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PubMed1990

Fine needle aspiration cytology of rectal masses.

This paper describes the results of transproctoscopic fine needle aspiration cytology in the diagnosis of rectal lesions. Fifty one consecutive patients referred with a presumptive diagnosis of rectal mass were subjected to proctoscopic examination when fine needle aspiration cytology, brush cytology and biopsy samples were taken. Of the 30 patients of malignancy of rectum in whom all the three sampling techniques were applied, the biopsy was positive in 27 (90%), brush cytology in 25 (83.3%) and fine needle aspiration cytology in 29 (96.6%). A combination of fine needle aspiration cytology with brush cytology gave a positive yield in 96.6% while that fine needle aspiration cytology with brush cytology gave a yield of 100%. Fine needle aspiration cytology was most helpful in infiltrative tumours. All 10 patients with secondaries in the pouch of Douglas or rectovesical pouch, and the single patient with submucosal rectal carcinoma were correctly diagnosed at fine needle aspiration cytology. There were no false positive results with fine needle aspiration cytology and no complications were encountered with the procedure.

Adenocarcinoma↗
PubMed1992

Distribution of collagenous colitis: utility of flexible sigmoidoscopy.

We investigated the distribution of the collagen band in 33 patients with collagenous colitis to estimate the likelihood of the disease being diagnosed in biopsy specimens from the left side of the colon, such as those obtained using flexible sigmoidoscopy. To be included in this study patients had a subepithelial collagen band greater than or equal to 10 microns, an increase in chronic inflammatory cells in the same specimen, and diarrhoea for which there was no other apparent cause. In 17 patients undergoing full colonoscopy with a thickened collagen band, collagenous colitis was frequently patchy, even though overall the thickened collagen band was almost equally distributed throughout the colon. Rectal biopsy specimens showed a normal collagen band in 73% of patients, while a thickened collagen band was found in 82% of patients in at least one specimen from the left side of the colon. Three patients had a thickened collagen band only in the caecum. In three of eight rectal biopsy specimens with a normal collagen band there was no mucosal inflammation to raise the possibility of proximal disease, although all but one specimen with a normal collagen band from the sigmoid and descending colon were inflamed. Rectal biopsy alone is therefore a relatively poor method of making the diagnosis. Flexible sigmoidoscopy with multiple biopsy specimens from several sites is a reasonable initial investigation but not sufficient to exclude collagenous colitis when based on the presence of a thickened collagen band alone. Should left sided biopsy specimens show a normal collagen band but an inflamed mucosa, total colonoscopy with multiple specimens including the caecum may be required to establish the diagnosis.

Adolescent↗
PubMed1993

Anthranoid laxative abuse--a risk for colorectal cancer?

Anthranoid-containing laxatives--aloe, cascara, frangula, and rheum--may play a role in colorectal cancer. This risk is particularly important in view of the wide abuse of self administered laxatives for chronic constipation. There are data on the genotoxic potential of anthranoids and there is evidence of a tumourigenic potential in rodents. A case report and clinical-epidemiological studies have evaluated the cancer risk in patients who have abused anthranoid laxatives over a long period. Pseudomelanosis coli is a reliable parameter of chronic laxative abuse (> 9-12 months) and is specific for anthranoid drugs. In a retrospective study of 3049 patients who underwent diagnostic colorectal endoscopy the incidence of pseudomelanosis coli was 3.13% in patients without pathological changes. In those with colorectal adenomas, the incidence increased to 8.64% (p < 0.01), and in those with colorectal carcinomas it was 3.29%. This lower rate was probably caused by incomplete documentation of pseudomelanosis coli in those with carcinoma. In a prospective study of 1095 patients, the incidence of pseudomelanosis coli was 6.9% for patients with no abnormality seen on endoscopy, 9.8% (p = 0.068) for patients with adenomas, and 18.6% for patients with colorectal carcinomas. From these data a relative risk of 3.04 (1.18, 4.90; 95% confidence interval) can be calculated for colorectal cancer as a result of anthranoid laxative abuse.

Adenoma↗
PubMed1980

Haemorrhoids--objective measurement of proctoscopic appearances.

The proctoscopic diagnosis of haemorrhoids may be influenced by the surgeon's knowledge of the presence or absence of associated symptoms. In this study, an observer with no knowledge of the history, was used to check the surgeon's proctoscopic findings in 12 asymptomatic controls, and 24 symptomatic patients on 2 occasions, the latter group undergoing McGivney rubber band ligation. There was very good correlation between the findings of the surgeon and the observer, indicating a lack of 'historical bias'. The documentation method designed to allow this comparison proved sufficiently accurate and reproducible to enable a correlation between haemorrhoidal mass and symptoms. Relief of symptoms after treatment correlated well with an objective reduction in haemorrhoidal mass.

Adult↗
PubMed2005

The value of anal cytology and human papillomavirus typing in the detection of anal intraepithelial neoplasia: a review of cases from an anoscopy clinic.

BACKGROUND: Previous studies have reached differing conclusions about the utility of anal cytology as a screening tool for anal intraepithelial neoplasia (AIN). There is a need also to establish whether HPV typing offers a useful adjunct to screening. METHODS: We analysed data from 99 consecutive homosexual/bisexual male patients (89 HIV-1 positive) who underwent high resolution anoscopy. Follow up visits for these patients were also included, giving a total of 160 anoscopic procedures. Comparison was made between results of anal cytology using the sampling method of Palefsky, and histological findings of biopsies taken from abnormal areas seen on high resolution anoscopic examination of the anal canal. Swabs taken concurrently with the cytology were analysed for the presence of human papillomavirus (HPV) DNA and compared with the cytological and histological findings. RESULTS: The sensitivity of the cytology was 83%, and the specificity 38% when compared with histology. At screening of 34 asymptomatic men, 83% had anal cytological dysplasia and 78% had AIN. There were no significant differences in the prevalence of hrHPV genotypes between different cytological or histological grades of abnormalities. CONCLUSION: Anal cytology by the Palefsky method is simple to undertake, has a sensitivity and specificity comparable with cervical cytology, and can therefore be used as the basis of a pilot screening project in centres with large cohorts of HIV positive homosexual men who have a high risk of developing anal carcinoma. HPV genotyping is not a useful adjunct to cytological screening.

Analysis of Variance↗
PubMed2005

Blind sampling is superior to anoscope guided sampling for screening for anal intraepithelial neoplasia.

OBJECTIVES: Anal cytology smears are either collected "blind" (swab inserted 4 cm into anal canal and rotated) or guided through an anoscope (transformation zone visualised and then sampled). We compared these smear techniques with respect to sample quality and patient acceptability. METHODS: Using a paired, random sequence clinical trial, 151 homosexual men (n = 95 HIV positive) underwent both smear techniques at a single visit; smear order was randomised and specimens were read blind. Both techniques utilised a Dacron swab, with water lubrication. Cytological specimens were prepared using a liquid based collection method (ThinPrep). The outcome measures were cytological specimen adequacy, cytological classification, presence of rectal columnar, squamous and metaplastic cells, contamination, patient comfort and acceptability, and volume of fluid that remained after the ThinPrep procedure. RESULTS: Regardless of smear order, guided smears were less likely to detect higher grade abnormalities than blind smears (15 v 27 cases, p = 0.001). Controlling for smear order, guided smears were more likely to be assessed as "unsatisfactory" for cytological assessment (OR 6.93, 95% CI 1.92 to 24.94), and contain fewer squamous (OR 0.20, 95% CI 0.04 to 0.94) and metaplastic cells (OR 0.12, 95% CI 0.03 to 0.54) than blind smears; there were no other statistically significant differences between techniques. Regardless of smear technique, first performed smears were more likely to detect a higher grade abnormality than second performed smears (23 v eight cases, p < 0.001). CONCLUSIONS: Blind cytology smears are superior to anoscope guided smears for screening for anal neoplasia in homosexual men.

Adult↗
PubMed1977

Diagnosis of rectal gonorrhoea by blind anorectal swabs compared with direct vision swabs taken via a proctoscope.

Eight hundred and twenty-three examinations were carried out on 662 homosexual patients. At each examination a blind anorectal swab and a rectal swab taken via a proctoscope were inoculated on to a culture plate. From a total of 100 gonococcal infections of the rectum 96 gave positive results from blind anorectal swabs and 99 from swabs taken via a proctoscope. Blind anorectal swabs proved to be a reliable method in the diagnosis of rectal gonorrhoea.

Gonorrhea↗
PubMed1991

Anal human papillomavirus infection: a comparative study of cytology, colposcopy and DNA hybridisation as methods of detection.

OBJECTIVE: To compare anal cytology, colposcopy and DNA hybridisation as methods of detecting anal HPV infection. SUBJECTS AND DESIGN: Patients attending: (1) a genitourinary medicine (GUM) clinic with ano-genital warts; (2) a surgical out-patient department with anal fissure or haemorrhoids were examined for evidence of anal HPV infection. RESULTS: Considering GUM clinic attenders, 17% (38/225) and 40% (90/225) had perianal or anal canal warts respectively. Colposcopic examination revealed anal acetowhite lesions without warts in 28% (63/225). Cytological evidence of HPV infection was found in 98%, 83%, and 90% of patients with anal canal warts, perianal warts and acetowhite lesions respectively. Anal intraepithelial neoplasia (AIN) was documented in 22% of patients with anal canal warts compared with 6% with perianal warts (p less than 0.01). HPV DNA was detected from the anal brushings of 71%, 50%, 32%, and 29% of patients with anal canal warts, perianal warts, acetowhite lesions and a normal anal examination respectively. HPV type 6/11 was detected in the majority of HPV positive samples. Considering surgical out-patient attenders with no history or signs of anal warts, 25% showed cytological evidence of anal HPV infection and HPV DNA was detected from anal brushings in 3% (2/71). CONCLUSION: Anal examination with the colposcope is a useful method for detecting subclinical HPV infection. Anal cytology may prove helpful for detecting AIN, however, since koilocytosis was rarely seen, the specificity of the cytological criteria for anal HPV infection in the absence of AIN is uncertain. DNA analysis of anal brushings proved only moderately sensitive.

Adult↗
PubMed1981

Double-contrast enema examination for detection of rectal carcinoma.

The role of the double-contrast enema examination (DCE) in the detection of rectal carcinoma was evaluated and compared to the proctoscopic examination. Records of 90 consecutive patients with a diagnosis of rectal carcinoma were reviewed. Sixty-six patients had a preoperative DCE. The correct diagnosis was either made or suggested in 91% of these patients. The proctoscopic examination was diagnostic in 86%. The causes of radiologic and proctoscopic error were evaluated. Findings confirm that the DCE is an accurate method for the diagnosis of rectal carcinoma. Careful examination of the rectum should be incorporated in all radiologic studies of the colon since a normal proctoscopic examination does not exclude the possibility of rectal carcinoma.

Barium Sulfate↗
PubMed1982

Barium enema examination following biopsy of the rectum or colon.

A four-component study was designated to evaluate the possible risk of perforation during barium enema examination following biopsy of the rectum or colon. The study included a survey of gastrointestinal radiologists, an in vitro study of pig colons after biopsy, colon pressure measurements in human subjects, and histological analysis of human colonoscopic biopsy specimens. The results suggest that superficial biopsy of the rectum of colon performed with small colonoscopic forceps is a safe procedure and no waiting period is necessary before performing a barium enema study. However, biopsy of the colon or rectum with proctoscopic forceps appears to have greater potential for perforation and a waiting period between biopsy and barium enema study is recommended. Radiologists should distinguish between proctoscopic and colonoscopic biopsy procedures before determining when a barium enema study will be performed following biopsy.

Animals↗
PubMed1983

The value of colonoscopy and double-contrast barium-enema examinations in the evaluation of patients with subacute and chronic lower intestinal bleeding.

We examined 136 consecutive patients with histories of guaiac positive stool examinations, bright red blood per rectum, or hematochezia to determine the value of the double-contrast barium-enema (DC-BE) examination and colonoscopy/proctoscopy in establishing bleeding sites. If examination findings were analyzed in conjunction with findings of visual examination of the anal area, the difference in the respective sensitivities of the two examinations was not statistically significant. If findings at the visual inspection were excluded, the DC-BE examination missed 45 of 155 proved bleeding sites (sensitivity, 71%) and 13 of 35 nonbleeding lesions (sensitivity for all lesions 70%), while colonoscopy missed 13 of 155 bleeding sites (sensitivity, 92%) and seven of 35 nonbleeding lesions (sensitivity for all lesions, 90%). The sensitivity of both methods was similar if all rectal and anal lesions were excluded. Only eight additional lesions (all polyps) were found in 78 patients who had bleeding internal and external hemorrhoids, anal fissures, and anal tears, and seven of these were found in patients who were older than 50 years of age. We conclude that colonoscopy is superior to the DC-BE examination in the detection of bleeding sites but similar in results to the DC-BE examination if lesions in the anal canal and rectum are excluded. The routine use of the DC-BE examination in patients with superficial lesions in the anal canal should be discouraged unless the patient has persistent bleeding or is 50 years old or older.

Adult↗
PubMed1985

Clinical application of in vitro studies for barium-enema examination following colorectal biopsy.

A total of 150 colorectal biopsies were performed in 71 patients and correlated with the barium-enema examination (BE). The investigation was divided into two parts. In the first part, involving 19 patients, the depth of each biopsy specimen was determined histologically prior to BE and potential complications related to the biopsy-BE sequence were evaluated. In the second part, involving all 71 patients, the depth of biopsy specimens taken from various colon lesions was determined histologically without regard to the timing of BE. The results confirm previous in vitro findings in pigs and dogs, namely: (a) BE may be performed without delay following a superficial biopsy, but should not be performed until at least 6 days after a deep biopsy; (b) transcolonoscopic biopsies are likely to be superficial, while transproctoscopic biopsies have the potential to be deep; and (c) BE should be delayed at least 6 days following polypectomy or polyp biopsy performed with electrosurgery.

Barium Sulfate↗
PubMed1985

Local recurrence after sphincter-saving resection for rectal and rectosigmoid carcinoma. Value of various diagnostic methods.

The authors reviewed 51 cases of local recurrence after sphincter-saving resection for rectal and rectosigmoid carcinoma to assess the sensitivity of current diagnostic procedures. A combination of follow-up serum CEA levels and rectoscopy was found to be most efficient during the first two years after surgery in terms of the time, frequency, and location of the recurrence as well as the cost-benefit ratio. On the other hand, almost all recurrent lesions developed extraluminally, infiltrating the suture line secondarily; moreover, one fourth extended outside the bowel wall. Thus in addition to endoscopy, CT is useful as a means of defining the entire mass at the anastomosis as well as detecting pericolic recurrence and is essential if repeat resection is contemplated.

Adult↗