Curriculum review: colorectal cancer surveillance and management of dysplasia in IBD

The significantly increased risk of colorectal cancer (CRC) in longstanding colonic inflammatory bowel disease (IBD) justifies the need for endoscopic surveillance. Unlike sporadic CRC, IBD-related CRC does not always follow the predictable sequence of low-grade to high-grade dysplasia and finally to invasive carcinoma, probably because the genetic events shared by both diseases occur in different sequences and frequencies. Surveillance is recommended for patients who have had colonic disease for at least 8-10 years either annually, every 3 years or every 5 years with the interval dependant on the presence of additional risk factors. Currently, the recommended endoscopic strategy is high-definition chromoendoscopy with targeted biopsies, although the associated lengthier procedure time and need for experienced endoscopists has limited its uniform uptake in daily practice. There is no clear consensus on the management of dysplasia, which continues to be a challenging area particularly when endoscopically invisible. Management options include complete resection (and/or referral to a tertiary centre), close surveillance or proctocolectomy. Technical advances in endoscopic imaging such as confocal laser endomicroscopy, show exciting potential in increasing dysplasia detection rates but are still far from being routinely used in clinical practice.

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Novel Diagnostic and Therapeutic Techniques for Surveillance of Dysplasia in Patients with Inflammatory Bowel Disease

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2014/825947 ◽

2014 ◽

Vol 28 (7) ◽

pp. 361-370 ◽

Cited By ~ 16

Author(s):

M Iacucci ◽

T Uraoka ◽

M Fort Gasia ◽

N Yahagi

Keyword(s):

Colorectal Cancer ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

New Technologies ◽

Therapeutic Management ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

High Definition ◽

Neoplastic Lesions ◽

Inflammatory Bowel

The risk for developing dysplasia and colorectal cancer in patients with longstanding inflammatory bowel disease (IBD) involving the colon is well documented. Random biopsies during white-light, standard-definition colonoscopy (33 to 50 biopsies) with or without dye spraying chromoendoscopy has been the recommended strategy in North America to detect dysplastic lesions in IBD. However, there are several limitations to this approach including poor physician adherence, poor sensitivity, increased procedure time and considerable cost. The new generation of high-definition endoscopes with electronic filter technology provide an opportunity to visualize colonic mucosal and vascular patterns in minute detail, and to identify subtle flat, multifocal, polypoid and pseudopolypoid neoplastic and non-neoplastic lesions. The application of these new technologies in IBD is slowly being adopted in clinical practice. In addition, the advent of confocal laser endomicroscopy provides an opportunity to explore real-time histology, thus redefining the understanding and characterization of the lesions in IBD. There is emerging evidence that serrated adenomas are also associated with longstanding IBD colitis and may be recognized as another important contributing factor to colorectal cancer development. The circumscribed neoplastic lesions can be treated using endoscopic therapeutic management such as mucosal resection or, especially, endoscopic submucosal dissection. This may replace panproctocolectomy in selected patients. The authors review the potential of these techniques to transform endoscopic diagnosis and therapeutic management of dysplasia in IBD.

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Choice of faecal immunochemical test matters: comparison of OC-Sensor and HM-JACKarc, in the assessment of patients at high risk of colorectal cancer

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2020-1170 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Caroline J. Chapman ◽

Ayan Banerjea ◽

David J Humes ◽

Jaren Allen ◽

Simon Oliver ◽

...

Keyword(s):

Colorectal Cancer ◽

Clinical Decision Making ◽

Full Range ◽

Clinical Decision ◽

Detection Rates ◽

Faecal Immunochemical Test ◽

Specimen Collection ◽

Increased Risk ◽

Immunochemical Test

AbstractObjectivesCurrently, NICE recommends the use of faecal immunochemical test (FIT) at faecal haemoglobin concentrations (f-Hb) of 10 μg Hb/g faeces to stratify for colorectal cancer (CRC) risk in symptomatic populations. This f-Hb cut-off is advised across all analysers, despite the fact that a direct comparison of analyser performance, in a clinical setting, has not been performed.MethodsTwo specimen collection devices (OC-Sensor, OC-S; HM-JACKarc, HM-J) were sent to 914 consecutive individuals referred for follow up due to their increased risk of CRC. Agreement of f-Hb around cut-offs of 4, 10 and 150 µg Hb/g faeces and CRC detection rates were assessed. Two OC-S devices were sent to a further 114 individuals, for within test comparisons.ResultsA total of 732 (80.1%) individuals correctly completed and returned two different FIT devices, with 38 (5.2%) CRCs detected. Median f-Hb for individuals diagnosed with and without CRC were 258.5 and 1.8 µg Hb/g faeces for OC-S and 318.1 and 1.0 µg Hb/g faeces for HM-J respectively. Correlation of f-Hb results between OC-S/HM-J over the full range was rho=0.74, p<0.001. Using a f-Hb of 4 µg Hb/g faeces for both tests found an agreement of 88.1%, at 10 µg Hb/g faeces 91.7% and at 150 µg Hb/g faeces 96.3%. A total of 114 individuals completed and returned two OC-S devices; correlation across the full range was rho=0.98, p<0.001.ConclusionsWe found large variations in f-Hb when different FIT devices were used, but a smaller variation when the same FIT device was used. Our data suggest that analyser-specific f-Hb cut-offs are applied with regard to clinical decision making, especially at lower f-Hb.

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S1426: High-Definition In-Vivo Probe-Based Confocal Laser Endomicroscopy of the Common Bile Duct

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2010.03.200 ◽

2010 ◽

Vol 71 (5) ◽

pp. AB158-AB159 ◽

Cited By ~ 1

Author(s):

Frederick K. Shieh ◽

Michael H. Nathanson ◽

Hillary Drumm ◽

Priya A. Jamidar

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

High Definition ◽

The Common

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Probe-based confocal laser endomicroscopy and Barrett's esophagus – just a scientific toy or significant improvement in diagnosis?

Digestive Diseases ◽

10.1159/000516257 ◽

2021 ◽

Author(s):

Luka Vranić ◽

Tin Nadarević ◽

Davor Štimac

Keyword(s):

Diagnostic Accuracy ◽

Real Time ◽

Barrett’S Esophagus ◽

Predictive Value ◽

Barrett's Esophagus ◽

High Reliability ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Imaging Method ◽

Increased Risk

Background: Barrett’s esophagus (BE) requires surveillance to identify potential neoplasia at early stage. Standard surveillance regimen includes random four-quadrant biopsies by Seattle protocol. Main limitations of random biopsies are high risk of sampling error, difficulties in histology interpretation, common inadequate classification of pathohistological changes, increased risk of bleeding and time necessary to acquire the final diagnosis. Probe-based confocal laser endomicroscopy (pCLE) has emerged as a potential tool with an aim to overcome these obvious limitations. Summary: pCLE represents real-time microscopic imaging method that offers evaluation of epithelial and subepithelial structures with 1000-fold magnification. In theory, pCLE has potential to eliminate the need for biopsy in BE patient. The main advantages would be real-time diagnosis and decision making, greater diagnostic accuracy and to evaluate larger area compared to random biopsies. Clinical pCLE studies in esophagus show high diagnostic accuracy and its high negative predictive value offers high reliability and confidence to exclude dysplastic and neoplastic lesions. However, it still cannot replace histopathology due to lower positive predictive value and sensitivity. Key messages: Despite promising results, its role in routine use in patients with Barrett’s esophagus remains questionable primarily due to lack of well-organized double-blind randomized trials.

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T1218 Detection of Aberrant Crypt Foci in Patients at High-Risk for Colorectal Cancer Using Confocal Laser Endomicroscopy

Gastroenterology ◽

10.1016/s0016-5085(10)62373-6 ◽

2010 ◽

Vol 138 (5) ◽

pp. S-513-S-514

Author(s):

Sanne Gulikers ◽

Eveline Rondagh ◽

Ann Driessen ◽

Ad Masclee ◽

Silvia Sanduleanu

Keyword(s):

Colorectal Cancer ◽

High Risk ◽

Aberrant Crypt Foci ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser

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Near-Infrared Confocal Laser Endomicroscopy Detects Colorectal Cancer via an Integrin αvβ3 Optical Probe

Molecular Imaging and Biology ◽

10.1007/s11307-015-0825-9 ◽

2015 ◽

Vol 17 (4) ◽

pp. 450-460 ◽

Cited By ~ 5

Author(s):

Petra Schulz ◽

Cordula Dierkes ◽

Bertram Wiedenmann ◽

Carsten Grötzinger

Keyword(s):

Colorectal Cancer ◽

Near Infrared ◽

Integrin Αvβ3 ◽

Optical Probe ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser

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Evaluation of New Morphometric Parameters of Neoangiogenesis in Human Colorectal Cancer Using Confocal Laser Endomicroscopy (CLE) and Targeted Panendothelial Markers

PLoS ONE ◽

10.1371/journal.pone.0091084 ◽

2014 ◽

Vol 9 (3) ◽

pp. e91084 ◽

Cited By ~ 5

Author(s):

Adriana Ciocâlteu ◽

Adrian Săftoiu ◽

Tatiana Cârţână ◽

Lucian Gheorghe Gruionu ◽

Daniel Pirici ◽

...

Keyword(s):

Colorectal Cancer ◽

Morphometric Parameters ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Human Colorectal Cancer

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Sizing of Polyp Illustrations Differs by Endoscopists’ Gender and Improves With a Measurement Reference

Evaluation & the Health Professions ◽

10.1177/0163278719840078 ◽

2019 ◽

Vol 43 (4) ◽

pp. 270-273 ◽

Cited By ~ 1

Author(s):

Nabiha Shamsi ◽

Aasma Shaukat ◽

Sofia Halperin-Goldstein ◽

Joshua Colton

Keyword(s):

Colorectal Cancer ◽

Cancer Surveillance ◽

Community Based ◽

Polyp Size ◽

Detection Rates ◽

Demographic Groups ◽

Adenoma Detection ◽

Adenoma Detection Rates ◽

Colorectal Cancer Surveillance ◽

The Impact

Colorectal cancer surveillance intervals by colonoscopy are based on the size and number of polyps removed. Evidence suggests endoscopists’ estimation of polyp size is often inaccurate, but the differences by endoscopists’ characteristics have not been reported. This study assesses endoscopists’ accuracy of measuring polyp illustrations, the effect of endoscopists’ characteristics, and the impact of having a measurement reference. Endoscopists in a community-based, gastroenterology practice estimated the size of several illustrations in a booklet. One month later, they estimated the size of illustrations with a provided measurement reference. Accuracy was defined as no difference between estimated and actual value. Endoscopists were accurate in sizing only 15% of the time, with a tendency toward undersizing. Female endoscopists, those with less than 10 years in practice and those with lower adenoma detection rates, were more likely to undersize polyps. Accuracy of measuring the polyp illustrations increased to 50% ( p < .01) with the measurement reference. The improvement in accuracy was seen across endoscopists’ demographic groups. Endoscopists had poor accuracy of measuring polyp illustrations. Almost universally, endoscopists tended to undersize the polyp illustrations. Accuracy improved significantly with the use of a polyp-measuring guide, particularly when considering important surveillance thresholds of 5 and 10 mm.

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Assessment of Endoscopic Healing by Using Advanced Technologies Reflects Histological Healing in Ulcerative Colitis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa056 ◽

2020 ◽

Vol 14 (9) ◽

pp. 1282-1289 ◽

Cited By ~ 2

Author(s):

Marietta Iacucci ◽

Rosanna Cannatelli ◽

Xianyong Gui ◽

Davide Zardo ◽

Alina Bazarova ◽

...

Keyword(s):

Ulcerative Colitis ◽

Roc Curves ◽

Mucosal Healing ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

High Definition ◽

Endoscopic Score ◽

Virtual Chromoendoscopy ◽

Sensitivity Specificity ◽

A Prospective Study

Abstract Background Several studies have reported that ulcerative colitis [UC] patients with endoscopic mucosal healing may still have histological inflammation. We investigated the relationship between mucosal healing defined by modified PICaSSO [Paddington International Virtual ChromoendoScopy ScOre], Mayo Endoscopic Score [MES] and probe-based confocal laser endomicroscopy [pCLE] with histological indices in UC. Methods A prospective study enrolling 82 UC patients [male 66%] was conducted. High-definition colonoscopy was performed to evaluate the activity of the disease with MES assessed with High-Definition MES [HD-MES] and modified PICaSSO and targeted biopsies were taken; pCLE was then performed. Receiver operating characteristic [ROC] curves were plotted to determine the best thresholds for modified PICaSSO and pCLE scores that predicted histological healing according to the Robarts Histopathology Index [RHI] and ECAP ‘Extension, Chronicity, Activity, Plus’ histology score. Results A modified PICaSSO of ≤ 4 predicted histological healing at RHI ≤ 3, with sensitivity, specificity, accuracy and area under the ROC curve [AUROC] of 89.8%, 95.7%, 91.5% and 95.9% respectively. The sensitivity, specificity, accuracy and AUROC of HD-MES to predict histological healing by RHI were 81.4%, 95.7%, 85.4% and 92.1%, respectively. A pCLE ≤ 10 predicted histological healing with sensitivity of 94.9%, specificity of 91.3%, accuracy of 93.9% and AUROC of 96.5%. An ECAP of ≤ 10 was predicted by modified PICaSSO ≤ 4 with accuracy of 91.5% and AUROC of 95.9%. Conclusion Histological healing by RHI and ECAP is accurately predicted by HD-MES and modified virtual electronic chromoendoscopy PICaSSO, endoscopic score; and the use of pCLE did not improve the accuracy any further.

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