RESUMO
RATIONALE: DNA damage and chromosomal alterations in peripheral lymphocytes parallels DNA mutations in tumor tissues. OBJECTIVE: The aim of our study was to predict the presence of neoplastic colorectal lesions by specific biomarkers in "medium risk" individuals (age 50 to 75, with no personal or family of any colorectal neoplasia). METHODS AND RESULTS: We designed a prospective cohort observational study including patients undergoing diagnostic or opportunistic screening colonoscopy. Specific biomarkers were analyzed for each patient in peripheral lymphocytes - presence of micronuclei (MN), nucleoplasmic bridges (NPB) and the Nuclear Division Index (NDI) by the cytokinesis-blocked micronucleus assay (CBMN). Of 98 patients included, 57 were "medium risk" individuals. MN frequency and NPB presence were not significantly different in patients with neoplastic lesions compared to controls. In "medium risk" individuals, mean NDI was significantly lower for patients with any neoplastic lesions (adenomas and adenocarcinomas, AUROC 0.668, p 00.5), for patients with advanced neoplasia (advanced adenoma and adenocarcinoma, AUROC 0.636 p 0.029) as well as for patients with adenocarcinoma (AUROC 0.650, p 0.048), for each comparison with the rest of the population. For a cut-off of 1.8, in "medium risk" individuals, an NDI inferior to that value may predict any neoplastic lesion with a sensitivity of 97.7%, an advanced neoplastic lesion with a sensitivity of 97% and adenocarcinoma with a sensitivity of 94.4%. DISCUSSION: NDI score may have a role as a colorectal cancer-screening test in "medium risk" individuals. ABBREVIATIONS: DNA = deoxyribonucleic acid; CRC = colorectal cancer; EU = European Union; WHO = World Health Organization; FOBT = fecal occult blood test; CBMN = cytokinesis-blocked micronucleus assay; MN = micronuclei; NPB = nucleoplasmic bridges; NDI = Nuclear Division Index; FAP = familial adenomatous polyposis; HNPCC = hereditary non-polypoid colorectal cancer; IBD = inflammatory bowel diseases; ROC = receiver operating characteristics; AUROC = area under the receiver operating characteristics curve.
Assuntos
Biomarcadores Tumorais/genética , Neoplasias Colorretais/genética , Adulto , Idoso , Área Sob a Curva , Divisão do Núcleo Celular , Colonoscopia , Demografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Fatores de Risco , Adulto JovemRESUMO
Neoplastic lesions of the gastrointestinal tract have a large prevalence worldwide and in Romania. Their therapy is tailored to their TNM stage, which can be estimated using non invasive or minimally invasive imaging studies. Precursor lesions and superficial carcinomas are amenable to endoscopic therapy, providing that their endoscopic and/or endoscopic ultrasound aspect suggest a maximal extension to the submucosal layer. Polypectomy, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are ablative techniques used for their curative intent treatment. Large superficial carcinomas are to be removed by ESD as "en bloc" resection is essential to post procedure histological appraisal of the curative oncology nature of their resection. ESD complications rates and duration are nowadays reduced with the aid of "water-jet" technology, by combining submucosal fluid jet injection and electro-resection in a single knife.
Assuntos
Carcinoma/cirurgia , Neoplasias Colorretais/cirurgia , Dissecação/métodos , Eletrocirurgia/métodos , Mucosa Intestinal/cirurgia , Neoplasias Gástricas/cirurgia , Água , Carcinoma/patologia , Colonoscopia , Neoplasias Colorretais/patologia , Dissecação/instrumentação , Gastroscopia , Humanos , Estadiamento de Neoplasias , Pressão , Neoplasias Gástricas/patologia , Fatores de Tempo , Resultado do TratamentoAssuntos
Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/cirurgia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia , Carcinoma de Células Escamosas/radioterapia , Corantes , Neoplasias Esofágicas/radioterapia , Esofagoscopia/efeitos adversos , Gastroscopia/efeitos adversos , Humanos , Iodetos , Luz , Mucosa/cirurgia , Neoplasias Gástricas/radioterapiaAssuntos
Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Detecção Precoce de Câncer , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/terapia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia , Dissecação/efeitos adversos , Endoscopia Gastrointestinal , Mucosa Gástrica/cirurgia , HumanosAssuntos
Ductos Pancreáticos/patologia , Pancreatite/etiologia , Doença Aguda , Adenocarcinoma/secundário , Biópsia/efeitos adversos , Colangiopancreatografia por Ressonância Magnética , Neoplasias do Colo/patologia , Evolução Fatal , Feminino , Humanos , Neoplasias Hepáticas/secundário , Pessoa de Meia-Idade , Pseudocisto Pancreático/diagnóstico por imagem , Tomografia Computadorizada por Raios XAssuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/cirurgia , Varizes Esofágicas e Gástricas/cirurgia , Esofagoscopia/métodos , Idoso , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/mortalidade , Endoscopia/métodos , Endoscopia/mortalidade , Endossonografia/métodos , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/mortalidade , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/mortalidade , Seguimentos , Humanos , Cirrose Hepática Alcoólica/complicações , Cirrose Hepática Alcoólica/diagnóstico , Masculino , Pessoa de Meia-Idade , Mucosa/patologia , Mucosa/cirurgia , Estadiamento de Neoplasias , Medição de Risco , Estudos de Amostragem , Sensibilidade e Especificidade , Taxa de Sobrevida , Resultado do TratamentoRESUMO
UNLABELLED: BACK AND STUDY AIMS: Endoscopic mucosal resection (EMR) is used to treat premalignant and malignant digestive tract lesions. This report presents the efficacy and safety of EMR for squamous superficial neoplastic esophageal lesions. PATIENTS AND METHODS: A retrospective cohort study presented data from 51 patients with 54 lesions over an 8-year period, between November 1997 and September 2005. Dysplasas or mucosal (m) T1 carcinomas were treated with repeated EMR until there was a complete local remission. Patients with submucosal (sm) T1 carcinomas were treated with repeated EMR until there was a complete local remission. Patients with submucosal (sm) T1 carcinomas or more advanced stage were offered surgery or chemoradiotherapy. RESULTS: There was no mortality, perforation, or major hemorrhage, and there were three easily dilated stenoses. Of the patients, 16 had lesions graded as T1sm or more advanced and one patient was found to have normal tissue post EMR. Complete local remission was achieved in 31 of the 34 patients with dysplasia or T1 m cancers (91%). There was no distant relapse and there was local disease recurrence in eight of the 31 patients (26%). The 5-year survival rate was 95%. CONCLUSIONS: EMR for squamous superficial neoplastic lesions of the esophagus is safe and provides satisfactory survival results.