Predictive value of diminutive colonic adenoma trial: The PREDICT trial

Schoenfeld, Philip; Shad, Javaid A.; Ormseth, Eric; Coyle, Walter; Cash, Brooks D.; Butler, James A.; Schindler, William R.; Kikendall, Walter; Furlong, Christopher; Sobin, Leslie H.; Hobbs, Christine M.; Cruess, David F.; Rex, Douglas K.

doi:10.1016/s1542-3565(03)70036-6

Cited by 15 publications

(5 citation statements)

References 34 publications

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“…Studies in non-screening cohorts have found higher rates of advanced histology (4-15%) in sub-centimeter polyps [15][16][17][18]. Although variations in the interpretation of villous composition percentage by pathologists is always possible in studies including our own, Schoenfeld et al reported greater than 90% (155/172 cases) agreement between pathologists from separate facilities [19].…”

Section: Discussionmentioning

confidence: 93%

Prevalence of Advanced Adenomas in Small and Diminutive Colon Polyps Using Direct Measurement of Size

Tsai

Strum

2011

Dig Dis Sci

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Section: Discussionmentioning

confidence: 93%

Prevalence of Advanced Adenomas in Small and Diminutive Colon Polyps Using Direct Measurement of Size

Tsai

Strum

2011

Dig Dis Sci

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“…The field effect is the basis for the widespread use of flexible sigmoidoscopy for cancer screening given that distal adenomas may serve as a marker for proximal neoplasia (5). The suboptimal performance characteristics (~ 40% in detecting advanced proximal lesions) and modest invasiveness represent important problems for utilization in population screening (6). An ideal marker of the field effect should be assessed in the rectum and have robust performance characteristics.…”

mentioning

confidence: 99%

Rectal Mucosal Microvascular Blood Supply Increase Is Associated with Colonic Neoplasia

Gomes¹,

Roy

Turzhitsky³

et al. 2009

Clinical Cancer Research

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Purpose: Endoscopic examination has proven effective in both detecting and preventing colorectal cancer; however, only about a quarter of eligible patients undergo screening. Even if the compliance rate increased, limited endoscopic capacity and cost would be prohibitive. There is a need for an accurate method to target colonoscopy to those most at risk of harboring colonic neoplasia. Exploiting field carcinogenesis seems to be a promising avenue. Our group recently reported that an early increase in blood supply (EIBS) is a reliable marker of field carcinogenesis in experimental models. We now investigate whether in situ detection of EIBS in the rectum can predict neoplasia elsewhere in the colon. Experimental Design:We developed a novel polarization-gated spectroscopy fiber-optic probe that allows depth-selective interrogation of microvascular blood content. Using the probe, we examined the blood content in vivo from the rectal mucosa of 216 patients undergoing screening colonoscopy. Results: Microvascular blood content was increased by f50% in the endoscopically normal rectal mucosa of patients harboring advanced adenomas when compared with neoplasia-free patients irrespective of lesion location. Demographic factors and nonneoplastic lesions did not confound this observation. Logistic regression using mucosal oxyhemoglobin concentration and patient age resulted in a sensitivity of 83%, a specificity of 82%, and an area under the receiver operating characteristic curve of 0.88 for the detection of advanced adenomas. Conclusions: Increased microvascular blood supply in the normal rectal mucosa is associated with the presence of clinically significant neoplasia elsewhere in the colon, supporting the development of rectal EIBS as a colon cancer risk-stratification tool.

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“…An additional study 53 reported a prevalence of advanced proximal neoplasia of 9.4% among patients with high risk (size at least 10 mm, three or more adenomas, villous features or dysplasia on histology) distal polyps and 2.5% among those with low risk lesions. The study by Schoenfeld et al 54 . supports the finding that patients with low risk lesions do not have a higher risk of proximal neoplasia compared with patients with a negative flexible sigmoidoscopy.…”

Section: Available Screening Methodsmentioning

confidence: 64%

Review article: population screening for colorectal cancer

Nicholson

Barro

Atkin

et al. 2005

Aliment Pharmacol Ther

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SUMMARYColorectal cancer is a common cancer and common cause of death. The mortality rate from colorectal cancer can be reduced by identification and removal of cancer precursors, adenomas, or by detection of cancer at an earlier stage.Pilot screening programmes have demonstrated decreased colorectal cancer mortality; as a result many countries are developing colorectal cancer screening programmes. The most common modalities being evaluated are faecal occult blood testing, flexible sigmoidoscopy and colonoscopy. Implementation of screening tests has been hampered by cost, invasiveness, availability of resources and patient acceptance. New technologies such at computed tomographic colonography and stool screening for molecular markers of neoplasia are in development as potential minimally invasive tools.This review considers who should be screened, which test to use and how often to screen. THE RATIONALE FOR SCREENINGWorldwide, colorectal cancer (CRC) ranks third in cancer incidence 1 after lung and breast, and is a major cause of cancer mortality. The estimated probability at birth of eventually developing CRC in the US and UK is 6% and the probability of dying from the disease is around 3%. In the US a pronounced decrease in incidence and mortality rates in white men and women began in the 1980s, but only small reductions have been recorded in black men and women. Some researchers 5,6 have speculated that the increased use of sigmoidoscopy and polypectomy have played an important role, although it has also been suggested that increased consumption of fruit and vegetables, non-steroidal anti-inflammatory drugs and hormone replacement therapy may also be playing a part.Reported 5-year survival rates for localized disease (Dukes' stage A and B) are 82-93%, compared with 55-60% for regional disease (Dukes' stage C) and only 5-8% for cases with distant disease (Dukes' stage D) at primary diagnosis. 7 In the UK, from 1988 to 1991, <10% of symptomatic cases were diagnosed at Dukes

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Predictive value of diminutive colonic adenoma trial: The PREDICT trial

Cited by 15 publications

References 34 publications

Prevalence of Advanced Adenomas in Small and Diminutive Colon Polyps Using Direct Measurement of Size

Prevalence of Advanced Adenomas in Small and Diminutive Colon Polyps Using Direct Measurement of Size

Rectal Mucosal Microvascular Blood Supply Increase Is Associated with Colonic Neoplasia

Review article: population screening for colorectal cancer

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