Opportunistic Screening For Aberrant Crypt Foci Of The Rectal By High Definition I-scan Endoscopy And The Study Of Its Risk Factors

BackgroundColorectal cancer is the most common malignancy in the world, the incidence rate is second only to lung cancer, breast cancer, the mortality rate of malignant second early multi asymptomatic, symptoms for advanced colorectal and metastatic despite surgery and chemotherapy program innovation, the survival rate of patients with advanced colorectal cancer is still poor, one of the effective measures in prevention of colorectal cancer is early diagnosis and treatment of colorectal precancerous lesions.The incidence of colorectal cancer in general there are two models:one colon polyp-adenoma-carcinoma, aberrant crypt foci-colorectal cancer (de novo doctrine). De novo the doctrine of the first to benefit from Bird in the mouse colon carcinogenesis model of colorectal aberrant crypt foci, dependent on the digestion of endoscopic technology continues to progress and reform, making include aberrant crypt foci, including small lesions, especially flat type and flat and depressed type lesions can be identified in the body. Change through the decades in molecular genetics, pathological features, epidemiology, endoscopic characteristics of the large number of studies abnormal crypt foci in the earliest possible identification of colorectal precancerous lesions have been gradually accepted by the majority, but the ACF is considered to be a group of unusual-borne disease, associated with colorectal cancer may be others unrelated.The findings of aberrant crypt foci risk factors vary greatly, and the small sample size, multi-univariate analysis. Aberrant crypt foci risk factors contribute to its deeper understanding, and colorectal cancer risk factors compared, so that it can in part be explained both with or without associated.After centuries of development, a large number of new endoscopic techniques such as the NBI, FICE, i-scan has to be shipped with clinical, greatly improving the detection rate of lesions in the indigo the popliteal violet, methylene blue dye assisted timely pre-sentence pathological nature. The newly invented high definition digital endoscopy (i-scan) has two functions:high-resolution and digital dyeing technology, compared with the NBI and FICE operation is simple. This study attempts to opportunistic screening dyeing endoscopy using high-resolution digital rectal aberrant crypt foci, and to predict its nature, the histopathologic findings as the gold standard to explore high-resolution digital staining of endoscopic screening for rectal abnormalities hidden The nest of the value of the stove, looking for new colorectal cancer screening simple, efficient and effective way. Analysis of the age, sex, associated with polyps, non-steroidal anti-inflammatory drugs (NSAIDs), smoking history, drinking history, family history of colorectal cancer, body mass index (BMI), a total of seven risk factors for rectal abnormalities through questionnaires crypt foci in the number of multivariate logistic regression analysis to find whether the risk factors associated with rectal aberrant crypt foci.Materials and Methods1. Digestive endoscopy center line opportunistic colorectal endoscopy patients from March2011to August2011at the Third Affiliated Hospital of Southern Medical University, its rectum object of observation, retirement15cm to the anal dentate line. All patients agreed to and after the hospital ethics committee approval. Inclusion criteria:age over18years of age with or without intestinal symptoms. Exclusion criteria:colonoscopy contraindications such as severe cardiopulmonary disease, shock, abdominal aortic aneurysm, recent myocardial infarction; acute peritonitis, intestinal perforation; mental disorders can not match.A total of two experienced endoscopists completed a "back-to-back" inspection program in the entire colonoscopy. First colonoscopy reach the terminal ileum, and then retire mirror to15cm, HD mode is careful observation of the rectal mucosa until the anal dentate line, counting the observed rectal aberrant crypt foci, then the second bit I do not know the test results of endoscopic clinicians to use HD+i-scan mode again retire mirror to observe the same segment of the bowel, and count the number of rectal crypt foci, all patients randomly assigned to check the order of the ratio of1:1. Patients to sign an agreement to take the biopsy case, each patient is randomly taken from an aberrant crypt foci histopathological examination, the specimens were taken before the first stored endoscopic images of aberrant crypt foci (vascular V, P, and the large intestine C mode) for analysis, the reference combined with a pathological nature of the the kudo duct genotyping predict rectal aberrant crypt foci.Using SPSS13.0statistical analysis, P<0.05is assumed meaningful difference. The mean expression as x±s. Comparison of HD and HD+i-scan of the observed number of aberrant crypt foci whether the differences in measurement data before and after analysis of variance. Histopathology as the gold standard, using the chi-square test to verify the sensitivity and specificity of high definition digital endoscopy to predict lesions, using the κ coefficient and the McNemar test HD+i-scan to predict abnormal crypt foci in the nature of the pathological diagnosis compliance. 2. Conducted a questionnaire survey of the line high difinition digital endoscopy opportunistic screening of patients. The questionnaire included demographic information, gender, age, height, weight, smoking, alcohol consumption, aspirin application, family history of colorectal cancer, whether associated with colorectal polyps or cancer. Another researcher records the basic information of the patient.Availability and number of rectal aberrant crypt foci of the number of HD+i-scan model results shall prevail.Application of body mass index (BMI) to measure the degree of obesity, calculated as weight (kg)/[height (m)]2, defined as follows:underweight BMI<18.5, a healthy body weight18.5≤BMI<24, overweight24≤BMI<28, obese BMI of≥28, taking into account the actual situation in China with the World Health Organization Western populations, the research data based on the classification criteria developed slightly different.Smoking is defined as one or more per day. continuous six months or more as. Drinking is defined as weekly drinking of alcohol content higher than30g (about the equivalent of three bottles of beer), has2years from the questionnaire is not drinking alcohol. Over the past year at least a week to take one dose of is confined as aspirin taking. Family history of colorectal cancer-positive blood ties with investigators one, two relatives of colorectal cancer.SPSS13.0software for statistical analysis, P≤0.05is assumedas significant differences. Chi-square test Single various risk factors with. From a number of factors, the application of two classification Logistic regression screening of rectal aberrant crypt foci have significant risk factors.Results1.The application of high definition digital endoscopy in outpatient opportunistic screening for rectal aberrant crypt foci From March2011to August2011, a total of502patients underwent outpatient colonoscopy opportunistic screening, of which428cases more than18years of age to sign an agreement in patients enrolled in this study,220cases were male, accounting for51.4%,208cases of women, accounting for48.6%. The youngest20years old,84-year-old, average age46.72±15.474years old, the group sample size of40-49people up to109cases, accounting for25.5%.High definition digital endoscopic can be clearly observed abnormal crypt foci, showing a clear boundary with the surrounding normal intestinal mucosa, the pit increases, mostly round or oval, on the cortex than the surrounding normal mucosa thick, divided into two main types, one type is flat to slightly elevated type (Ⅱ a), another type is flat (Ⅱ b).HD model were found in the number of aberrant crypt foci553, the overall screening population average of1.29±2.423, HD+i-scan mode were found abnormal crypt foci in1024, population screening for an average of2.39±3.984, found that up to23(HD mode up to abnormal crypt foci15), compared with single HD mode an additional25cases of objects with abnormal crypt foci. HD+i-scan subject outpatient opportunistic screening population,40.4%of aberrant crypt foci, found that60.6%of the40-49group of aberrant crypt foci. HD+i-scan mode compared with single-use HD mode can significantly improve the detection rate of aberrant crypt foci (F=134.405, P<0.001).Histopathology as the gold standard, high-resolution digital staining endoscope anticipation profiled rectal aberrant crypt foci, the sensitivity was47.1%, specificity of96.8%(χ2=42.128, p<0.001). HD+i-scan and histopathological diagnosis consistent coefficient κ=0.490, P<0.001.2. Rectal aberrant crypt foci of the risk factors associatedA total of371patients completed questionnaires,192cases were male, accounting for51.8%,179cases of women, accounting for48.2%. The average age is45.99±15.237.150cases were found to have abnormal crypt foci, accounting for40.4%.Detection rate of different age rectal aberrant crypt foci (χ2=43.074, P<0.001), different gender (χ2=4.822, P=0.028), and whether drinking (χ2=11.835, p0.001), with or withoutwith colorectal polyps or tumors (χ2=6.576, P=0.010), degree of obesity of the population (χ2=26.545, P<0.001) between the rectal aberrant crypt foci detection rate difference was statistically significant. Do not prove the non-steroidal anti-inflammatory drugs (χ2=0.007, P=0.973), smoking status (χ2=2.894, P=0.089), family history of colorectal cancer (χ2=0.396, P=0.529) and rectal abnormalities implicit fossa lesions discovery rate.Risk factors for rectal aberrant crypt foci of the risk factors for rectal aberrant crypt stove BMI (OR=2.397,95%CI=1.623-3.542, P<0.001), with colon polyps or tumors (OR=2.656,95%CI=1.526-4.620, P=0.001); gender (OR=0.499,95%CI=0.310-0.803, P=0.004), alcohol consumption (OR=0.106,95%CI=0.046-0.244, P<0.001). The model test resultsχ2=58.049, P<0.001, regression equation has a significant meaning.Conclusion1. High difinition digital endoscope can clearly identify the rectal aberrant crypt foci, and endoscopic features described in the literature consistent with the NBI, FICE, endoscopy have similar diagnostic value. Compared to single HD mode, the HD+i-scan mode can significantly increase rectal aberrant crypt foci of detection.2. Histopathology as the gold standard, HD+i-scan to predict rectal aberrant crypt foci with high specificity and low sensitivity compared with histological diagnosis agreement in general.3. In different gender, age, body mass index, with or without history of drinking, found that rates of colorectal polyps or cancer and rectal aberrant crypt, and the history of smoking, the body of non-steroidal anti-inflammatory drugs, family history of colorectal cancer and has nothing to do its detection rate. Regression analysis to filter out the risk factors associated with rectal aberrant crypt foci with or without gender, body mass index, history of alcohol consumption and associated with colorectal cancer or polyps, in which women and alcohol as a protective factor.