Caracterização morfológica da abertura de glândulas colônicas usando imagens de microscopia de autofluorescência / Morphological characterization of colorectal pits using autofluorescence microscopy images

ABSTRACT BACKGROUND: Colorectal cancer is one of the most prevalent pathologies. Its prognosis is linked to the early detection and treatment. Currently diagnosis is performed by histological analysis from polyp biopsies, followed by morphological classification. Kudo's pit pattern classification is frequently used for the differentiation of neoplastic colorectal lesions using hematoxylin-eosin stained samples. Few articles have reported this classification with image software processing, using exogenous markers over the samples. The processing of autofluorescence images is an alternative that could allow the characterization of the pits from the crypts of Lieberkühn, bypassing staining techniques. OBJECTIVE: Processing and analysis of widefield autofluorescence microscopy images obtained by fresh colon tissue samples from a murine model of colorectal cancer in order to quantify and characterize the pits morphology by measuring morphology parameters and shape descriptors. METHODS: Adult male BALB/cCmedc strain mice (n=27), ranging from 20 to 30 g, were randomly assigned to four and five groups of treated and control animals. Colon samples were collected at day zero and at fourth, eighth, sixteenth and twentieth weeks after treatmentwith azoxymethane. Two-dimensional (2D) segmentation, quantification and morphological characterization of pits by image processing applied using macro programming from FIJI. RESULTS: Type I is the pit morphology prevailing between 53 and 81% in control group weeks. III-L and III-S types were detected in reduced percentages. Between the 33 and 56% of type I was stated as the prevailing morphology for the 4th, 8th and 20th weeks of treated groups, followed by III-L type. For the 16th week, the 39% of the pits was characterized as III-L type, followed by type I. Further, pattern types as IV, III-S and II were also found mainly in that order for almost all of the treated weeks. CONCLUSION: These preliminaries outcomes could be considered an advance in two-dimensional pit characterization as the whole image processing, comparing to the conventional procedure, takes a few seconds to quantify and characterize non-pathological colon pits as well as to estimate early pathological stages of colorectal cancer.

RESUMO CONTEXTO: O câncer colorretal é uma das patologias mais prevalentes. Seu prognóstico é ligado à detenção e ao tratamento precoces. Atualmente o diagnóstico é realizado por análise histológica de biópsias de pólipo, seguida de classificação morfológica. A classificação de padrões de Kudo é frequentemente utilizada para a diferenciação de lesões colorretais neoplásicas usando amostras coradas por hematoxilina-eosina. Poucos artigos relatam esta classificação com utilização de processamento por software de imagem, utilizando marcadores exógenos sobre as amostras. O processamento de imagens de autofluorescência é uma alternativa que pode permitir a caracterização do padrão das criptas de Lieberkühn, contornando técnicas de coloração. OBJETIVO: Analisar, quantificar e caracterizar a morfologia do padrão das criptas medindo os parâmetros morfológicos e descritores de forma, através do processamento e análise de imagens de microscopia de autofluorescência de campo de Widefield obtidas em amostras de tecido de cólon fresco a partir de um modelo murino de câncer colorretal. MÉTODOS: Camundongos machos adultos BALB/cCmedc (n=27), variando de 20 a 30 g, foram distribuídos aleatoriamente em quatro e cinco grupos de animais tratados e de controle. As amostras de cólon foram coletadas no dia zero e na 4ª, 8ª, 16ª e 20ª semanas após o tratamento com azoxometano. Segmentação bidimensional (2D), quantificação e caracterização morfológica do padrão das criptas por processamento de imagem aplicados utilizando programação macro de FIJI. RESULTADOS: O tipo I é a morfologia da cripta prevalente entre 53% e 81% semanas do grupo controle. Os tipos III-L e III-S foram detectados em porcentagens reduzidas. A morfologia do tipo I entre os 33% e 56% foi constatada como a predominante para as 4ª, 8ª e 20ª semanas de grupos tratados, seguidos pelo tipo III-L. Para a 16ª semana, os 39% dos padrões das criptas foram caracterizados como tipo III-L, seguidos pelo tipo I. Além disso, os tipos de padrão como IV, III-S e II também foram encontrados principalmente nessa ordem para quase todas as semanas tratadas. CONCLUSÃO: Estes resultados preliminares podem ser considerados um avanço na caracterização bidimensional da cripta como um processamento integral da imagem, comparando-se ao procedimento convencional; demora-se alguns segundos a mais para quantificar e caracterizar pontos não-patológicos, bem como para estimar estágios patológicos precoces do câncer colorretal.

Colonoscopia pediátrica. Nuestra experiencia en el Instituto de Gastroenterología / Pediatric colonoscopy. Our experience at the Institute of Gastroenterology

RESUMEN Fundamento: la colonoscopia permite la visualización endoscópica del colon para el diagnóstico de enfermedades del mismo y el íleon terminal. Objetivo: describir los resultados de la realización de la colonoscopía en pacientes pediátricos en el Instituto de Gastroenterología de la provincia La Habana. Métodos: se realizó un estudio retrospectivo, descriptivo en pacientes pediátricos que se hicieron colonoscopia en el Instituto de Gastroenterología, entre 2007 y 2016. Resultados: la indicación más frecuente de la colonoscopia fue la enterorragia, relacionada con la presencia de pólipos, que junto a la hiperplasia linfoide, fueron más frecuentes en el sexo masculino y en grupo de edad de nueve a 18 años. La coincidencia entre diagnóstico endoscópico e histológico para los pólipos fue alta no fue así para la hiperplasia linfoide y la enfermedad inflamatoria intestinal. La tasa de intubación cecal y el índice de complicaciones coincidieron con lo reportado en la literatura. Conclusiones: las indicaciones de la colonoscopia y hallazgos endoscópicos, coinciden con los reportes de otros estudios. Los diagnósticos endoscópicos más frecuentes fueron pólipos y colitis inespecífica. La mayoría de los diagnósticos endoscópicos fueron más frecuentes en el sexo masculino y entre nueve y 18 años. Hubo concordancia diagnóstica entre endoscopia e histología en pólipos, no así en enfermedades inflamatorias e hiperplasia linfoide. Los indicadores de calidad evaluados se comportaron según los estándares establecidos.

ABSTRACT Background: colonoscopy allows endoscopic visualization of the colon for the diagnosis of disease and terminal ileum. Objective: to describe the results of the colonoscopy in pediatric patients at the Institute of Gastroenterology of Havana. Methods: a retrospective, descriptive study was performed in pediatric patients who underwent colonoscopy at the Institute of Gastroenterology, between 2007 and 2016. Results: the most frequent indication for colonoscopy was rectal bleeding, related to the presence of polyps, which together with lymphoid hyperplasia, were more frequent in males and in the 9 to 18 age group. The coincidence between endoscopic and histological diagnosis for the polyps was high, as it was not so for lymphoid hyperplasia and inflammatory bowel disease. The rate of cecal intubation and the complication rate coincided with that reported in the literature. Conclusions: the indications for colonoscopy and endoscopic findings coincide with reports from other studies. The most frequent endoscopic diagnoses were polyps and unspecific colitis. The majority of endoscopic diagnoses were more frequent in males and between 9 and 18 years. There was a diagnostic agreement between endoscopy and histology in polyps, but not in inflammatory diseases and lymphoid hyperplasia. The quality indicators evaluated behaved according to established standards.

Concordância entre diferentes patologistas no diagnóstico anatomopatológico de uma série de 128 pólipos gástricos / Agreement between different pathologists in histopathologic diagnosis of 128 gastric polyps

ABSTRACT BACKGROUND - Gastric polyps are elevated mucosal lesions. Most of them are less than 1 cm and when larger than 2 cm, has a high malignancy probability. The histopathological types are mainly fundic gland polyps, hyperplastic polyps and adenomatous polyps. OBJECTIVE - To evaluate the agreement between three different pathologists in the histopathological diagnosis of 128 biopsied gastric polyps in Digestive Endoscopy Unit from Walter Cantídeo University Hospital, between May 2010 to May 2012. METHODS - To describe the intensity of agreement between observers, we use kappa index that is based on the number of concordant measures between them. RESULTS - There was substantial agreement in the diagnosis of adenoma (kappa=0.799, CI: 0.899-0.698) and fundic glands (kappa=0.655, CI: 0.755-0.555). Regarding to hyperplastic polyps (kappa=0.415, CI: 0.515-0.315) and inflammatory (kappa=0.401, CI: 0.501-0.301), we obtained a moderate agreement. Regarding the presence of Helicobacter pylori in biopsy of the polyp, there was a low agreement (kappa=0.219, CI: 0.319-0.119). CONCLUSION - It is clear that the agreement between pathologists depends on the histological type of the biopsied polyp and this agreement is more substantial in adenoma, or fundic gland polyps.

RESUMO CONTEXTO - Os pólipos gástricos são lesões elevadas da mucosa. A maioria são menores que 1 cm (60%-82%) e quando maiores do que 2 cm, tem alta probabilidade de malignidade. Os tipos histopatológicos são principalmente pólipos de glândulas fúndicas, pólipos hiperplásicos e pólipos adenomatosos. OBJETIVO - Avaliar a concordância entre três diferentes patologistas no diagnóstico histopatológico de 128 pólipos gástricos biopsiados na Unidade de Endoscopia Digestiva do Hospital Universitário Walter Cantídeo no período de maio de 2010 a maio de 2012. MÉTODOS - Para descrevermos a intensidade de concordância entre os avaliadores, utilizamos o índice kappa que é baseado no número de medidas concordantes entre eles. RESULTADOS - Houve uma substancial concordância no diagnóstico de adenoma (kappa=0,799, IC: 0,899-0,698) e glândulas fúndicas (kappa=0,655, IC: 0,755-0,555). Em relação aos pólipos hiperplásicos (kappa=0,415, IC: 0,515-0,315) e inflamatórios (kappa=0,401, IC: 0,501-0,301), obtivemos uma concordância moderada. Em relação à presença do Helicobacter pylori na biópsia do pólipo, houve uma baixa concordância (kappa=0,219, IC: 0,319-0,119). CONCLUSÃO - Em vista do que foi observado, torna-se claro que a concordância entre observadores depende do tipo histológico do pólipo biopsiado, sendo essa mais alcançada no diagnóstico de adenoma e pólipos de glândulas fúndicas.

The rate and correlation factors of missing diagnosis of colorectal polyps with colonoscopy / 中国医师杂志

Objective To investigate the missing rate of polypus with colonoscopy and correlation factors for missed diagnosis.Methods Data with colorectal polyps collected a second colonoscopy within 180 days after polyps were detected and removed on the initial colonoscopy in 186 patients between July 2009 and June 2013.The following factors were statistically analyzed,including lesionrelated factors (the lesion size,location,shape,number,and pathology),and non-lesion-related factors (intestinal cleanliness,colonoscopy post-set time,colonoscopy operator experience,and whether colonoscopy with sedation).Results Polypus missed diagnosis was found in 57 patients out of 186 recruited subjects (30.64％).A total of 76 polypus were missed out of 343 (22.16％) polypus detected by repeated colonoscopy.Flat small polyps were easily missed diagnosis (P ＜ 0.01).Polyps located at sigmoid,cecum and ascending colon,hepatic flexure,and splenic flexure were easily missed diagnosis (P ＜0.05).The rate of missed diagnosis was significantly increased in the condition of the low intestinal cleanliness,short colonoscopy post-set time,non-intravenous anesthesia,and beginner colonoscopy doctors (P ＜ 0.01).Conclusions A markedly missing rate of polyp existed on colonoscopy,and was closely related to the lesion-related factors (the lesion size,location,shape,number,and pathology) and the non-lesion-related factors (the intestinal cleanliness,colonoscopy post-set time,colonoscopy operator experience,and whether colonoscopy with sedation).