Objectives -The aim of this study was to evaluate the histological characteristics of adenomatous polyps (AP), non adenomatous polyps (NAP), and colorectal cancers (CRC) diagnosed in the greater Paris area. Material a...Objectives -The aim of this study was to evaluate the histological characteristics of adenomatous polyps (AP), non adenomatous polyps (NAP), and colorectal cancers (CRC) diagnosed in the greater Paris area. Material and methods -Pathologists filled out an identification and histological questionnaire for each biopsy or surgical specimen received between 20/09/02 and 20/12/02, which had at least one colorectal polyp or CRC, taken from a patient of the greater Paris area. Results -The participation rate of pathologists was 73.3%and 10 396 patients with 16 681 lesions were included. Lesions consisted in 1 223 CRC among 1 107 patients, 9 280 AP and 6 178 NAP. Mean age of patients with CRC was 68 years, with at least one AP without CRC 62 years, and with at least one NAP without CRC or AP 58 years. The mean number of polyps per patient was 1.4, and increased with age. Average size of AP was larger than that of NAP and the size increased with age for AP but not NAP. pTNM staging of CRC was: pT0, 1%pT1, 4%pT2, 13%pT3, 63%pT4, 19%N0, 55%N1, 24%N2, 19%Nx, 2%. Conclusion -This study provides detailed data on colorectal polyps and colorectal cancers in the greater Paris region, which does not have a cancer registry. Repeated surveys could be helpful for evaluating the efficacy of screening programs in the general population.展开更多
Background: This prospective study compared multislice CT colonography with ultra-low-dose technique to high-resolution videocolonoscopy as the standard for detection of colorectal cancer and polyps. Methods: After st...Background: This prospective study compared multislice CT colonography with ultra-low-dose technique to high-resolution videocolonoscopy as the standard for detection of colorectal cancer and polyps. Methods: After standard bowel preparation,115 patients underwent multislice CT colonography with an ultra-low-dose multislice CT colonography protocol immediately before videocolonoscopy. After noise reduction by using a mathematical algorithm, ultra-low-dose multislice CT colonographic images were analyzed in blinded fashion,and the results were compared with the results of high-resolution videocolonoscopy. Results: A total of 150 lesions weredetected by high-resolution videocolonoscopy in 115 patients.For ultra-low-dose multislice CT colonography, sensitivities for detection of polyps less than 5 mm in size, 5 to 10 mm, and greater than 10 mm in diameter were 76% , 91% , and 100% , respectively.Although the sensitivity for detection of flat lesions was only 50% , the sensitivity and the specificity for detection of polyps 5 mm or greater in size were 94% and 84% ,respectively. For adenomatous lesions greater than 5 mm in size, sensitivity was 94% and specificity was 92% . The overall specificity was 79% . The calculated effective radiation dose ranged between 0.75 and 1.25 mSv. Conclusions: Compared with high-resolution videocolonoscopy, ultra-low-dose multislice CT colonography has excellent sensitivity and specificity for detection of colorectal lesions 5 mm or greater in size, and the radiation exposure is relatively low. However, before this technique can be generally recommended for colorectal screening,further improvement in the detection of flat and extremely small lesions must be achieved.展开更多
PURPOSE: The probability of colorectal cancer is moderately increased among carriers of the APC I1307K polymorphism. However, it is not known if endoscopic surveillance of this high-risk group is warranted. The preval...PURPOSE: The probability of colorectal cancer is moderately increased among carriers of the APC I1307K polymorphism. However, it is not known if endoscopic surveillance of this high-risk group is warranted. The prevalence of polyps and adenomas in specimens of colorectal cancer who are carriers and noncarriers of the APC I1307K polymorphism is compared. METHOD: Prevalence of adenomatous polyps in the pathology specimens of the study participants, stratified by their APC I1307K polymorphism status, was studied in 900 consecutive cases of colorectal cancer diagnosed in northern Israel between 1998 and 2002, within the framework of a population-based, case-controlled study (MECC Study). RESULTS: The APC I1307K mutation was detected in 78 colorectal cancer cases (8.7 percent) of the study population. Prevalence was higher among Ashkenazi Jews (11.2 percent) than among non-Ashkenazi Jews (2.7 percent) or Arabs (3.1 percent). After adjustment for age, APC I1307K carriers were significantly more likely than non-carriers to have polyps in their surgical specimen (51.3 percent vs. 32.6 percent, P = 0.002). Adenomas with a tubular component (either tubular adenomas or tubulovillous adenomas), but not villous adenomas, were significantly more frequent among carriers (37.2 percent vs. 23.6 percent, P = 0.005). CONCLUSION: Together with former evidence of I1307K being a risk factor for colorectal cancer, these data suggest that colonoscopic surveillance for colorectal adenomas and cancer may be warranted in I1307K carriers, even in the absence of other identifiable risk factors.展开更多
Background & Aims: To date, computed tomographic (CT)colonography has been compared with an imperfect test,colonoscopy, and has been mainly assessed in patients with positive screening test results or symptoms. Th...Background & Aims: To date, computed tomographic (CT)colonography has been compared with an imperfect test,colonoscopy, and has been mainly assessed in patients with positive screening test results or symptoms. Therefore, the available data may not apply to screening of patients with a personal or family history of colorectal polyps or cancer (increased risk). We prospectively investigated the ability of CT colonography to identify individuals with large (≥ 10 mm) colorectal polyps in consecutive patients at increased risk for colorectal cancer. Methods: A total of 249 consecutive patients at increased risk for colorectal cancer underwent CT colonography before colonoscopy. Two reviewers interpreted CT colonography examinations independently. Sensitivity, specificity, and predictive values were determined after meticulous matching of CT colonography with colonoscopy. Unexplained large falsepositive findings were verified with a second-look colonoscopy.Results: In total, 31 patients (12% ) had 48 large polyps at colonoscopy.This included 8 patients with 8 large polyps that were overlooked initially and detected at the second-look colonoscopy.In 6 of 8 patients, the missed polyp was the only large lesion. With CT colonography, 84% of patients (26/31)with large polyp(s) were identified, paired for a specificity of 92% (200-201/218). Positive and negative predictive values were 59%-60% (26/43-44) and 98% (200-201/205-206), respectively.CT colonography detected 75%-77% (36-37/48) of large polyps, with 9 of the missed lesions being flat. Conclusions:CT colonography and colonoscopy have a similar ability to identify individuals with large polyps in patients at increased risk for colorectal cancer. The large proportion of missed flat lesions warrants further study.展开更多
文摘Objectives -The aim of this study was to evaluate the histological characteristics of adenomatous polyps (AP), non adenomatous polyps (NAP), and colorectal cancers (CRC) diagnosed in the greater Paris area. Material and methods -Pathologists filled out an identification and histological questionnaire for each biopsy or surgical specimen received between 20/09/02 and 20/12/02, which had at least one colorectal polyp or CRC, taken from a patient of the greater Paris area. Results -The participation rate of pathologists was 73.3%and 10 396 patients with 16 681 lesions were included. Lesions consisted in 1 223 CRC among 1 107 patients, 9 280 AP and 6 178 NAP. Mean age of patients with CRC was 68 years, with at least one AP without CRC 62 years, and with at least one NAP without CRC or AP 58 years. The mean number of polyps per patient was 1.4, and increased with age. Average size of AP was larger than that of NAP and the size increased with age for AP but not NAP. pTNM staging of CRC was: pT0, 1%pT1, 4%pT2, 13%pT3, 63%pT4, 19%N0, 55%N1, 24%N2, 19%Nx, 2%. Conclusion -This study provides detailed data on colorectal polyps and colorectal cancers in the greater Paris region, which does not have a cancer registry. Repeated surveys could be helpful for evaluating the efficacy of screening programs in the general population.
文摘Background: This prospective study compared multislice CT colonography with ultra-low-dose technique to high-resolution videocolonoscopy as the standard for detection of colorectal cancer and polyps. Methods: After standard bowel preparation,115 patients underwent multislice CT colonography with an ultra-low-dose multislice CT colonography protocol immediately before videocolonoscopy. After noise reduction by using a mathematical algorithm, ultra-low-dose multislice CT colonographic images were analyzed in blinded fashion,and the results were compared with the results of high-resolution videocolonoscopy. Results: A total of 150 lesions weredetected by high-resolution videocolonoscopy in 115 patients.For ultra-low-dose multislice CT colonography, sensitivities for detection of polyps less than 5 mm in size, 5 to 10 mm, and greater than 10 mm in diameter were 76% , 91% , and 100% , respectively.Although the sensitivity for detection of flat lesions was only 50% , the sensitivity and the specificity for detection of polyps 5 mm or greater in size were 94% and 84% ,respectively. For adenomatous lesions greater than 5 mm in size, sensitivity was 94% and specificity was 92% . The overall specificity was 79% . The calculated effective radiation dose ranged between 0.75 and 1.25 mSv. Conclusions: Compared with high-resolution videocolonoscopy, ultra-low-dose multislice CT colonography has excellent sensitivity and specificity for detection of colorectal lesions 5 mm or greater in size, and the radiation exposure is relatively low. However, before this technique can be generally recommended for colorectal screening,further improvement in the detection of flat and extremely small lesions must be achieved.
文摘PURPOSE: The probability of colorectal cancer is moderately increased among carriers of the APC I1307K polymorphism. However, it is not known if endoscopic surveillance of this high-risk group is warranted. The prevalence of polyps and adenomas in specimens of colorectal cancer who are carriers and noncarriers of the APC I1307K polymorphism is compared. METHOD: Prevalence of adenomatous polyps in the pathology specimens of the study participants, stratified by their APC I1307K polymorphism status, was studied in 900 consecutive cases of colorectal cancer diagnosed in northern Israel between 1998 and 2002, within the framework of a population-based, case-controlled study (MECC Study). RESULTS: The APC I1307K mutation was detected in 78 colorectal cancer cases (8.7 percent) of the study population. Prevalence was higher among Ashkenazi Jews (11.2 percent) than among non-Ashkenazi Jews (2.7 percent) or Arabs (3.1 percent). After adjustment for age, APC I1307K carriers were significantly more likely than non-carriers to have polyps in their surgical specimen (51.3 percent vs. 32.6 percent, P = 0.002). Adenomas with a tubular component (either tubular adenomas or tubulovillous adenomas), but not villous adenomas, were significantly more frequent among carriers (37.2 percent vs. 23.6 percent, P = 0.005). CONCLUSION: Together with former evidence of I1307K being a risk factor for colorectal cancer, these data suggest that colonoscopic surveillance for colorectal adenomas and cancer may be warranted in I1307K carriers, even in the absence of other identifiable risk factors.
文摘Background & Aims: To date, computed tomographic (CT)colonography has been compared with an imperfect test,colonoscopy, and has been mainly assessed in patients with positive screening test results or symptoms. Therefore, the available data may not apply to screening of patients with a personal or family history of colorectal polyps or cancer (increased risk). We prospectively investigated the ability of CT colonography to identify individuals with large (≥ 10 mm) colorectal polyps in consecutive patients at increased risk for colorectal cancer. Methods: A total of 249 consecutive patients at increased risk for colorectal cancer underwent CT colonography before colonoscopy. Two reviewers interpreted CT colonography examinations independently. Sensitivity, specificity, and predictive values were determined after meticulous matching of CT colonography with colonoscopy. Unexplained large falsepositive findings were verified with a second-look colonoscopy.Results: In total, 31 patients (12% ) had 48 large polyps at colonoscopy.This included 8 patients with 8 large polyps that were overlooked initially and detected at the second-look colonoscopy.In 6 of 8 patients, the missed polyp was the only large lesion. With CT colonography, 84% of patients (26/31)with large polyp(s) were identified, paired for a specificity of 92% (200-201/218). Positive and negative predictive values were 59%-60% (26/43-44) and 98% (200-201/205-206), respectively.CT colonography detected 75%-77% (36-37/48) of large polyps, with 9 of the missed lesions being flat. Conclusions:CT colonography and colonoscopy have a similar ability to identify individuals with large polyps in patients at increased risk for colorectal cancer. The large proportion of missed flat lesions warrants further study.
