Detection of early gastric cancer using hydro-stomach CT:Blinded vs unblinded analysis

AIM:To evaluate the difference in diagnostic performance of hydro-stomach computed tomography(CT) to detect early gastric cancer(EGC) between blinded and unblinded analysis and to assess independent factors affecting visibility of cancer foci.METHODS:Two radiologists initially blinded and then unblinded to gastroscopic and surgical-histological findings independently reviewed hydro-stomach CT images of 110 patients with single EGC.They graded the visibility of cancer foci for each of three gastric segments(upper,middle and lower thirds) using a 4-point scale(1:definitely absent,2:probably absent,3:probably present,and 4:definitely present).The sensitivity and specificity for detecting an EGC were calculated.Intraobserver and interobserver agreements were analyzed.The visibility of an EGC was evaluated with regard to tumor size,invasion depth,gastric segments,histological type and gross morphology using univariate and multivariate analysis.RESULTS:The respective sensitivities and specificities [reviewer 1:blinded,20%(22/110) and 98%(215/220);unblinded,27%(30/110) and 100%(219/220)/reviewer 2:blinded,19%(21/110) and 98%(216/220);unblinded,25%(27/110) and 98%(215/220)] were not significantly different.Although intraobserver agreements were good(weighted κ = 0.677 and 0.666),interobserver agreements were fair(blinded,0.371) or moderate(unblinded,0.558).For both univariate and multivariate analyses,the tumor size and invasion depth were statistically significant factors affecting visibility.CONCLUSION:The diagnostic performance of hydrostomach CT to detect an EGC was not significantly different between blinded and unblinded analysis.The tumor size and invasion depth were independent factors for visibility.

Early detection of pancreatic cancer

Pancreatic adenocarcinoma is a low-incident but highly mortal disease. It accounts for only 3% of estimated new cancer cases each year but is currently the fourth common cause of cancer mortality. By 2030, it is expected to be the 2nd leading cause of cancer death. There is a clear need to diagnose and classify pancreatic cancer at earlier stages in order to give patients the best chance at a definitive cure through surgery. Three precursor lesions that distinctly lead to pancreatic adenocarcinoma have been identified, and we have increasing understanding the non-genetic and genetic risk factors for the disease. With increased understanding about the risk factors, the familial patters, and associated accumulation of genetic mutations involved in pancreatic cancer, we know that there are mutations that occur early in the development of pancreatic cancer and that improved genetic risk-based strategies in screening for pancreatic cancer may be possible and successful at saving or prolonging lives. The remaining challenge is that current standards for diagnosing pancreatic cancer remain too invasive and too costly for widespread screening for pancreatic cancer. Furthermore, the promises of noninvasive methods of detection such as blood, saliva, and stool remain underdeveloped or lack robust testing. However, significant progress has been made, and we are drawing closer to a strategy for the screening and early detection of pancreatic cancer.

A double constrained robust capon beamforming based imaging method for early breast cancer detection

Ultra-wideband （UWB） microwave images are proposed for detecting small malignant breast tumors based on the large contrast of electric parameters between a malignant tumor and normal breast tissue. In this study, an antenna array composed of 9 antennas is applied to the detection. The double constrained robust capon beamforming （DCRCB） algorithm is used for reconstructing the breast image due to its better stability and high signal-to-interference-plus-noise ratio （SINR）. The successful detection of a tumor of 2 mm in diameter shown in the reconstruction demonstrates the robustness of the DCRCB beamforming algorithm. This study verifies the feasibility of detecting small breast tumors by using the DCRCB imaging algorithm.

Advancements in Barrett's esophagus detection:The role of artificial intelligence and its implications

Artificial intelligence(AI)is making significant strides in revolutionizing the detection of Barrett's esophagus(BE),a precursor to esophageal adenocarcinoma.In the research article by Tsai et al,researchers utilized endoscopic images to train an AI model,challenging the traditional distinction between endoscopic and histological BE.This approach yielded remarkable results,with the AI system achieving an accuracy of 94.37%,sensitivity of 94.29%,and specificity of 94.44%.The study's extensive dataset enhances the AI model's practicality,offering valuable support to endoscopists by minimizing unnecessary biopsies.However,questions about the applicability to different endoscopic systems remain.The study underscores the potential of AI in BE detection while highlighting the need for further research to assess its adaptability to diverse clinical settings.

Applications of artificial intelligence in, early detection of cancer, clinical diagnosis and personalized medicine

Artificial intelligence(AI)refers to the simulation of human intelligence in machines programmed to convert raw input data into decision-making actions,like humans.AI programs are designed to make decisions,often using deep learning and computer-guided programs that analyze and process raw data into clinical decision making for effective treatment.New techniques for predicting cancer at an early stage are needed as conventional methods have poor accuracy and are not applicable to personalized medicine.AI has the potential to use smart,intelligent computer systems for image interpretation and early diagnosis of cancer.AI has been changing almost all the areas of the medical field by integrating with new emerging technologies.AI has revolutionized the entire health care system through innovative digital diagnostics with greater precision and accuracy.AI is capable of detecting cancer at an early stage with accurate diagnosis and improved survival outcomes.AI is an innovative technology of the future that can be used for early prediction,diagnosis and treatment of cancer.

Novel automated non-invasive detection of ocular surface squamous neoplasia using artificial intelligence

Ocular surface squamous neoplasia(OSSN)is a common eye surface tumour,characterized by the growth of abnormal cells on the ocular surface.OSSN includes invasive squamous cell carcinoma(SCC),in which tumour cells penetrate the basement membrane and infiltrate the stroma,as well as non-invasive conjunctival intraepithelial neoplasia,dysplasia,and SCC in-situ thereby presenting a challenge in early detection and diagnosis.Early identification and precise demarcation of the OSSN border leads to straightforward and curative treatments,such as topical medicines,whereas advanced invasive lesions may need orbital exenteration,which carries a risk of death.Artificial intelligence(AI)has emerged as a promising tool in the field of eye care and holds potential for its application in OSSN management.AI algorithms trained on large datasets can analyze ocular surface images to identify suspicious lesions associated with OSSN,aiding ophthalmologists in early detection and diagnosis.AI can also track and monitor lesion progression over time,providing objective measurements to guide treatment decisions.Furthermore,AI can assist in treatment planning by offering personalized recommendations based on patient data and predicting the treatment response.This manuscript highlights the role of AI in OSSN,specifically focusing on its contributions in early detection and diagnosis,assessment of lesion progression,treatment planning,telemedicine and remote monitoring,and research and data analysis.

Abnormal DNA methylation as a cell-free circulating DNA biomarker for colorectal cancer detection:A review of literature

Colorectal cancer(CRC) is one of the most prevalent malignancies in the world. CRC-associated morbidity and mortality is continuously increasing, in part due to a lack of early detection. The existing screening tools such as colonoscopy, are invasive and yet high cost, affecting the willingness of patients to participate in screening programs. In recent years, evidence is accumulating that the interaction of aberrant genetic and epigenetic modifications is the cornerstone for the CRC development and progression by alternating the function of tumor suppressor genes, DNA repair genes and oncogenes of colonic cells. Apart from the understanding of the underlying mechanism(s) of carcinogenesis, the aforementioned interaction has also allowed identification of clinical biomarkers, especially epigenetic, for the early detection and prognosis of cancer patients. One of the ways to detect these epigenetic biomarkers is the cell-free circulating DNA(circ DNA), a blood-based cancer diagnostic test, mainly focusing in the molecular alterations found in tumor cells, such as DNA mutations and DNA methylation.In this brief review, we epitomize the current knowledge on the research in circ DNA biomarkers-mainly focusing on DNA methylation-as potential blood-based tests for early detection of colorectal cancer and the challenges for validation and globally implementation of this emergent technology.

Useful detection of CD147 (EMMPRIN) for pathological diagnosis of early hepatocellular carcinoma in needle biopsy samples

AIM:To make clear whether CD147 (EMMPRIN) expression in pathological tumor samples with a fine-needle aspiration biopsy is useful for pathological diagnosis of early hepatocellular carcinoma (HCC). METHODS:Twenty-two patients (15 men and 7 women; median age 68 years,range 56-81 years) underwent a liver tissue biopsy in order to make a diagnosis of HCC. Paraffin-embedded liver biopsy tissue samples from 22 patients were stained with anti-CD147 antibody,murine monoclonal antibody 12C3 (MAb12C3) for immunohistochemical analysis. An immunohistochemical analysis of CD147 was performed and the degree of staining compared between tumor and non-tumor tissue. In addition,the degree of staining within tumor tissue was compared according to a number of clinicopathological variables. RESULTS:The degree of staining of CD147 was significantly higher in tumor tissues than non-tumor tissues,even in tumors less than 15 mm in diameter.The expression of this protein was significantly elevated in HCC tissue specimens from patients with a low value of serum AST and γ-GTP.

Acceptance on colorectal cancer screening upper age limit in South Korea

BACKGROUND The Korea National Cancer Screening Program currently provides screening for colorectal cancer(CRC)for adults older than 50 years with no upper age limit.In general,people are likely to only pay attention to the benefits of cancer screening and to neglect its risks.Most consider the benefits of cancer screening as being far greater than the risks and are unaware that any potential benefits and harms can vary with age.AIM To report acceptance of an upper age limit for CRC screening and factors associated therewith among cancer-free individuals in Korea.METHODS The present study analyzed data from the Korea National Cancer Screening Survey 2017,a nationally representative random sample of 4500 Korean individuals targeted for screening for the five most common types of cancer.A total of 1922 participants were included in the final analysis.The baseline characteristics of the study population are presented as unweighted numbers and weighted proportions.Both univariate and multivariate logistic regression models were developed to examine factors related with acceptance of an upper age limit for CRC screening;subgroup analysis was also applied.RESULTS About 80%(1554/1922)of the respondents agreed that CRC screening should not be offered for individuals older than 80 years.Specifically,those who had never been screened for CRC had the highest acceptance rate(91%).Overall,screening history for CRC[screened by both fecal occult blood test and colonoscopy,adjusted odds ratio(aOR)=0.33,95%CI:0.22-0.50]and other cancers(aOR=0.55,95%CI:0.34-0.87),as well as a family history of cancer(aOR=0.66,95%CI:0.50-0.87),were negatively associated with acceptance of an upper age limit for CRC screening.In contrast,metropolitan residents(aOR=1.86,95%CI:1.29-2.68)and people who exercised regularly(aOR=1.42,95%CI:1.07-1.89)were more likely to accept an upper age limit.After subgrouping,we found gender,marital status,and lifetime smoking history among never-screened individuals and residential region,family history of cancer,and physical activity among never-screened individuals to be associated with acceptance of an upper age limit.CONCLUSION This study describes acceptance of an upper age limit for CRC screening and factors associated with it,and provides perspectives that should be considered,in addition to scientific evidence,when developing population-based cancer screening policies and programs.

Chinese national clinical practice guidelines on prevention,diagnosis and treatment of early colorectal cancer

Background:The incidence and mortality of colorectal cancer(CRC)in China are increasing in recent years.The clarified pathogenesis and detectable precancerous lesions of CRC make it possible to prevent,screen,and diagnose CRC at an early stage.With the development of endoscopic and surgical techniques,the choice of treatment for early CRC is also worth further discussion,and accordingly,a standard follow-up program after treatment needs to be established.Methods:This clinical practice guideline(CPG)was developed following the recommended process of the World Health Organization,adopting Grading of Recommendations Assessment,Development and Evaluation(GRADE)in assessing evidence quality,and using the Evidence to Decision framework to formulate clinical recommendations,thereby minimizing bias and increasing transparency of the CPG development process.We used the Reporting Items for practice Guidelines in HealThcare(RIGHT)statement and Appraisal of Guidelines for Research and Evaluation II(AGREE II)as reporting and conduct guides to ensure the guideline’s completeness and transparency.Results:This CPG comprises 46 recommendations concerning prevention,screening,diagnosis,treatment,and surveillance of CRC.In these recommendations,we have indicated protective and risk factors for CRC and made recommendations for chemoprevention.We proposed a suitable screening program for CRC based on the Chinese context.We also provided normative statements for the diagnosis,treatment,and surveillance of CRC based on existing clinical evidence and guidelines.Conclusions:The 46 recommendations in this CPG are formed with consideration for stakeholders’values and preferences,feasibility,and acceptability.Recommendations are generalizable to resource-limited settings with similar CRC epidemiology pattern as China.

Usefulness of CA 19–9 for pancreatic cancer screening in patients with new-onset diabetes

Background： Generally, carbohydrate antigen 19–9 （CA 19–9） is not useful for screening pancreatic cancerin the asymptomatic general population. This study aimed to evaluate the utility of CA 19–9 level as a screening indicator of pancreatic cancer in asymptomatic patients with new-onset diabetes.

Fecal immunochemical test accuracy in average-risk colorectal cancer screening

AIM: To assess the fecal immunochemical test (FIT) accuracy for colorectal cancer (CRC) and advanced neoplasia (AN) detection in CRC screening.

Health beliefs toward lung cancer screening among Chinese American high-risk smokers:Interviews based on Health Belief Model

Objective This study aims to explore health beliefs toward lung cancer screening with low dose computed tomography among Chinese American high-risk smokers.Methods Guided by the Health Belief Model,semi-structured individual interviews were conducted with Chinese American high-risk smokers via phone.Additional questionnaires on demographic information,history of smoking and lung cancer screening were collected via email or phone before the interview,depending on participants’preference.Content analysis was used to extract meaningful and significant themes in the dataset.Constant comparison analysis and process coding were used to categorize and code data.Results Data saturation was reached after interviewing 12 participants.Chinese American high-risk smokers perceived a low susceptibility to lung cancer,since they believed various protective factors of lung cancer(e.g.,doing exercise,healthy diet,etc.)reduced their risk of getting lung cancer.All the participants perceived a high severity of lung cancer.They acknowledged lung cancer would have a huge impact on their life.Perceived benefits of lung cancer screening were accurate in most aspects although minor confusions were still noticed among this population.Perceived barriers varied on participants’,physicians’,and institutional levels.High-risk Chinese American smokers had little confidence to screening for lung cancer.Cues to action for them to screening for lung cancer included recommendations from health care providers,support from family members and friends,and information shared on Chinese-based social media.Conclusions Misconceptions and barriers to screening for lung cancer existed widely among Chinese American high-risk smokers.Intervention programs and targeted health education should be implemented to promote lung cancer screening among this population.

Cancer/testis antigen, Kita-Kyushu lung cancer antigen-1 and ABCD stratification for diagnosing gastric cancers

BACKGROUND The ABCD stratification[combination of serum pepsinogen(PG)levels and titers of antibody(immunoglobulin G,IgG)against Helicobacter pylori(H.pylori)]is effective for the classification of individuals at risk of developing gastric cancer(GC).The Kita–Kyushu lung cancer antigen-1(KK-LC-1)is a Cancer/Testis antigen frequently expressed in GC.AIM To evaluate the effectiveness of KK-LC-1 and ABCD stratification in the diagnosis of GC.METHODS We analyzed the gene expression of KK-LC-1 in surgical specimens obtained from GC tumors.The levels of serum PG I/PG II and IgG against H.pylori were measured.According to their serological status,the patients were classified into the four groups of the ABCD stratification.RESULTS Of the 77 examined patients,63(81.8%)expressed KK-LC-1.The IgG titers of H.pylori and PG II were significantly higher in patients expressing KK-LC-1 than those measured in patients not expressing KK-LC-1(P=0.0289 and P=0.0041,respectively).The expression of KK-LC-1 in group C[PG method(+)/H.pylori infection(+)]was as high as 93.9%high.KK-LC-1 was also detected in group A[-/-].CONCLUSION The KK-LC-1 expression in GC was associated with H.pylori infection and atrophic status,so that,KK-LC-1 may be a useful marker for the diagnosis of GC.

Affinity peptide developed by phage display selection for targeting gastric cancer

AIM:To develop an affinity peptide that binds to gastric cancer used for the detection of early gastric cancer.METHODS:A peptide screen was performed by biopanning the PhD-12 phage display library,clearing non-specific binders against tumor-adjacent normal appearing gastric mucosa and obtaining selective binding against freshly harvested gastric cancer tissues.Tumortargeted binding of selected peptides was confirmed by bound phage counts,enzyme-linked immunosorbent assay,competitive inhibition,fluorescence microscopy and semi-quantitative analysis on immunohistochemistry using different types of cancer tissues.RESULTS:Approximately 92.8% of the non-specific phage clones were subtracted from the original phage library after two rounds of biopanning against normal-appearing gastric mucosa.After the third round of positive screening,the peptide sequence AADNAKTKSFPV(AAD) appeared in 25%(12/48) of the analyzed phages.For the control peptide,these values were 6.8 ± 2.3,5.1 ± 1.7,3.5 ± 2.1,4.6 ± 1.9 and 1.1 ± 0.5,respectively.The values for AAD peptide were statistically signif icant(P < 0.01) for gastric cancer as compared with other histological classif ications and control peptide.CONCLUSION:A novel peptide is discovered to have a specific binding activity to gastric cancer,and can be used to distinguish neoplastic from normal gastric mucosa,demonstrating the potential for early cancer detection on endoscopy.

Colorectal cancer screening in the COVID-19 era

Colorectal cancer(CRC)is the third most diagnosed form of cancer and second most deadly cancer worldwide.Introduction of better screening has improved both incidence and mortality.However,as the coronavirus disease 2019(COVID-19)pandemic began,healthcare resources were shunted away from cancer screening services resulting in a sharp decrease in CRC screening and a backlog of patients awaiting screening tests.This may have significant effects on CRC cancer mortality,as delayed screening may lead to advanced cancer at diagnosis.Strategies to overcome COVID-19 related disruption include utilizing stool-based cancer tests,developing screening protocols based on individual risk factors,expanding telehealth,and increasing open access colonoscopies.In this review,we will summarize the effects of COVID-19 on CRC screening,the potential longoutcomes,and ways to adapt CRC screening during this global pandemic.

Uptake of prostate cancer screening and associated factors among Chinese men aged 50 or more: a population-based survey

Objective: To investigate the uptake rate of prostate specific antigen(PSA) testing among Hong Kong Chinese males aged 50 or above, and identify factors associated with the likelihood of undergoing a PSA test.Methods: A population-based telephone survey was conducted in Hong Kong in 2007. The survey covered demographic information, perceived health status, use of complementary therapy, cancer screening behavior, perceived susceptibility to cancer and family history of cancer. Descriptive statistics, percentages and logistic regression analysis were used for data analysis.Results: A total of 1,002 men aged 50 or above took part in the study(response rate =67%), and the uptake rate of PSA testing was found to be 10%. Employment status, use of complementary therapy, perceiving regular visits to a doctor as good for health and the recommendations of health professionals were significant factors associated with PSA testing.Conclusion: The uptake rate of PSA testing in the study population was very low. Among all the factors identified, recommendations from health professionals had the strongest association with the uptake of PSA testing, and they should therefore take an active role in educating this population about cancer prevention and detection.

Impact of colorectal cancer screening participation in remote northern Canada:A retrospective cohort study

BACKGROUND Screening provides earlier colorectal cancer(CRC)detection and improves outcomes.It remains poorly understood if these benefits are realized with screening guidelines in remote northern populations of Canada where CRC rates are nearly twice the national average and access to colonoscopy is limited.AIM To evaluate the participation and impact of CRC screening guidelines in a remote northern population.METHODS This retrospective cohort study included residents of the Northwest Territories,a northern region of Canada,age 50-74 who underwent CRC screening by a fecal immunohistochemical test(FIT)between January 1,2014 to March 30,2019.To assess impact,individuals with a screen-detected CRC were compared to clinically-detected CRC cases for stage and location of CRC between 2014-2016.To assess participation,we conducted subgroup analyses of FIT positive individuals exploring the relationships between signs and symptoms of CRC at the time of screening,wait-times for colonoscopy,and screening outcomes.Two sample Welch t-test was used for normally distributed continuous variables,Mann-Whitney-Wilcoxon Tests for data without normal distribution,and Chi-square goodness of fit test for categorical variables.A P value of<0.05 was considered to be statistically significant.RESULTS 6817 fecal tests were completed,meaning an annual average screening rate of 25.04%,843(12.37%)were positive,629 individuals underwent a follow-up colonoscopy,of which,24.48%had advanced neoplasia(AN),5.41%had CRC.There were no significant differences in stage,pathology,or location between screen-detected cancers and clinically-detected cancers.In assessing participation and screening outcomes,we observed 49.51%of individuals referred for colonoscopy after FIT were ineligible for CRC screening,most often due to signs and symptoms of CRC.Individuals were more likely to have AN if they had signs and symptoms of cancer at the time of screening,waited over 180 d for colonoscopy,or were indigenous[respectively,estimated RR 1.1895%CI of RR(0.89-1.59)];RR 1.523(CI:1.035,2.240);RR 1.722(CI:1.165,2.547)].CONCLUSION Screening did not facilitate early cancer detection but facilitated higher than anticipated AN detection.Signs and symptoms of CRC at screening,and long colonoscopy wait-times appear contributory.

Practical considerations for colorectal cancer screening in older adults

Recent guidelines recommend that colorectal cancer(CRC)screening after age 75 be considered on an individualized basis,and discourage screening for people over 85 due to competing causes of mortality.Given the heterogeneity in the health of older individuals,and lack of data within current guidelines for personalized CRC screening approaches,there remains a need for a clearer framework to inform clinical decision-making.A revision of the current approach to CRC screening in older adults is even more compelling given the improvements in CRC treatment,post-treatment survival,and increasing life expectancy in the population.In this review,we aim to examine the personalization of CRC screening cessation based on specific factors influencing life and health expectancy such as comorbidity,frailty,and cognitive status.We will also review screening modalities and endoscopic technique for minimizing risk,the risks of screening unique to older adults,and CRC treatment outcomes in older patients,in order to provide important information to aid CRC screening decisions for this age group.This review article offers a unique approach to this topic from both the gastroenterologist and geriatrician perspective by reviewing the use of specific clinical assessment tools,and addressing technical aspects of screening colonoscopy and periprocedural management to mitigate screening-related complications.

Current and future opportunities for liquid biopsy of circulating biomarkers to aid in early cancer detection

Early diagnosis of cancer can significantly improve treatment and survival outcomes.Imaging and tissue biopsy are the gold standard diagnostic approaches but are costly,invasive,and often unable to detect early-stage tumors.The past decade has marked an acceleration in the discovery and development of liquid biopsy tests for aiding in the detection of various types of tumor markers in non-tissue samples,such as blood.Liquid biopsy markers include circulating tumor cells,as well as tumor cell fragments,nucleic acids,and proteins.Liquid biopsy may be useful in screening patients considered to be at high risk of developing cancer,for refining diagnosis when combined with other test results,and for early detection of recurrence.Advances in big data analytics,informatics,and artificial intelligence will make it possible to combine patient history,clinical data,and liquid biopsy marker profiles to achieve more accurate and earlier diagnosis.In this review,we summarize the current use of liquid biopsy in cancer care,including the development of multi-analyte panels to improve diagnostic accuracy and detect several cancer types in a single assay.We highlight recent advances for potential future applications of liquid biopsy to aid in the diagnosis of early-stage lung cancer.We also discuss the opportunities and challenges of integrating liquid biopsy into current algorithms for cancer screening and diagnosis.