Detection of Upper Gastrointestinal Disorders in Patients with Positive Fecal Immunochemical Test (FIT) and Normal Colonoscopy: A Cross-Sectional Study

Abstract Introduction Colorectal cancer (CRC) is the second most prevalent cancer in the world, and the fecal immunochemical test (FIT) can be mentioned among the CRC screening methods based on the detection of occult blood in the feces, which may indicate upper gastrointestinal (UGI) malignancies; therefore, patients with a positive FIT but normal colonoscopy may be considered for a UGI endoscopy. Materials and Methods The present study was conducted on patients with a positive FIT who were submitted to colonoscopy with normal results. They subsequently underwent endoscopy for the detection of UGI disorders. Results We included 121 patients (64.5% of women and 35.5% of men; average age: 58.85 ± 12.93 years), 72.7% of whom were positive for Helicobacter pylori. The predominant result of the UGI endoscopy was normal, followed by erythema of the gastric mucosa, and anemia and dyspepsia were the most common clinical findings. The most common pathological result was chronic gastritis, followed by acute gastritis. Only one patient presented stomach cancer (adenocarcinoma). Conclusion Considering the small prevalence of cancer in the UGI endoscopies of patients with positive FIT and normal colonoscopy, to the performance of UGI endoscopy in these patients may not be necessary.

Neurofibroma solitario en maxilar superior: reporte de caso inusual / Solitary neurofibroma in upper maxillary: an unusual case report

Los neurofibromas solitarios han sido reportados en la literatura, pero son casos muy raros; por definición se presentan en pacientes que no tienen enfermedad de Von Recklinghausen, que se hereda en forma autosómica dominante, y se presenta con mayor frecuencia en hombres. Es un tumor benigno que puede presentarse solitario o múltiple; su aparición en la cavidad oral suele ser muy rara, pero su sitio de predilección es la lengua, seguido de la mucosa alveolar, paladar y encía gingival. Aparecen con más frecuencia durante la tercera década de vida, aunque se describen casos desde los 10 meses hasta los 70 años de edad. En este reporte se expondrá el caso clínico de un paciente de sexo femenino, de 17 años de edad, que acudió a consulta a la clínica dental centenario por presentar una lesión superior que cubría parte de las coronas anatómicas en piezas dentales del maxilar superior izquierdo, además, en el reporte de estudio inmunoquimicohistológico se diagnosticó neurofibroma, con expresión de S-100. Consideramos de suma importancia el reconocimiento de estos crecimientos intraorales para lograr establecer un diagnóstico definitivo cierto y veraz de la situación (AU)

Solitary neurofibromas have been reported in the literature, but they are very rare cases. By definition they occur in patients who do not have Von Recklinghausen disease, which is inherited in an autosomal dominant manner; It occurs more frequently in men. It is a benign tumor that can appear solitary or multiple. Its appearance in the oral cavity is usually very rare, but its site of preference is the tongue, followed by the alveolar mucosa, palate, and gingival gingiva. They appear more frequently during the third decade of life, although cases from 10 months to 70 years of age are described. This report will present the clinical case of a 17-year-old female patient who came to the Centennial Dental Clinic for consultation presenting an elevated lesion covering part of the anatomical crowns in dental pieces in the left upper jaw and in the report. Neurofibroma was diagnosed from the Immunochemicalhistological study, with S-100 expression. We consider the recognition of these intraoral growths of utmost importance in order to establish a true and truthful definitive diagnosis of the situation (AU)

Implementation of an organized colorectal cancer screening program through quantitative fecal immunochemical test followed by colonoscopy in an urban low-income community: Guidance and strategies

Abstract Fecal Immunochemical Test (FIT) followed by a colonoscopy is an efficacious strategy to improve the adenoma detection rate and Colorectal Cancer (CRC). There is no organized national screening program for CRC in Brazil. The aim of this research was to describe the implementation of an organized screening program for CRC through FIT followed by colonoscopy, in an urban low-income community of São Paulo city. The endpoints of the study were: FIT participation rate, FIT positivity rate, colonoscopy compliance rate, Positive Predictive Values (PPV) for adenoma and CRC, and the rate of complications. From May 2016 to October 2019, asymptomatic individuals, 50-75 years old, received a free kit to perform the FIT. Positive FIT (≥ 50 ng/mL) individuals were referred to colonoscopy. 10,057 individuals returned the stool sample for analysis, of which (98.2%) 9,881 were valid. Women represented 64.8% of the participants. 55.3% of individuals did not complete elementary school. Positive FIT was 7.8% (776/9881). The colonoscopy compliance rate was 68.9% (535/776). There were no major colonoscopy complications. Adenoma were detected in 63.2% (332/525) of individuals. Advanced adenomatous lesions were found in 31.4% (165/525). CRC was diagnosed in 5.9% (31/525), characterized as adenocarcinoma: in situ in 3.2% (1/31), intramucosal in 29% (9/31), and invasive in 67.7% (21/31). Endoscopic treatment with curative intent for CRC was performed in 45.2% (14/31) of the cases. Therefore, in an urban low-income community, an organized CRC screening using FIT followed by colonoscopy ensued a high participation rate, and high predictive positive value for both, adenoma and CRC.

Application analysis of quantitative fecal immunochemical test in opportunistic screening of colorectal cancer / 中华消化杂志

Objective:To analyze and evaluate the application of quantitative fecal immunochemical test(FIT) in opportunistic screening of colorectal cancer in asymptomatic population undergoing health checkups.Methods:From January 1, 2018 to December 31, 2021, at the Health Management Center of the First Affiliated Hospital of Soochow University, 53 319 subjects who underwent routine health checkups and with quantitative FIT opportunistic screening for colorectal cancer were selected. Those with positive quantitative FIT results and received colonoscopy were enrolled in the FIT positive group, and those with negative quantitative FIT results and received colonoscopy were enrolled in the FIT negative group. The participation rate and positive rate of quantitative FIT were analyzed. The results of colonoscopy and pathological findings were taken as the gold standard, including normal, non-polyposis lesions, polyposis (hyperplastic and(or) inflammatory polyps, non-advanced adenoma, advanced adenoma), and colorectal cancer, the detection rates of various lesions of the FIT positive and negative groups, the quantitative FIT measurement value of subjects, and the sensitivity and negative predictive value of quantitative FIT for colorectal cancer and advanced adenoma were analyzed. The receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was calculated, the screening efficacy of quantitative FIT for colorectal cancer and advanced adenoma was evaluated. Chi-square test or Fisher exact probability method and Wilcoxon rank sum test were used for statistical analysis.Results:A total of 51 420 cases had completed quantitative FIT, and the total participation rate was 96.44% (51 420/53 319). Quantitative FIT was positive in 2 483 cases (4.83%). The participation rate of colonoscopy in FIT positive group was 26.22% (651/2 483), of which 540 cases were enrolled in FIT positive group. The colonoscopy participation rate of FIT negative group was 1.18% (576/48 937), of which 523 cases were enrolled in the FIT negative group. The detection rates of colorectal cancer and advanced adenoma in FIT positive group were both higher than those of the FIT negative group(3.9%, 21/540 vs. 0, 0/523; 16.1%, 87/540 vs. 3.3%, 17/523), and the differences were statistically significant(Fisher exact probability method and χ2=49.79; both P<0.001). Populations with quantitative FIT values from high to low were those with colorectal cancers, advanced adenomas, non-polyp lesions, non-advanced adenomas, normal, and hyperplastic and (or) inflammatory polyps (1 052.0 ng/mL(390.5 ng/mL, 3 058.0 ng/mL); 294.5 ng/mL (116.8 ng/mL, 951.8 ng/mL); 131.5 ng/mL (10.5 ng/mL, 327.3 ng/mL); 97.0 ng/mL (11.0 ng/mL, 238.0 ng/mL); 20.0 ng/mL (0.0 ng/mL, 175.3 ng/mL); 14.0 ng/mL (0.0 ng/mL, 171.0 ng/mL)), and the difference was statistically significant( H=120.53, P<0.001). The sensitivities(95% confidence interval (95% CI)) of quantitative FIT in colorectal cancer and advanced adenoma were 100.0%(80.8% to 100.0%) and 83.6%(74.8% to 89.9%), respectively. The negative predictive values (95% CI) were 100.0%(99.1% to 100.0%) and 96.7%(94.7% to 98.0%), respectively. The results of ROC analysis showed that the AUCs(95% CI) of quantitative FIT in colorectal cancer and advanced adenoma were 0.874(0.820 to 0.928) and 0.723(0.675 to 0.770), respectively. Conclusions:In this study, the participation rate of quantitative FIT is high. More patients with advanced adenomas and colorectal cancers are found in the high risk popolation with positive quantitative FIT. Quantitative FIT has a good sensitivity and a negative predictive value for colorectal cancer and advanced adenoma. Therefore, positive quantitative FIT-colonoscopies sequential screening should be advocated in population undergoing health checkups for colorectal cancer screening, and it may be applicable to large-scale population screening in China.

Diagnostic efficacy of hypersensitivity quantitative fecal immunochemical test in colorectal cancer and advanced adenoma / 中华消化杂志

Objective:To evaluate the diagnostic efficiency of hypersensitivity quantitative fecal immunochemical test (hs-qFIT) in colorectal cancer (CRC) and advanced adenoma.Methods:From July to December 2020, consecutive patients aged 50 to 75 years who underwent colonoscopy in Qilu Hospital of Shandong University, and had the Asia-Pacific colorectal screening score of medium or high risk were enrolled. All patients were requested to complete two hs-qFIT before colonoscopy. The diagnostic efficacy of hs-qFIT for CRC and advanced adenoma were assessed. Receiver operating characteristic curve of hs-qFIT in CRC diagnosis was drawn and the area under the curve (AUC) was calculated.Results:A total of 811 patients including 20 (2.5%) cases of CRC, 47 (5.8%) cases of advanced adenoma, 206 (25.4%) cases of non-advanced adenoma, 219 (27.0%) cases of non-adenomatous polyp, 76 (9.4%) cases of other colorectal lesions and 243 (30.0%) cases of non-colorectal lesions were involved. When the fecal hemoglobin cut-off values were 10, 30, 50, 75 and 100 ng/mL, the positive rates of hs-qFIT detection were 17.9% (145/811), 10.9% (88/811), 8.3% (67/811), 7.4% (60/811) and 5.8% (47/811), respectively. When the cut-off value of fecal hemoglobin decreased from 100 ng/mL to 10 ng/mL, the sensitivity of hs-qFIT for CRC diagnosis increased from 90.0% to 100.0%, and the specificity decreased from 96.3% to 84.2%; and the sensitivity of hs-qFIT for the diagnosis of advanced adenoma increased from 19.1% to 66.0%, and the specificity decreased from 95.0% to 85.1%. The AUC of hs-qFIT for the diagnosis of CRC and advanced adenoma were 0.981 (95% confidence interval ( CI) 0.970 to 0.992) and 0.846 (95% CI 0.807 to 0.886), respectively. When the optimal cut-off values were taken, the sensitivity and specificity were 100.0% and 91.2% for the diagnosis of CRC, and 66.0% and 85.3% for the diagnosis of advanced adenoma, respectively. Conclusion:Hs-qFIT can help the early screening of CRC and advanced adenoma.

Evaluation of quantitative stool occult blood test in opportunistic screening for colorectal cancer / 中华健康管理学杂志

Objective:To evaluate the efficacy of quantitative fecal immunochemical test (fecal immunochemical test, FIT) in the screening of colorectal cancer and precancerous lesions.Methods:47 243 patients who underwent quantitative FIT screening for colorectal cancer in the Health Management Department of Shenzhen People′s Hospital from January 2019 to October 2020 were enrolled as subjects. Colonoscopy was recommended for patients with positive quantitative FIT. A follow-up was done after one year to compare the results of the quantitative FIT positive group and the negative group after colonoscopy. Data were adjusted by propensity score matching method and a receiver operating characteristic curve ( ROC) was established to evaluate the diagnostic effect of quantitative FIT combined with colonoscopy on colorectal cancer and precancerous lesions. Results:A hemoglobin concentration>100 μg/L was set as a positive threshold. There were 2 472 positive cases of quantitative FIT, and the positive rate was 5.23%. After one-year follow-up, 284 patients had completed colonoscopy; the colonoscopy compliance was 11.49%. Of the negative population, 1 493 patients selected colonoscopy within one year. Compared with the results of gold standard colonoscopy, the sensitivity and specificity of quantitative FIT for screening for advanced adenoma and cancer were 26.53% and 86.54%, respectively. The sensitivity for colorectal cancer screening was 94.44% and screening for advanced adenoma was 22.77%. After propensity score matching, there were 256 FIT positive patients and 705 FIT negative patients. Colorectal cancer was the outcome variable, while FIT combined with colonoscopy, age combined with colonoscopy, and FIT combined with age combined with colonoscopy were the diagnostic indicators. The areas under the curve were 0.841(95% CI:0.778-0.904), 0.677(95% CI: 0.535-0.820), and 0.882(95% CI:0.807-0.958), respectively. Conclusion:Quantitative FIT has a high susceptibility to opportunistic screening for colorectal cancer, and a low sensitivity to advanced adenoma. At the same time, quantitative FIT combined with colonoscopy has a good diagnostic accuracy for colorectal cancer, which is better than the effect of using age as a cut-off point for colonoscopy. Quantitative FIT combined with age and colonoscopy has the best effect on screening for colorectal cancer. Quantitative FIT has a high sensitivity to colorectal cancer and a low sensitivity to advanced adenoma.

Toxicological, enzymatic, and immunochemical characterization of Bothrops asper (Serpentes: Viperidae) reference venom from Panama / Caracterización toxicológica, enzimática e inmunoquímica del veneno de referencia de Bothrops asper (Serpentes: Viperidae) de Panamá

Introduction: It is estimated that 2 000 snakebites occur in Panama every year, 70 % of which are inflicted by Bothrops asper. Objective: To determine the biochemical and toxicologic effects and to assess the immunochemical characteristics of a reference pool of B. asper venom representative of Panama. Methods: The reference venom was prepared as a homogeneous mixture of the venoms obtained from 78 adult snakes collected in four geographic areas of Panama. Enzymatic and toxicological activities were assessed. The electrophoretic pattern was studied by SDS-PAGE. Immunoreactivity of various antivenoms was analyzed by Western blot. Results: B. asper reference venom has lethal, hemorrhagic, myotoxic, edema-forming, coagulant, defibrinating, proteinase and phospholipase A2 activities. SDS-PAGE showed the presence of protein bands with molecular weights ranging from 8 to 70 kDa, with the presence of predominant bands at ≈ 15 kDa and ≈ 30 to 66 kDa, which likely correspond to phospholipases A2 and metalloproteinases, respectively. Immunoblotting showed a high degree of recognition by various antivenoms, especially by antivenoms from Colombia and Costa Rica. Conclusions: Following recommendations by the World Health Organization, this reference venom of B. asper of Panama will become a useful tool for the preclinical evaluation of antivenoms distributed in this country.

Introducción: Se estima que 2 000 mordeduras de serpiente ocurren en Panamá cada año, el 70 % de las cuales son infligidas por Bothrops asper. Objetivo: Determinar los efectos bioquímicos y toxicológicos y evaluar las características inmunoquímicas del veneno de referencia de B. asper representativo de Panamá. Métodos: El veneno de referencia se preparó como una mezcla homogénea de los venenos obtenidos de 78 serpientes adultas recolectadas en cuatro áreas geográficas de Panamá. Se evaluaron las actividades enzimáticas y toxicológicas. El patrón electroforético se estudió mediante SDS-PAGE. La inmunoreactividad de varios antivenenos se analizó mediante transferencia de Western. Resultados: El veneno de referencia de B. asper tiene actividades letales, hemorrágicas, miotóxicas, formadoras de edema, coagulantes, desfibrinante, proteolítica y de fosfolipasa A2. El análisis de SDS-PAGE mostró la presencia de bandas de proteínas con pesos moleculares que varían de 8 a 70 kDa, con la presencia de bandas predominantes a ≈ 15 kDa y ≈ 30 a 66 kDa, que probablemente corresponden a fosfolipasas A2 y metaloproteinasas, respectivamente. La inmunotransferencia mostró un alto grado de reconocimiento por varios antivenenos, especialmente por antivenenos de Colombia y de Costa Rica. Conclusiones: Siguiendo las recomendaciones de la Organización Mundial de la Salud, este veneno de referencia de B. asper de Panamá se convertirá en una herramienta útil para la evaluación preclínica de antivenenos distribuidos en este país.

Colorectal Cancer Screening: Current Status and Progress / 胃肠病学

Colorectal cancer (CRC) is one of the most common malignancies worldwide. In recent years, the overall incidence of CRC in China has shown an upward trend. According to the national estimates of cancer in China, CRC was the second most commonly diagnosed cancer of the digestive system. Screening of CRC can significantly reduce its morbidity and mortality. The screening methods are diverse. At present, a two-step screening program based on fecal immuno-chemical test (FIT) and colonoscopy is recommended by authoritative guidelines or consensus in many countries. Other screening methods can be used as individualized options and supplements. Multigene germline mutation detection should be performed for extremely high-risk population with multiple colorectal polyps (>10 polyps) and CRC personal or family history; or with more than 20 polyps.

The novel latex agglutination turbidimetric immunoassay system for simultaneous measurements of calprotectin and hemoglobin in feces

BACKGROUND/AIMS: Fecal calprotectin (Fcal) as well as the fecal immunochemical test (FIT) are useful biomarkers for detecting activity and mucosal healing in inflammatory bowel diseases. Here, we report the performance of simultaneous measurements of Fcal and FIT for ulcerative colitis (UC) patients using the newly-developed latex agglutination turbidimetric immunoassay (LATIA) system. METHODS: Fcal and hemoglobin were measured by the LATIA system in 152 UC patients who underwent colonoscopy. Fcal was also quantified with a conventional enzyme-linked immunosorbent assay (ELISA). Fecal markers were evaluated in conjunction with the mucosal status of UC, which was assessed via the Mayo endoscopic subscore (MES) classification. RESULTS: The LATIA system could quantify calprotectin and hemoglobin simultaneously with the same fecal samples within 10 minutes. The values of the Fcal-LATIA closely correlated with those of the Fcal-ELISA (Spearman rank correlation coefficient, r=0.84; P<0.0001). The values of Fcal for each assay and the FIT all significantly correlated with the MESs (Spearman rank correlation coefficient, Fcal-LATIA: r=0.58, Fcal-ELISA: r=0.55, and FIT: r=0.72). The mucosal healing predictability (determined by an MES of 0 alone) of the Fcal-LATIA, Fcal-ELISA, and FIT-LATIA with the cutoffs determined by receiver operating characteristic curve analysis was 0.79, 0.78, and 0.92 for sensitivity, respectively, and 0.78, 0.69, and 0.73 for specificity, respectively. CONCLUSIONS: The performance of the novel Fcal-LATIA was equivalent to that of the conventional Fcal assay. Simultaneous measurements with FITs would promote the clinical relevance of fecal biomarkers in UC.

Application and prospect of fecal DNA test in colorectal cancer screening / 中华胃肠外科杂志

Effective early screening and primary prevention is one of the major initiatives to decrease the morbidity and mortality of colorectal cancer in China. As a new non-invasive screening method for colorectal cancer in recent years, fecal DNA test detects colorectal cancer by analyzing gene mutations from intestinal tumor cells in the feces. The most widely used method among fecal DNA test is multi-target stoolDNA test (MT-sDNA). Many studies abroad on this emerging technique have been carried out to verify its high sensitivity, and it is gradually used in the clinic with continuous improvement and development of technology. Meanwhile, domestic MT-sDNA is still in the prototype stage, and more researches from Chinese population are needed. Compared with traditional screening methods, MT-sDNA technology has the advantages of non-invasiveness, painlessness and convenience. But its defects exist, such as high cost and low specificity. MT-sDNAis in accordance with precision medicine, and can largely make up for the shortcomings of traditional screening methods for colorectal cancer. It also holds a great promise for promoting the screening for colorectal cancer. This paper is aimed to discuss the application value of fecal DNA test by introducing its related researches at home and abroad,and summarizing its merits and demerits.

Usefulness of fecal immunochemical test and fecal calprotectin for detection of active ulcerative colitis

BACKGROUND/AIMS: Ulcerative colitis undergoes periods of exacerbation and remission. Fecal calprotectin levels increase with gut inflammation and correlate with endoscopic disease activity in ulcerative colitis. Intestinal blood loss and fecal immunochemical test levels also correlate with endoscopic disease activity. This study statistically evaluated the usefulness of fecal calprotectin, fecal immunochemical test, and C-reactive protein (CRP) as markers of disease activity. METHODS: A total 106 ulcerative colitis patients who underwent endoscopy and fecal calprotectin, fecal immunochemical test, and CRP testing, from March 2015 to August 2016, were retrospectively reviewed. Disease activity was assessed using a partial Mayo score and Mayo endoscopic score. The ability of fecal and serologic tests to reflect endoscopic disease severity was statistically evaluated. RESULTS: Among 106 patients, 68 underwent endoscopy and stool study within 2 weeks. In patients with mild to severe activity, fecal immunochemical test and fecal calprotectin were superior to CRP at Mayo endoscopic score detection rate. The area under the curves of fecal immunochemical test and fecal calprotectin for the detection of Mayo endoscopic score ≥1 were 0.956 and 0.942, respectively, and were superior to that of CRP (0.756). At Mayo endoscopic score, the effects of combination of fecal immunochemical test and CRP or fecal calprotectin and CRP were found to be higher than those of the independent fecal immunochemical test or fecal calprotectin. CONCLUSIONS: Fecal immunochemical test and fecal calprotectin can effectively detect active ulcerative colitis better than remission. As these markers reflect the status of mucosal inflammation, they may reduce the requirement for invasive endoscopic examination.

Fecal Immunochemical Test and Fecal Calprotectin Results Show Different Profiles in Disease Monitoring for Ulcerative Colitis

BACKGROUND/AIMS: Both fecal immunochemical test (FIT) and fecal calprotectin (Fcal) results are useful biomarkers for ulcerative colitis (UC). However, the situations in which each marker should be used are largely unknown. METHODS: A total of 110 colonoscopy intervals of UC patients were assessed, and correlations between changes in colonoscopic findings and changes in the two aforementioned fecal markers were examined. RESULTS: Among patients with mucosal healing (MH) and negative FIT or Fcal results at the initial colonoscopy, FIT and Fcal findings exhibited accuracies of 93% (38/41) and 79% (26/33), respectively, for predicting the results of the subsequent examination. Among the 24 patients who showed endoscopic activity at the precedent colonoscopy and MH at the subsequent examination, positive-to-negative conversion of FIT and Fcal findings at the subsequent examination was observed in 92% (12/13) and 62% (8/13) of patients, respectively. Among the 43 patients who showed endoscopic activity at both the precedent and subsequent examinations, Fcal findings reflected the change in endoscopic activity better than FIT results (r=0.59, p<0.0001 vs r=0.30, p=0.054). CONCLUSIONS: The FIT is useful for confirming MH and the occurrence of relapse. In contrast, Fcal is useful for monitoring the mucosal status of patients with active inflammation.

Is It Necessary to Repeat Fecal Occult Blood Tests with Borderline Results for Colorectal Cancer Screening?

The fecal immunochemical test (FIT) is the initial non-invasive investigation of choice for population-based colorectal cancer (CRC) screening. We evaluated the positivity rate in repeated tests using the same fecal specimen that showed borderline results in the FIT. A total of 6,465 patients were tested with the FIT in a tertiary-care hospital from July to December 2016. FIT was done using OC-Sensor PLEDIA (Eiken Chemical Co., Tokyo, Japan). Among 6,465 patients, 364 (5.6%) patients showed a positive FIT result of over 20 µg Hb/g feces. A total of 112 (1.7%) patients showed borderline scores of 10.2–20 µg Hb/g feces, and 5,989 (92.6%) patients showed negative results of less than 10 µg Hb/g feces. Among the 101 repeat-tested patients, 19 (18.8%) of the patients' scores converted to levels above the positive cut-off threshold. Repeated results of 19 patients showed score elevations from 20.2 to 68 µg Hb/g feces. These results suggest that it is most important to analyze properly prepared samples, even if only once. Therefore, the laboratory staff should ensure the proper preparation of stool specimens for FIT. Laboratory directors should choose the best cut-off value for detecting CRC at their respective institutions.

The value of cerebrospinal fluid cytology and cell immunochemical staining in diagnosing meningeal carcinomatosis / 中国医师进修杂志

Objective To explore the diagnostic value of cytologic examination of cerebrospinal fluid (CSF) combined with cell immunochemical staining examination in the patients with meningeal carcinomatosis in the clinical track.Methods CSF was centrifuged and precipitated using the StatSpin Cytofuge 12 centrifuge. It was dyed by the May-Grunwald-Giemsa Staining (MGG) method and cell immunochemical staining (S-P method). Clinical data of 16 cases with the diagnosis of meningeal carcinomatosis were retrospectively analyzed. Results Sixteen patients diagnosed meningeal carcinomatosis prior to imaging findings in 11 of 16 patients were diagnosed meningeal carcinomatosis through the cerebrospinal fluid cytology combined with cell immunochemical staining prior to imaging findings. CSF cytology observed the cancer cell pleomorphism. Cell immunochemical staining examination clearly distinguished classification organic source of meningeal carcinomatosis. Conclusions CSF cytology combined with cell immunochemical staining examination is one of the important means in tracking intracranial metastatic tumor in clinic.

Budget Impact of the Accreditation Program for Clinical Laboratories on Colorectal Cancer Screening via Fecal Immunochemical Testing: Results from the National Cancer Screening Program in Korea

BACKGROUND: False-positive fecal immunochemical test (FIT) results in the National Cancer Screening Program (NCSP) for colorectal cancer may lead to unnecessary procedures, such as colonoscopies, increasing the medical costs. We estimated reductions in the cost of National Health Insurance according to the accreditation status of screening facilities participating in the NCSP for colorectal cancer. METHODS: We used data collected between 2007 and 2010 from NCSP and the Korea Central Cancer Registry to identify patients with colorectal cancer. We also ascertained the history of the accreditation of each facility by the Korean Laboratory Accreditation Program (KLAP). Budget impact was defined as a reduction in medical costs achieved when the false-positive rate of the non-accredited facilities decreased relative to that of the accredited facilities. RESULTS: A total of 3,285 screening facilities participated in the NCSP. Of these, 196 were accredited by the KLAP. The false-positive rate of the accredited facilities was 2.47%, and that of the non-accredited facilities was 6.83%. Medical costs were estimated to be reduced by approximately 19 million US dollars (USD), and the cost of detecting one case of colorectal cancer was estimated to decrease from 9,212 USD to 7,332 USD if the false-positive rate of non-accredited facilities were decreased to that of the accredited facilities. Clinics were estimated to have the largest associated cost reduction. CONCLUSIONS: Quality assurance in clinical laboratories could lower false-positive rates and prevent the use of unnecessary procedures, ensuring patient safety and increasing the cost-effectiveness of FIT screening in the NCSP for colorectal cancer.

Evaluation of Satb1, Survivin, and Ki-67 as Possible Markers to Differentiate Phyllodes Tumour from Fibroadenoma

Aims Difficulties in diagnosis of phyllodes tumour are well known. Our aim was to observe whether the expressions of satb1, survivin, and ki-67 were helpful in differentiating fibroadenoma and phyllodes tumour. Settings and design Retrospective. Methods and material Paraffin embedded tissue samples from 60 female patients with phyllodes tumour and 60 female patients with fibroadenoma were studied. Expression of the gene products was studied and confirmed using immunohisto chemical and western blot analysis. Statistical analysis used The statistical analysis was performed using Fisher's exact test to find out the significant changes. Results Statistically significant difference was observed in Satb1, survivin expression between fibroadenoma and benign phyllodes cases. The difference between the Ki-67 expression in fibroadenoma and benign phyllodes cases was not statistically significant. Conclusions Our finding of strong stromal expression of satb1 and survivin in phyllodes as compared to fibroadenoma can be helpful for the development of additional diagnostic and prognostic indicators for otherwise difficult cases. Such immunochemical markers can be used to elucidate cellular basis of tumour behaviour. Validation of such immunochemical test in future will reduce diagnostic uncertainty in this rare tumour. In addition to that such parameters may serve as a therapeutic target that could increase effectiveness of chemotherapy or radiation therapy. A study with large number of samples along with clinical and follow-up data is required for confirmation.

Comparison of in vitro isolation of adenohypophyseal cells from SD rats / 医学研究生学报

Objective In vitro isolation of adenohypophyseal mainly includes enzymatic digestion and mechanical methods.But there is no relevant report about which method is better.In this paper,several mainstream methods of the vitro isolation of adenohypophysis cells in rats are compared and the identification of gonadotropin secretory cells is carried out to figure out which preparation method is more convenient and efficient.Methods 48 mature female SD rats were randomly divided into 4 groups:trypsin group (0.25％ trypsin EDTA digestion),Ⅳ-type collagen enzyme group (Ⅳ type collagen enzyme digestion),mechanical separation group (200 mesh cell sieves grinding) and trypsin digestion plus mechanical separation group (0.25％ trypsin EDTA digestion plus 200 mesh cell sieves grinding).12 rats in each group.The effect of these 4 methods was evaluated.Secondly,the primary cells of each group were cultured.We dynamically observed the vitro growth of cells in each group.Finally,the cells were identified by using the immunocytochemi-cal staining technique Results Compared with the mechanical separation group and-ⅣV type collagen enzyme group [(90.2 ± 0.96) ％,(93.32± 1.77)％],Cell viability of trypsin group and trypsin digestion plus mechanical separation group was elevated [(94.11 ± 1.71) ％,(94.92± 1.92) ％] (P＜0.05).Morphological observation:The pituitary ceils prepared by each methods were all round with strong refraction and clear edges and began to partly adhere to the wall after cultured for 16-24 hours.Then most of the cells adhered to wall after 48-72 hours,while the early glandular ceils were still round.But the volume was smaller than before.Also,a small amount of large cells were scattered among them.7 days later,the cells began to become polygonal or spindle shaped and were connected to pieces.Till around 10 days,the fibrosis gradually became obvious;Immunocytochemical staining:It is indicated that FSH positive cells were larger in volume while less in number and scattered in the cytoplasm.And the positive products,showing blue,were located in the cytoplasm;The Enzyme linked immunosorbent assay (ELISA) was used to determine the supematant of cells and confirmed that the cells in vitro still had hormone secretion functions.Conclusion Compared with the single cell preparation method,the trypsin digestion plus mechanical separation method has certain advantages;The anterior pituitary cells vitro cultured are in good health conditions and still have secrete functions.They are tested to be competent for related scientific experiments.

Cost-effectiveness comparison in colorectal cancer screening with fecal immunochemical test and colonoscopy between ages and genders / 中华消化内镜杂志

Objective To investigate the rational program of colorectal cancer(CRC)screening between ages and genders by using single or repeated fecal immunochemical test(FIT)and colonoscopy. Methods Data of 6 193 patients who underwent opportunistic CRC screening at Peking Union Medical College Hospital were retrospectively analyzed.Patients were divided into four groups:(1)direct colonoscopy;(2)one FIT followed by colonoscopy;(3)two FITs followed by colonoscopy;(4)three FITs followed by colonoscopy.Cost-effectiveness of the four screening procedures was compared between different age groups and genders.Results Ninety-seven(1.6%)patients with CRC and 1 038(16.8%)with colorectal adenoma were detected. In patients younger than 40 years old,1-3 positive FIT strategies were superior to direct colonoscopy. In men aged 40 to 60,one or two positive FITs out of three was more cost-effective than direct colonoscopy,so was one positive FIT out of three in women aged 40 to 60. Direct colonoscopy was the most cost-effective strategy in men older than 60,while one positive FIT out of two was the best screening choice in women older than 60. Conclusion Age and gender are two influential factors for cost-effectiveness of CRC screening. Direct colonoscopy is the most cost-effective screening strategy for men older than 60,but one or more positive FIT followed by colonoscopy is preferred in other age and gender groups.

Fecal immunochemical test followed by colonoscopy in opportunistic screening for colorectal neoplasm / 中华全科医师杂志

Objective To assess the fecal immunochemical test (FIT) followed by colonoscopy in opportunistic screenings for colorectal neoplasm.Methods Total 6 193 patients, who underwent opportunistic colorectal cancer (CRC) screening, were classified into four groups: 3 812 patients underwent direct colonoscopy (group 1), 1 244 patients received one FIT followed by colonoscopy (group 2), 341 patients received two FITs followed by colonoscopy (group 3), and 796 patients received three FITs followed by colonoscopy (group 4).Results Total 97 (1.6%) patients with CRC and 1 038 (16.8%) with colorectal adenoma were detected.The positive predictive value of 1, 2 and 3 positive tests out of three FITs for CRC were 4.53%, 5.62% and 8.94%, respectively, which was higher than that of direct colonoscopy (1.52%).One or more positive tests out of three FIT had the largest area under receiver operating characteristic curve (0.743).For colorectal adenoma, detection rate of direct colonoscopy (17 581.25/105) was higher than all FIT strategies (3 732.30/105-13 127.41/105).Conclusions Single or repeated FIT and colonoscopy have different screening utility.One or more positive tests out of three FIT followed by colonoscopy is preferred to screen CRC, and direct colonoscopy is better for detection of colorectal adenoma.

Colorectal Cancer Screening Using Immunochemical Fecal Occult Blood Test

Fecal occult blood test (FOBT) screening has been shown to decrease the incidence and mortality of colorectal cancer (CRC). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the immunochemical fecal occult blood test (i-FOBT) in diagnosing CRC were assessed among the patients in a tertiary referral hospital in Malaysia. A total sample of 814 patients aged 16 to 85 years old who performed i-FOBT and endoscopic screenings was obtained. The patients were recruited for a retrospective investigation. Sensitivity, specificity, PPV, and NPV were derived for the CRC screenees. Out of the 814 patients screened using i-FOBT, half of them were above 59 years old (49.6%), and 36% had positive i-FOBT. Gender distribution was almost equal, where 53.4% of the patients were female, and 46.6% were male. Majority of the patients were Malays (56.6%), followed by Chinese (24.0%), Indians (16.5%), and others (2.9%). Among the 71 patients referred for colonoscopy, 57.7% and 42.3% corresponded to positive and negative i-FOBT cases, respectively. Polyps were found to be most common among the patients (25.6%), 7.0% were found positive for invasive CRC, and 35.2% had normal colonoscopic findings. There was a significant association between colonoscopic finding and positive i-FOBT (p=0.001). The sensitivity, specificity, PPV, and NPV for CRC detection were 66.7%, 43.0%, 9.8%, and 93.3%, respectively. The results indicate that i-FOBT is a useful tool in the detection of abnormalities in the lower gastrointestinal tract and therefore serves as a cornerstone for potential large-scale screening programmes.