESUMO

INTRODUCTION: Lipomas are the most common non-epithelial benign tumors of the gastrointestinal tract with a reported incidence in the colon of 0.2-4.4%. These lesions are usually asymptomatic with a typical endoscopic finding of a smooth, slightly yellow, circular, polyp that is sessile in most cases, covered with normal colonic mucosa. AREAS COVERED: There are rare reported cases of alterations of the overlying mucosa such as hyperplasia, atrophy, adenomatous changes, and necrosis. EXPERT COMMENTARY: We report a rare case of pedunculated colonic lipoma of the transverse colon covered with hyperplastic and ulcerated epithelium easily misdiagnosed as an adenomatous lesion.


Assuntos
Adenoma/diagnóstico , Neoplasias do Colo/patologia , Pólipos do Colo/patologia , Mucosa Intestinal/patologia , Lipoma/patologia , Úlcera/patologia , Idoso , Colo Transverso , Neoplasias do Colo/diagnóstico , Pólipos do Colo/diagnóstico , Colonoscopia , Diagnóstico Diferencial , Feminino , Humanos , Hiperplasia , Lipoma/diagnóstico , Sangue Oculto
20.
Dis Colon Rectum ; 63(6): 842-849, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32118624

RESUMO

BACKGROUND: The optimal strategy for colonic polyps not amenable to traditional endoscopic polypectomy is unknown. Endoscopic step up is a promising strategy for definitive treatment. OBJECTIVE: The purpose of this study was to determine whether endoscopic step up leads to improved outcomes and decreased costs compared with planned colectomy for endoscopically unresectable colon polyps. DESIGN: This was a retrospective review of a prospective database. SETTING: The study was conducted at a tertiary referral center. PATIENTS: Consecutive patients referred for endoscopically unresectable colon polyps 15 to 50 mm in size were included. INTERVENTIONS: Patients underwent planned colectomy or endoscopic step up at the surgeon's discretion. Endoscopic step up began with diagnostic colonoscopy in the operating room. If the polyp was amenable to endoscopic removal, endoscopic mucosal resection or endoscopic submucosal dissection was performed with progression to combined endoscopic-laparoscopic surgery or laparoscopic colectomy, as indicated. MAIN OUTCOME MEASURES: The primary outcome was 30-day adverse events. We also examined length of stay, hospital charges, insurer payments, and polyp recurrence. RESULTS: A total of 52 patients underwent planned colectomy (48 laparoscopic), and 38 underwent endoscopic step up (28 endoscopic mucosal resection, 2 endoscopic submucosal dissection, 6 combined endoscopic-laparoscopic surgery, and 2 colectomy). Compared with planned colectomy, endoscopic step-up patients had fewer complications (13% vs 33%; p = 0.03) and shorter length of stay (median, 0 vs 4 d; p < 0.001). There was 1 readmission in the endoscopic step-up group and 5 in the planned colectomy group. Endoscopic step-up patients had lower hospital costs ($4790 vs $13,004; p < 0.001) and insurer payments ($2431 vs $19,951; p < 0.001). One-year polyp recurrence-free survival was 84% (95% CI, 67%-93%) in endoscopic step-up patients. All of the recurrences were benign, <1 cm, and managed endoscopically. LIMITATIONS: The study was limited by its nonrandomized design and short follow-up. CONCLUSIONS: An endoscopic step-up approach to colon polyps is associated with less morbidity, decreased healthcare costs, and colon preservation in 95% of patients. Additional studies are needed to evaluate long-term quality of life and polyp recurrence in this group. See Video Abstract at http://links.lww.com/DCR/B188. ENDOSCOPIC STEP UP: UNA ALTERNATIVA A COLECTOMíA PARA PRESERVACIóN DE COLON CON LOS PROPóSITOS DE MEJORAR RESULTADOS Y REDUCIR COSTOS EN PACIENTES CON PóLIPOS NEOPLáSICOS AVANZADOS: Se desconoce la estrategia óptima para los pólipos de colon no susceptibles a la polipectomia endoscópica tradicional. Endoscopic Step Up es una estrategia prometedora para el tratamiento definitivo.Determinar si Endoscopic Step Up produce mejores resultados y menores costos en comparación con la colectomía programada para pólipos de colon endoscópicamente no resecables.Revisión retrospectiva de una base de datos prospectiva.Centro de referencia de tercer nivel.Pacientes consecutivos remitidos para pólipos de colon endoscópicamente irresecables de tamaño 15-50 mm.Los pacientes se sometieron a colectomía programada o Endoscópico Step Up a discreción del cirujano. Endoscopic Step Up comenzó con una colonoscopia diagnóstica en el quirófano. Si el pólipo era susceptible de extirpación endoscópica, la resección endoscópica de la mucosa o la disección submucosa endoscópica se realizaba con progresión a cirugía endoscópica-laparoscópica combinada o colectomía laparoscópica, según a cosnideraciones clínicas en el transoperatorio.El resultado primario fue los eventos adversos a 30 días. Duración de la estadía hospitalaria, los cargos hospitalarios, los pagos de las aseguradoras y la recurrencia de pólipos también fueron examinados.Un total de 52 pacientes se sometieron a colectomía programada (48 laparoscópicas) y 38 se sometieron a Endoscopic Step Up (28 resección endoscópica de la mucosa, 2 disección submucosa endoscópica, 6 cirugía endoscópica-laparoscópica combinada y 2 colectomía). En comparación con la colectomía programada los pacientes endoscópicos Step Up tuvieron menos complicaciones (13% versus 33%, p = 0.03) y una estadía hospitalaria más corta (mediana 0 versus 4 días, p <0.001). Hubo 1 reingreso hospitalario en el grupo Endoscopic Step Up y 5 en el grupo de colectomía programada. Los pacientes endoscópicos Step Up tuvieron costos hospitalarios más bajos ($ 4,790 versus $ 13,004, p <0,001) y pagos de la aseguradora ($ 2,431 versus $ 19,951, p <0,001). La supervivencia libre de recurrencia de pólipos a un año fue del 84% (IC 95% 67-93) en pacientes endoscópicos Step Up. Todas las recurrencias fueron benignas, <1 cm, y manejadas endoscópicamente.Diseño no aleatorizado y seguimiento corto.El abordaje endoscópico Step Up para pólipos de colon se asocia con menos morbilidad, disminución de los costos de atención médica y preservación del colon en el 95% de los pacientes. Se ocupan más estudios para evaluar la calidad de vida a largo plazo y la recurrencia de pólipos en este grupo. Consulte Video Resumen en http://links.lww.com/DCR/B188. (Traducción-Dr Adrián Ortega Robles).


Assuntos
Colectomia/efeitos adversos , Pólipos do Colo/cirurgia , Colonoscopia/métodos , Ressecção Endoscópica de Mucosa/efeitos adversos , Idoso , Estudos de Casos e Controles , Colectomia/métodos , Pólipos do Colo/patologia , Terapia Combinada/métodos , Gerenciamento de Dados , Ressecção Endoscópica de Mucosa/economia , Ressecção Endoscópica de Mucosa/métodos , Feminino , Seguimentos , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Laparoscopia/métodos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Ensaios Clínicos Controlados não Aleatórios como Assunto/métodos , Preservação de Órgãos/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Qualidade de Vida , Estudos Retrospectivos , Centros de Atenção Terciária
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