ABSTRACT
Most diminutive polyps (< 5 mm) detected during colonoscopy are hyperplastic, with no cancer risk. Endoscopic diagnosis would prevent unnecessary resection. Objective: To assess diagnostic accuracy of a simple endoscopic classification of diminutive polyps, applicable with current standard endoscopes. Methods: Subjects included patients with diminutive polyps, detected during colonoscopy. A generational cohort served for suggesting an endoscopic classification that was prospectively validated in a new cohort. Colonoscopies were performed by two experienced endoscopists, with standard colonoscopes (CFH180AL, Evis Exera II; Olympus), with narrow-band imaging (NBI). Endoscopic diagnosis was assessed in terms of Sensitivity, Specificity, Positive (PPV) and Negative Predictive Values (NPV) and Accuracy, using histological diagnosis as gold standard. Results: Generational cohort included 42 polyps. To classify polyps as neoplastic or non-neoplastic we used pit pattern (regular or irregular) and vascular marks (visible or non-visible). Validation cohort included 235 polyps, 63 percent of them hyperplastic. Neoplastic polyps were more frequent in proximal colon (49.2 percent) than in rectosigmoid (21.4 percent; p < 0.05). Endoscopic diagnosis revealed: Sensitivity = 75 percent; Specificity = 70 percent; PPV = 59 percent; NPV = 82 percent, and Accuracy = 72 percent. Diagnostic performance was better in rectosigmoid compared to proximal colon (NPV 90 percent vs 74 percent, respectively; p = NS). Both endoscopists showed significant differences in terms of their sensitivity (89 percent vs 60 percent, respectively; p < 0.05). The endoscopist with best results reached NPV = 97 percent in the rectosigmoid (n = 60). Conclusions: The proposed classification can be used in real-time. Endoscopic assessment may replace histological assessment of diminutive polyps of the rectosigmoid. Formal training is needed to reach the required diagnostic accuracy.
La mayoría de los pólipos < 5 mm detectados durante una colonoscopia son hiperplásticos, sin riesgo de cáncer. Su diagnóstico endoscópico evitaría resecciones innecesarias. Objetivo: Evaluar la precisión diagnóstica de una clasificación endoscópica de pólipos colónicos diminutos, aplicable con endoscopios habituales. Métodos: Se incluyeron pacientes con pólipos diminutos detectados durante colonoscopia. Una cohorte de generación sirvió para proponer una clasificación endoscópica, que se validó prospectivamente en una segunda cohorte. Las colonoscopias fueron realizadas por dos endoscopistas experimentados, con colonoscopios estándar (CFH180AL, Evis Exera II; Olympus), con narrow-band imaging (NBI). El diagnóstico endoscópico fue evaluado en términos de sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y precisión, usando el diagnóstico histológico como gold standard. Resultados: La cohorte de generación incluyó 42 pólipos. Para clasificar los pólipos como neoplásico o no neoplásico se utilizó el patrón superficial (regular o irregular) y las marcas vasculares (visibles o no visibles). La cohorte de validación incluyó 235 pólipos, 63 por ciento hiperplásticos. Los pólipos neoplásicos fueron más frecuentes en colon proximal (49,2 por ciento) que en rectosigmoides (21,4 por ciento; p < 0,05). El diagnóstico endoscópico indicó: Sensibilidad = 75 por ciento; Especificidad = 70 por ciento; VPP = 59 por ciento; VPN = 82 por ciento y Certeza Diagnóstica = 72 por ciento, y fue mejor en rectosigmoides que en colon proximal (VPN = 90 vs 74 por ciento, respectivamente; p = NS). Se observaron diferencias significativas en la sensibilidad al comparar ambos (89 vs 60 por ciento, respectivamente; p < 0,05). El endoscopista con mejor resultado alcanzó VPN = 97 por ciento en rectosigmoides (n = 60). Conclusiones: La clasificación propuesta es utilizable en tiempo real...
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged, 80 and over , Colonoscopy/methods , Colonic Polyps/diagnosis , Adenoma/diagnosis , Hyperplasia/diagnosis , Predictive Value of Tests , Prospective Studies , Colonic Polyps/pathology , Sensitivity and SpecificityABSTRACT
Background: In Chile, 40 percent of deaths due to acute myocardial infarction occur in women. Aim: To assess the presence of cardiovascular risk factors in women with acute coronary syndromes. Patients and methods: Thirty four women aged 46 to 55 years old, admitted to the hospital due to an acute coronary syndrome and 102 age matched healthy women were studied. A clinical history was obtained, blood pressure and fasting serum lipids were measured. Results: A history of high blood pressure was present in 65 and 16 percent of patients and healthy controls respectively. Seventy seven percent of patients and 36 percent of controls smoked, 76 percent of patients and 48 percent of controls were postmenopausal, 21 percent of patients an 5 percent of controls were diabetic. In patients and controls respectively serum total cholesterol was 230.1ñ36.2 and 211.2ñ34.8 mg/dl, serum triacylglycerol was 213.4ñ109.4 and 143.2ñ76.9 mg/dl and serum HDL cholesterol was 44.1ñ10.8 and 49.8ñ13.3 mg/dl (p<0.001 or less). In univariate analysis, the risk of acute coronary syndrome increased with high blood pressure (OR: 9.3, CI: 2.5-18.6), menopause (OR: 8.3, CI: 2,2-31:5), smoking (OR: 6.9, CI: 2.5-18.6), diabetes mellitus (OR: 5.0, CI: 1.4-17.5), a high total cholesterol/HDL cholesterol ratio (OR: 6.6, CI: 1.8-12.5) and hypertriglyceridemia (OR: 3.6, CI: 1.5-8.5). Logistic regression analysis showed that hypertension and menopause had the higher predictive values for acute coronary syndrome. Conclusions: In this group of women with acute coronary syndromes, the main coronary risk factors were high blood pressure and menopause