PubMed · 3557030
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A V Banez, S A Bozek, R F Simon. 1987. A double endoscope method for multiple colonic polypectomy.. https://doi.org/10.1016/s0016-5107(87)71482-5
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Autosomal dominant, familial forms of colorectal adenocarcinoma are recognized, but more than 90% of cases are sporadic. Most familial and sporadic cases arise through malignant transformation of benign adenomas in a process known as the adenoma-to-carcinoma sequence. Adenomas are classified histologically as tubular, tubulovillous, or villous. As a neoplasm, adenomas all manifest mild, moderate, or severe dysplasia. The majority (> 90%) of adenomas are small (< 1 cm in diameter) and do not progress. Risk factors for carcinomatous progression include the presence of multiple adenomas, size greater than or equal to 1 cm, and villous histology or severe dysplasia in adenomas of any size. The adenoma-to-carcinoma sequence advances through the accumulation of lesions involving multiple genes. It appears that similar molecular genetic mechanisms are involved in familial and sporadic forms of colorectal neoplasia.
BACKGROUND & AIMS: Screening for colonic polyps is desirable. A new concept based on cross-sectional and endoscopic analysis of a magnetic resonance (MR) data set is presented. METHODS: Ex vivo autopsy colonic specimens, containing artificially placed polyps, were obtained and filled with a gadolinium-containing solution. Forty-four thin-section MR images were obtained in a 1.5-T MR scanner in 28 seconds. A three-dimensional endoscopic fly-through of these images was rendered. Fly-throughs and two-dimensional cross-sectional images were analyzed by two observers for the presence of polyps. RESULTS: The average sensitivity and specificity for the detection of polyps based on three-dimensional endoscopic MR colon imaging were 87% and 96%, respectively. Analysis of cross-sectional images showed an overall sensitivity and specificity of merely 57% and 84%, respectively. The difference in the interpretation of three-dimensional MR colonoscopy and two-dimensional cross-sections was statistically significant (P < 0.001). With three-dimensional MR colonoscopy, overall sensitivity for detection of polyps measuring < or =5 mm in length and diameter was 70%; for larger polyps, it increased to 95% (P < 0.01). CONCLUSIONS: The feasibility of an MR-based endoluminal assessment of the colon is shown. Minimal invasiveness, lack of radiation exposure, and high in vitro diagnostic accuracy warrant further investigation of this novel concept.