Disagreement between high confidence endoscopic adenoma prediction and histopathological diagnosis in colonic lesions ≤ 3 mm in size

Endoscopy ◽  
2019 ◽  
Vol 51 (03) ◽  
pp. 221-226 ◽  
Author(s):  
Prasanna Ponugoti ◽  
Amit Rastogi ◽  
Tonya Kaltenbach ◽  
Margaret MacPhail ◽  
Andrew Sullivan ◽  
...  
Keyword(s):  
Gold Standard ◽  
Normal Tissue ◽  
Normal Mucosa ◽  
Poor Quality ◽  
Colorectal Polyps ◽  
Histopathological Diagnosis ◽  
High Confidence ◽  
Endoscopic Appearance ◽  
Specimen Handling ◽  
Tissue Specimens

Abstract Background Diminutive colorectal polyps resected during colonoscopy are sometimes histologically interpreted as normal tissue. The aim of this observational study was to explore whether errors in specimen handling or processing account in part for polyps ≤ 3 mm in size being interpreted as normal tissue by pathology when they were considered high confidence adenomas by an experienced endoscopist at colonoscopy. Methods One endoscopist photographed 900 consecutive colorectal lesions that were ≤ 3 mm in size and considered endoscopically to be high confidence conventional adenomas. The photographs were reviewed blindly to eliminate poor quality images. The remaining 644 endoscopy images were reviewed by two external experts who predicted the histology while blinded to the pathology results. Results Of 644 consecutive lesions ≤ 3 mm in size considered high confidence conventional adenomas by a single experienced colonoscopist, 15.4 % were reported as normal mucosa by pathology. The prevalence of reports of normal mucosa in polyps removed by cold snare and cold forceps were 15.2 % and 16.0 %, respectively. When endoscopy photographs were reviewed by two blinded outside experts, the lesions found pathologically to be adenomas and normal mucosa were interpreted as high confidence adenomas by endoscopic appearance in 96.9 % and 93.9 %, respectively, by Expert 1 (P = 0.15), and in 99.6 % and 100 %, respectively, by Expert 2 (P = 0.51). Conclusion Retrieval and/or processing of tissue specimens of tiny colorectal polyps resulted in some lesions being diagnosed as normal tissue by pathology despite being considered endoscopically to be high confidence adenomas. These findings suggest that pathology interpretation is not a gold standard for lesion management when this phenomenon is observed.

scholarly journals Definition of competence standards for optical diagnosis of diminutive colorectal polyps: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Endoscopy ◽  
2021 ◽  
Author(s):  
Britt B. S. L. Houwen ◽  
Cesare Hassan ◽  
Veerle M. H. Coupé ◽  
Marjolein J. E. Greuter ◽  
Yark Hazewinkel ◽  
...  
Keyword(s):  
Gold Standard ◽  
Literature Search ◽  
Gastrointestinal Endoscopy ◽  
Colorectal Neoplasia ◽  
Position Statement ◽  
Colorectal Polyps ◽  
Optical Diagnosis ◽  
High Confidence ◽  
Level Of Agreement

Abstract Background The European Society of Gastrointestinal Endoscopy (ESGE) has developed a core curriculum for high quality optical diagnosis training for practice across Europe. The development of easy-to-measure competence standards for optical diagnosis can optimize clinical decision-making in endoscopy. This manuscript represents an official Position Statement of the ESGE aiming to define simple, safe, and easy-to-measure competence standards for endoscopists and artificial intelligence systems performing optical diagnosis of diminutive colorectal polyps (1 – 5 mm). Methods A panel of European experts in optical diagnosis participated in a modified Delphi process to reach consensus on Simple Optical Diagnosis Accuracy (SODA) competence standards for implementation of the optical diagnosis strategy for diminutive colorectal polyps. In order to assess the clinical benefits and harms of implementing optical diagnosis with different competence standards, a systematic literature search was performed. This was complemented with the results from a recently performed simulation study that provides guidance for setting alternative competence standards for optical diagnosis. Proposed competence standards were based on literature search and simulation study results. Competence standards were accepted if at least 80 % agreement was reached after a maximum of three voting rounds. Recommendation 1 In order to implement the leave-in-situ strategy for diminutive colorectal lesions (1–5 mm), it is clinically acceptable if, during real-time colonoscopy, at least 90 % sensitivity and 80 % specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1–5 mm in the rectosigmoid. Histopathology is used as the gold standard.Level of agreement 95 %. Recommendation 2 In order to implement the resect-and-discard strategy for diminutive colorectal lesions (1–5 mm), it is clinically acceptable if, during real-time colonoscopy, at least 80 % sensitivity and 80 % specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1–5 mm. Histopathology is used as the gold standard.Level of agreement 100 %. Conclusion The developed SODA competence standards define diagnostic performance thresholds in relation to clinical consequences, for training and for use when auditing the optical diagnosis of diminutive colorectal polyps.

scholarly journals Association between colorectal cancer and Fusobacterium nucleatum and Bacteroides fragilis bacteria in Iranian patients: a preliminary study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Aref Shariati ◽  
Shabnam Razavi ◽  
Ehsanollah Ghaznavi-Rad ◽  
Behnaz Jahanbin ◽  
Abolfazl Akbari ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Relative Abundance ◽  
Normal Tissue ◽  
Bacteroides Fragilis ◽  
Fusobacterium Nucleatum ◽  
Normal Mucosa ◽  
Clinicopathologic Characteristics ◽  
Tissue Samples ◽  
Adjacent Normal Mucosa ◽  
Iranian Patients

Abstract Background and aim Recent studies have proposed that commensal bacteria might be involved in the development and progression of gastrointestinal disorders such as colorectal cancer (CRC). Therefore, in this study, the relative abundance of Fusobacterium nucleatum, Bacteroides fragilis, Streptococcus bovis/gallolyticus, and Enteropathogenic Escherichia coli (EPEC) in CRC tissues, and their association with clinicopathologic characteristics of CRC was investigated in Iranian patients. Moreover, the role of these bacteria in the CRC-associated mutations including PIK3CA, KRAS, and BRAF was studied. Method To these ends, the noted bacteria were quantified in paired tumors and normal tissue specimens of 30 CRC patients, by TaqMan quantitative Real-Time Polymerase Chain Reaction (qPCR). Next, possible correlations between clinicopathologic factors and mutations in PIK3CA, KRAS, and BRAF genes were analyzed. Results In studied samples, B. fragilis was the most abundant bacteria that was detected in 66 and 60% of paired tumor and normal samples, respectively. Furthermore, 15% of the B. fragilis-positive patients were infected with Enterotoxigenic B. fragilis (ETBF) in both adenocarcinoma and matched adjacent normal samples. F. nucleatum was also identified in 23% of tumors and 13% of adjacent normal tissue samples. Moreover, the relative abundance of these bacteria determined by 2-ΔCT was significantly higher in CRC samples than in adjacent normal mucosa (p < 0.05). On the other hand, our findings indicated that S. gallolyticus and EPEC, compared to adjacent normal mucosa, were not prevalent in CRC tissues. Finally, our results revealed a correlation between F. nucleatum-positive patients and the KRAS mutation (p = 0.02), while analyses did not show any association between bacteria and mutation in PIK3CA and BRAF genes. Conclusion The present study is the first report on the analysis of different bacteria in CRC tissue samples of Iranian patients. Our findings revealed that F. nucleatum and B. fragilis might be linked to CRC. However, any link between gut microbiome dysbiosis and CRC remains unknown.

Clinical outcome prediction in esophageal adenocarcinoma based on tumor and germ-line single nucleotide polymorphisms (SNP) in DNA-repair pathways

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15144-15144 ◽  
Author(s):  
H. Yoon ◽  
K. M. Murphy ◽  
M. K. Gibson
Keyword(s):  
Dna Repair ◽  
Tumor Cells ◽  
Esophageal Adenocarcinoma ◽  
Cell Lines ◽  
Normal Tissue ◽  
Germ Line ◽  
Normal Mucosa ◽  
Snp Analysis ◽  
Dna Repair Genes ◽  
Repair Genes

15144 Background: Germ-line SNPs in DNA repair enzymes are studied as predictive factors in various cancers. More rarely studied, however, is the presence of SNPs in tumor cells and how they relate to both germ-line SNPs as well as outcome. We explored the presence of and relationship between germ-line and tumor SNPs in esophageal adenocarcinoma using two systems: (1) Cell lines, to determine whether loss of heterozygosity (LOH) occurs near DNA repair genes, and for genotyping; (2) Patient samples, to determine whether SNPs differ between normal and tumor mucosa. Methods: (1) For LOH analysis, we examined three short tandem repeat (STR) loci on 19q13.2- 13.3 (near DNA-repair genes XPD, ERCC1, and XRCC1) in four esophageal adenocarcinoma cell lines. (The STR markers have a false positive rate of <10-3 for LOH when all three demonstrate homozygosity.) Then, using a real-time PCR allelic discrimination TaqMan assay (AB), we analyzed two SNPs of interest in these cell lines. (2) We performed SNP analysis on tumor and adjacent normal mucosa from paraffin-embedded esophageal specimens taken at resection in patients with T3N0–1 esophageal adenocarcinoma who received preoperative cisplatin, paclitaxel, gefitinib and radiotherapy followed by transhiatal resection. Results: (1) Cell lines: SEG1 and BiC1 were consistent with LOH, showing a single-allele pattern at XPD 751 (C allele) and XPD 312 (G allele). TE7 and SKGT4 did not have LOH. (2) Tumor and normal tissue: We obtained data on two patients for XPD 751. Genotypes in normal mucosa were heterozygous for one patient and homozygous at the minor allele (Q/Q) for the second patient. Genotypes in tumor were identical to those in normal tissue. Conclusions: Our cell line data shows that LOH occurs in esophageal tumor cells at DNA-repair genes of interest. Our data in two patients with esophageal adenocarcinoma did not demonstrate a difference at XPD 751 between tumor and normal tissue. Given the technical success and encouraging data from this work, we plan to evaluate tissue from ∼90 patients who underwent preoperative cisplatin-based chemoradiotherapy followed by surgery (as part of completed ECOG trial E1201). [Table: see text]

scholarly journals Obestatin/ghrelin cells in normal mucosa and endocrine tumours of the stomach

2009 ◽  
Vol 160 (6) ◽  
pp. 941-949 ◽  
Author(s):  
Apostolos V Tsolakis ◽  
Lars Grimelius ◽  
Mats Stridsberg ◽  
Sture E Falkmer ◽  
Helge L Waldum ◽  
...  
Keyword(s):  
Gastric Mucosa ◽  
Endocrine Cells ◽  
Plasma Concentrations ◽  
Normal Mucosa ◽  
Normal Gastric Mucosa ◽  
Biopsy Material ◽  
Endocrine Tumours ◽  
Ecl Cells ◽  
Cellular Expression ◽  
Tissue Specimens

ObjectiveObestatin and ghrelin are derived from the same gene and co-expressed in the same endocrine cells. Vesicular monoamine transporter-2 (VMAT-2), a marker for enterochromaffin-like (ECL) cells, is considered to be expressed in ghrelin cells. The aim was to establish if the two peptides and the transporter are co-expressed, both in normal gastric mucosa and in gastric endocrine tumours.DesignAn immunohistochemical study was performed on gastric biopsy material and on surgical specimens from 63 patients with gastric endocrine tumours and from individuals with normal gastric mucosa. Cells displaying obestatin immunoreactivity were examined regarding co-localization with ghrelin and VMAT-2. Both single- and double-immunostaining techniques were applied. Obestatin concentration in blood was measured in a subgroup of these patients. The results were correlated to various clinico-pathological parameters.ResultsIn the normal mucosa, obestatin/ghrelin-immunoreactive cells rarely co-expressed VMAT-2. In most tumour tissue specimens, only a fraction of neoplastic cells displayed immunoreactivity to obestatin, and these cells always co-expressed ghrelin. Neoplastic obestatin-/ghrelin-IR cells invariably expressed VMAT-2, except for two ghrelinomas. The obestatin concentrations in blood were consistently low and did not correlate to clinico-pathological data.ConclusionsObestatin and ghrelin immunoreactivity always occurred in the same endocrine cells in the gastric mucosa but these cells only occasionally co-expressed VMAT-2, opposite to the findings in tumours. These results indicate that endocrine cells expressing obestatin and ghrelin mainly differ from VMAT-2 expressing cells (ECL-cells) and can develop into pure ghrelinomas. Plasma concentrations of obestatin did not correlate to cellular expression.

scholarly journals Digital Chromoendoscopy for Diagnosis of Diminutive Colorectal Lesions

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Carlos Eduardo Oliveira dos Santos ◽  
Daniele Malaman ◽  
César Vivian Lopes ◽  
Júlio Carlos Pereira-Lima ◽  
Artur Adolfo Parada
Keyword(s):  
Gold Standard ◽  
Morphological Analysis ◽  
Pattern Analysis ◽  
Randomized Study ◽  
Indigo Carmine ◽  
High Accuracy ◽  
Histopathological Diagnosis ◽  
Hyperplastic Polyps ◽  
Pit Pattern ◽  
Virtual Chromoendoscopy

Introduction. To compare the accuracy of digital and real-time chromoendoscopy for the differential diagnosis of diminutive (<5 mm) neoplastic and nonneoplastic colorectal lesions. Materials and Methods. This is a prospective randomized study comparing the Fujinon intelligent color enhancement (FICE) system (65 patients/95 lesions) and indigo carmine (69 patients/120 lesions) in the analysis of capillary meshwork and pit pattern, respectively. All lesions were less than 5 mm in diameter, and magnification was used in both groups. Histopathology was the gold standard examination. Results. Of 215 colorectal lesions, 153 (71.2%) were adenomas, and 62 were hyperplastic polyps (28.8%). Morphological analysis revealed 132 (61.4%) superficial lesions, with 7 (3.3%) depressed lesions, and 83 (38.6%) protruding lesions. Vascular meshwork analysis using FICE and magnification resulted in 91.7% sensitivity, 95.7% specificity, and 92.6% accuracy in differentiating neoplastic from nonneoplastic lesions. Pit pattern analysis with indigo carmine and magnification showed 96.5% sensitivity, 88.2% specificity, and 94.2% accuracy for the same purpose. Conclusion. Both magnifying virtual chromoendoscopy and indigo carmine chromoendoscopy showed high accuracy in the histopathological diagnosis of colorectal lesions less than 5 mm in diameter.

scholarly journals Multiplexed proteomics and imaging of resolving and lethal SARS-CoV-2 infection in the lung

2020 ◽  
Author(s):  
Marian Kalocsay ◽  
Zoltan Maliga ◽  
Ajit J. Nirmal ◽  
Robyn J. Eisert ◽  
Gary A. Bradshaw ◽  
...  
Keyword(s):  
Immune System ◽  
Normal Tissue ◽  
Molecular Level ◽  
Rhesus Macaques ◽  
Primary Site ◽  
Disease Response ◽  
New Methods ◽  
Combined Use ◽  
Multiplexed Imaging ◽  
Tissue Specimens

ABSTRACTNormal tissue physiology and repair depends on communication with the immune system. Understanding this communication at the molecular level in intact tissue requires new methods. The consequences of SARS-CoV-2 infection, which can result in acute respiratory distress, thrombosis and death, has been studied primarily in accessible liquid specimens such as blood, sputum and bronchoalveolar lavage, all of which are peripheral to the primary site of infection in the lung. Here, we describe the combined use of multiplexed deep proteomics with multiplexed imaging to profile infection and its sequelae directly in fixed lung tissue specimens obtained from necropsy of infected animals and autopsy of human decedents. We characterize multiple steps in disease response from cytokine accumulation and protein phosphorylation to activation of receptors, changes in signaling pathways, and crosslinking of fibrin to form clots. Our data reveal significant differences between naturally resolving SARS-CoV-2 infection in rhesus macaques and lethal COVID-19 in humans. The approach we describe is broadly applicable to other tissues and diseases.SummaryProteomics of infected tissue reveals differences in inflammatory and thrombotic responses between resolving and lethal COVID-19.

Tumor Markers in Squamous Cell Carcinoma of Esophagus: Immunometric Assay in Cytosol and Membrane Fraction

1990 ◽  
Vol 5 (1) ◽  
pp. 7-13 ◽  
Author(s):  
M. Gion ◽  
C. Tremolada ◽  
R. Mione ◽  
R. Dittadi ◽  
P. Della Palma ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Tumor Markers ◽  
Squamous Cell ◽  
Membrane Fraction ◽  
Normal Tissue ◽  
Normal Mucosa ◽  
Tumor Burden ◽  
Esophageal Mucosa ◽  
Carcinoma Of The Esophagus

Carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), ferritin, and the monoclonal antibody-detected tumor-associated antigens CA19.9 and CA50 were measured by radioimmunoassay in tissue fractions of carcinoma and normal esophageal mucosa from 59 patients with untreated primary squamous cell carcinoma of the esophagus. Tumor markers were measured in cytosol (118 samples) and in a membrane-enriched fraction (32 samples). CEA, TPA and ferritin were detected in almost all the cytosol samples evaluated, CA19.9 and CA50 in 66% and 50% of cases respectively. Ferritin was significantly higher in carcinoma than in normal mucosa. The cytosol concentrations of CEA, TPA, CA19.9 and CA50 were not significantly different in carcinoma and normal tissue. Concentrations of CEA, CA19.9 and CA50 in the membrane fraction tended to be higher in normal tissue than in carcinoma, whereas the cytosol-to-membrane ratio was significantly higher in carcinoma. For CEA, CA19.9 and CA50, the phenotypic pattern of the malignant transformation seems to involve a different intracellular distribution rather than a quantitative change. No correlations were found between tissue and serum concentrations of the tumor markers, the former being related to the phenotypic characteristics of the tumor, the latter to the tumor burden.

The Endometrium

2007 ◽  
Vol 131 (3) ◽  
pp. 372-382 ◽  
Author(s):  
Steven G. Silverberg
Keyword(s):  
Myometrial Invasion ◽  
Daily Practice ◽  
Endometrial Biopsy ◽  
Classification Systems ◽  
Specimen Handling ◽  
Consensus Statements ◽  
Intraepithelial Carcinoma ◽  
Error Recognition ◽  
Tissue Specimens ◽  
Diagnostic Pitfalls

Abstract Context.—Endometrial tissue specimens are commonly encountered in daily practice. It is well known that a number of problematic diagnostic scenarios occur relative to these specimens. Objective.—To emphasize practical aspects of endometrial specimen handling and reporting, with selected comments on common diagnostic pitfalls, including (1) the diagnosis of endometrial intraepithelial carcinoma in atrophic endometrial biopsy specimens, (2) evaluation of adequacy of endometrial sampling specimens, (3) problems in diagnosing and measuring the depth of myometrial invasion in endometrial carcinoma, (4) the question of metastasis versus independent primaries in concurrent carcinomas of endometrium and one or both ovaries, (5) the problematic differential diagnoses between type 1 (primarily endometrioid) and type 2 (primarily serous) adenocarcinomas, and (6) atypical hyperplasia and proposed classification systems for its replacement. Data Sources.—Published literature, consensus statements, and personal experience. Conclusions.—A systematic approach to the handling and reporting of endometrial specimens reduces the potential for omission and error. Recognition of diagnostic pitfalls and practical approaches to their resolution help improve quality.

High Confidence Optical Diagnosis Of Small Polyps at Colonoscopy Versus Histopathology: Moving Towards a New Gold Standard?

2021 ◽  
Author(s):  
A Ahmad ◽  
A Wilson ◽  
M Moorghen ◽  
A Dhillon ◽  
S Thomas-Gibson ◽  
...  
Keyword(s):  
Gold Standard ◽  
Optical Diagnosis ◽  
High Confidence

Advanced Endoscopic Technologies to Improve the Diagnosis of Colorectal Polyps

2022 ◽  
Author(s):  
Maria Daca Alvarez ◽  
Liseth Rivero-Sanchez ◽  
Maria Pellisé
Keyword(s):  
Gold Standard ◽  
Detection Rate ◽  
Colorectal Polyps ◽  
Diagnostic Colonoscopy ◽  
Risk Of Death ◽  
The Past ◽  
Technological Advances ◽  
Adenoma Detection ◽  
Neoplastic Lesions

AbstractColonoscopy is the gold standard for colorectal cancer (CRC) prevention. The main quality indicator of colonoscopy is the adenoma detection rate, which is inversely associated with the risk of interval CRC and the risk of death from this neoplasia. In the setting of CRC prevention, diagnostic colonoscopy has undergone a remarkable evolution in the past 20 years. Hand in hand with the implementation of CRC prevention programs and technological advances, we are now able to identify tiny and subtle neoplastic lesions and predict their histology with great efficiency. In this article, we briefly review the endoscopy technologies that can be used to improve the detection and characterization of colorectal polyps.

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