Intelligent recognition of colorectal cancer combining application of computer-assisted diagnosis with deep learning approaches

<span>The malignancy of the colorectal testing methods has been exposed triumph to decrease the occurrence and death rate; this cancer is the relatively sluggish rising and has an extremely peculiar to develop the premalignant lesions. Now, many patients are not going to colorectal cancer screening, and people who do, are able to diagnose existing tests and screening methods. The most important concept of this motivation for this research idea is to evaluate the recognized data from the immediately available colorectal cancer screening methods. The data provided to laboratory technologists is important in the formulation of appropriate recommendations that will reduce colorectal cancer. With all standard colon cancer tests can be recognized agitatedly, the treatment of colorectal cancer is more efficient. The intelligent computer assisted diagnosis (CAD) is the most powerful technique for recognition of colorectal cancer in recent advances. It is a lot to reduce the level of interference nature has contributed considerably to the advancement of the quality of cancer treatment. To enhance diagnostic accuracy intelligent CAD has a research always active, ongoing with the deep learning and machine learning approaches with the associated convolutional neural network (CNN) scheme.</span>

The Correlation of Papanicolaou Smears and Clinical Features to Identify the Common Risk Factors for Cervical Cancer: a Retrospective and Descriptive Study From a Tertiary Care Hospital in Trinidad

Background: Cervical cancer, the fourth most frequent cancer in women, is associated with the human papilloma virus (HPV). This study focuses on identifying any risk factors and clinical findings for abnormal cervical cytology and histopathology in relation to the Trinidad and Tobago population. Some risk factors include early age of first coitus, high number of sexual partners, high parity, smoking, and use of certain medications such as oral contraception. This study is aimed to identify the significance of Papanicolaou (pap) smears and to identify the common risk factors that contribute to the development of premalignant and malignant cervical lesions. Method: A three-year retrospective, descriptive study of cervical cancer was conducted at the Eric Williams Medical Sciences Complex to assess the risk factors and clinical findings using cervical cytology and histopathology data of patients with premalignant lesions. The subject population included 215 female patients aged 18 years and older who had the following documented abnormal cervical cytology: (ASCUS), ASC-H, LSIL, HSIL, Atypical Glandular cells, HPV, Adenocarcinoma, Invasive Squamous Cell Carcinoma. Histopathology records were analysed for thirty-three of these patients. Patients’ information were recorded on data collection sheets adapted from the North Central Regional Health Authority’s cytology laboratory standardised reporting format request form (Appendix I). Results and findings: The data were analysed via Statistical Package for Social Sciences (SPSS) software edition 23 using frequency tables and descriptive analysis. The sample mean age of the population was 36.7 years, first age of coitus was 18.1 years, number of sexual partners was 3.8 and number of live births was 2. LSIL was the most popular abnormal finding, 32.6 %, followed by HSIL, 28.8% and ASCUS, 27.4%. Most histopathological reports resulted in CIN I and II.Conclusion: The major risk factors observed for cytology abnormalities and premalignant lesions were early age of coitus, high number of sexual partners, and no use of contraception.Patients mostly presented as asymptomatic despite obtaining abnormal cytology results. Hence, regular pap smear screening should continue to be highly encouraged.

Clinical Review and Management of Oral Potentially Malignant Disorders with Epithelial Dysplasia

Background: Oral potentially malignant disorders (OPMDs) comprise any disorders, tumors, in addition to any microscopic alterations that have a risk of malignant development of cancers of the mouth. When epithelial dysplasia is detected in an oral lesion, it is termed as a precancerous lesion. Finding: Several changes in the color or thickness of normal oral mucosa might be detected during the clinical diagnosis of the oral lesions. Leukoplakia of the oral cavity is a clinical name for one of the most predominant OPMDs of the oral mucosa. When comparing oral examination with naked eyes to planning to apply staining with special stain or using an image of optical fluorescence, the incidence of patients with oral epithelial dysplasia may rise, as well as the clearing of the lesion boundary. Increased size of more than 2cm2, the presence of colored regions with a red hue, the presence of lichenoid process characteristics, and severe epithelial dysplasia are all considered risk factors. One-third of premalignant lesions may progress to cancer, whereas the other two-thirds may stay stable or regress without progressing to malignancy. Conclusion: It is critical to research the patients' unique characteristics, which include psychological, genetic, dietary, and dental problems. When epithelial dysplasia is present in an oral lesion, it is termed a precancerous lesion. Oral potential malignant diseases with epithelial dysplasia may or may not develop into carcinoma and may or may not be recurrent.

Endometrial Metaplastic/Reactive Changes Coexistent with Endometrial Hyperplasia and Carcinoma: A Morphological and Immunohistochemical Study

The aim of this study was to assess the relationship between endometrial metaplastic/reactive changes (EMRCs) and endometrial neoplastic lesions. Twenty cases of “simple” (without architecture complexity) EMRCs coexistent with endometrial malignant/premalignant lesions, twenty cases of neoplasia-unassociated EMRCs, and eight cases of complex metaplastic lesions were assessed by immunohistochemistry. EMRCs coexisted with endometrioid carcinoma (n = 12), atypical endometrial hyperplasia (n = 3), serous carcinoma (n = 2), and clear cell carcinoma (n = 3). Neoplasia-associated EMRCs showed a mean Ki67 labeling index of 12.6% (range 0–30%); with nuclear atypia in 16/20 (80%) cases; diffuse p16 expression in 15/20 (75%) cases; and heterogeneous ER, PR, and vimentin expression. Compared to the associated neoplasia, EMRCs showed a lower Ki67 expression (p < 0.001) and higher p16 expression (p < 0.001). No EMRC case showed mitotic activity, PTEN loss, MMR deficiency, nuclear β-catenin, p53-mutant pattern, Napsin A, or AMACR expression. No significant differences were found between neoplasia-associated and neoplasia-unassociated EMRCs. Complex metaplastic lesions showed a lower Ki67 expression than EMRCs (p = 0.044) and PTEN loss in 5/8 cases, even in the absence of nuclear atypia. In conclusion, neoplasia-associated simple EMRCs may show evident atypia and a worrisome immunophenotype, but no data support their involvement in endometrial carcinogenesis. Architectural complexity appears as a crucial factor to identify precancerous lesions.

Surgery in autoimmune pancreatitis

Introduction: Autoimmune pancreatitis (AIP) is a disease that may mimic malignant pancreatic lesions both in terms of symptomatology and imaging appearance. The aim of the present study is to analyse experiences of surgery in patients with AIP in one of the largest European cohorts. Methods: We performed a single-centre retrospective study of patients diagnosed with AIP at the Department of Abdominal Diseases at Karolinska University Hospital in Stockholm, Sweden, between January 2001 and October 2020. Results: There were 159 patients diagnosed with AIP, and among them 35 (22.0%) patients had surgery: 20 (57.1%) males and 15 (42.9%) females; average age at surgery was 59 years (range 37-81). Follow-up period after surgery was 67 months (range 1-235). AIP type 1 was diagnosed in 28 (80%) patients and AIP type 2 in 7 (20%) patients. Malignant and premalignant lesions were diagnosed in 8 (22.9%) patients for whom AIP was not the primary differential diagnosis but, in all cases, it was described as a simultaneous finding and recorded in retrospective analysis in histological reports of surgical specimens. Conclusions: Diagnosis of AIP is not always straightforward, and, in some cases, it is not easy to differentiate it from the malignancy. Surgery is generally not indicated for AIP but might be considered in patients when suspicion of malignant/premalignant lesions cannot be excluded after complete diagnostic work-up.

Oral Squamous Cells and Age Estimation in Exfoliative Cytology with Hematoxylin and Eosin Stain– A Quantitative Study

Introduction: Exfoliative cytology in age estimation is a simple, painless, less invasive collection of exfoliative cells from epithelial layers, used as a diagnostic aid for age estimation. The oral cavity is an ideal site for exfoliative epithelial cells with a physiological turnover of cells, turnover decreases as the age increases show age variation with cellular morphological changes. Age estimation is one of the important factors to identify an individual and also helps to know the chronological age of a person. Aim: To analyze and estimate the age from buccal smear and comparing the average cellular size under Image morphometric analysis. Materials and Methods: Buccal mucosal smears are taken using a wooden spatula in gentle motion of scraping and smeared on a clean glass slide and fixed in 95% ethanol immediately after smearing a minimum of around 15 minutes and stained with Haematoxylin and eosin stain. After staining, the cells were observed by microscope and measured by a paint tool. Pearson correlation analysis was done using SPSS software. Results: The cell and nuclear size difference values observed using a Pearson correlation coefficient were statistically significant with p value<0.05 revealing that there is shrinkage in cells with increase in age. Conclusion: Exfoliative cytology is a successful and vastly growing technology that is used for the detection of premalignant lesions.

Kinesin Family Member C1 (KIFC1/HSET): A Potential Actionable Biomarker of Early Stage Breast Tumorigenesis and Progression of High-Risk Lesions

The enigma of why some premalignant or pre-invasive breast lesions transform and progress while others do not remains poorly understood. Currently, no radiologic or molecular biomarkers exist in the clinic that can successfully risk-stratify high-risk lesions for malignant transformation or tumor progression as well as serve as a minimally cytotoxic actionable target for at-risk subpopulations. Breast carcinogenesis involves a series of key molecular deregulatory events that prompt normal cells to bypass tumor-suppressive senescence barriers. Kinesin family member C1 (KIFC1/HSET), which confers survival of cancer cells burdened with extra centrosomes, has been observed in premalignant and pre-invasive lesions, and its expression has been shown to correlate with increasing neoplastic progression. Additionally, KIFC1 has been associated with aggressive breast tumor molecular subtypes, such as basal-like and triple-negative breast cancers. However, the role of KIFC1 in malignant transformation and its potential as a predictive biomarker of neoplastic progression remain elusive. Herein, we review compelling evidence suggesting the involvement of KIFC1 in enabling pre-neoplastic cells to bypass senescence barriers necessary to become immortalized and malignant. We also discuss evidence inferring that KIFC1 levels may be higher in premalignant lesions with a greater inclination to transform and acquire aggressive tumor intrinsic subtypes. Collectively, this evidence provides a strong impetus for further investigation into KIFC1 as a potential risk-stratifying biomarker and minimally cytotoxic actionable target for high-risk patient subpopulations.

Adjunctive Utility of Toluidine Blue in Detecting Dysplastic Cells in Oral Mucosal Lesions in Comparison with Histopathology

Introduction: Oral cancer is one of the most common cancers globally and in Sri Lanka, which follows premalignant lesions. It is curable if it is detected early. Several adjunctive methods to diagnose premalignant lesions early are available. Among these, Toluidine blue staining method before a biopsy is currently receiving much attention. Method: This is a prospective study done by studying 103 patients presented to the Oral and Maxillofacial Surgery Unit, District General Hospital, Gampaha, Sri Lanka. The oral lesions of all the patients are categorized as benign, premalignant, and malignant by clinical examination. Toluidine Blue mouth wash is introduced to all the patients, followed by biopsy from the stained sites and the clinically decided sites in non-stained lesions. Histopathological diagnosis was obtained for all cases. The accuracy of diagnosis of premalignant, malignant, and benign cases by clinical assessment and by using Toluidine blue was assessed and compared statistically in relation to sensitivity, specificity, positive predictive and negative predictive values, and likelihood ratios (LR). Results: Toluidine blue has no added advantage over clinical examination in our setup even though it might be helpful in screening. However, it has an added value to confirm clinically benign cases as benign. Conclusion: Toluidine Blue can be used as an adjunct in screening and to confirm clinically benign cases so that those can be followed up in clinics without doing unnecessary biopsies.