Top

Published in:

01-02-2012 | Original paper

Aberrant crypt foci as predictors of colorectal neoplasia on repeat colonoscopy

Authors: Joseph C. Anderson, Helen Swede, Tarun Rustagi, Petr Protiva, Devon Pleau, Bruce M. Brenner, Thiruchandurai V. Rajan, Christopher D. Heinen, Joel B. Levine, Daniel W. Rosenberg

Published in: Cancer Causes & Control | Issue 2/2012

Abstract

Objective

To estimate the risk for colorectal neoplasia detected on repeat colonoscopy in relation to aberrant crypt foci (ACF) frequency reported during the previous baseline examination.

Methods

From July 2003 until December 2008, patients had a colonoscopy with an ACF study using a magnifying colonoscope. The distal 20 cm section of colon was sprayed with Methylene Blue to ascertain the ACF frequency, the independent variable. Patients were categorized into low and high ACF count using the median as the cut point. Data collected from consenting patients included age, gender, height, weight, ethnicity, smoking history, family history of colorectal cancer (CRC), and personal history of colorectal neoplasia. A follow-up colonoscopy was performed at an interval as dictated by clinical surveillance guidelines. The main outcome was surveillance detected advanced colorectal neoplasia (SDAN) detected on repeat colonoscopy. Logistic Regression was used to calculate risk of SDAN on repeat colonoscopy in relation to baseline ACF count.

Results

74 patients had a baseline ACF exam and a repeat surveillance colonoscopy. The median ACF was six and thus a high ACF count was >6 ACF and a low ACF count was ≤6 ACF. Patients diagnosed with SDAN were more likely to have had a high ACF number at baseline compared to patients without these lesions at follow-up (adjusted odds ratio = 12.27; 95% confidence interval: 2.00–75.25) controlling for age, sex, smoking, history of prior adenoma, family history of colon cancer, obesity, and time interval to surveillance exam. A sub analysis of our results demonstrated that this relationship was observed in 48 patients who were undergoing a surveillance colonoscopy for a previous adenoma and not those receiving surveillance for a family history of neoplasia.

Conclusions

Increased number of ACF in the distal colorectum was independently associated with substantial risk for future advanced neoplasia. This relationship was observed in patients undergoing surveillance for previous adenomas. Thus, ACF may serve as potential biomarkers in patients with adenomas to help identify patients who may need additional surveillance.

Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM (2009) American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol 104:739–750PubMedCrossRef

Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L (2009) Association of colonoscopy and death from colorectal cancer. Ann Intern Med 150:1–8PubMed

Brenner H, Hoffmeister M, Arndt V, Stegmaier C, Altenhofen L, Haug U (2010) Protection from right- and left-sided colorectal neoplasms after colonoscopy: population-based study. J Natl Cancer Inst 102:89–95PubMedCrossRef

Pretlow TP, Barrow BJ, Ashton WS et al (1991) Aberrant crypts: putative preneoplastic foci in human colonic mucosa. Cancer Res 51:1564–1567PubMed

Roncucci L, Stamp D, Medline A, Cullen JB, Bruce WR (1991) Identification and quantification of aberrant crypt foci and microadenomas in the human colon. Hum Pathol 22:287–294PubMedCrossRef

Anderson JC, Pleau DC, Rajan TV et al (2010) Increased frequency of serrated aberrant crypt foci among smokers. Am J Gastroenterol 105:1648–1654PubMedCrossRef

Moxon D, Raza M, Kenney R et al (2005) Relationship of aging and tobacco use with the development of aberrant crypt foci in a predominantly African-American population. Clin Gastroenterol Hepatol 3:271–278PubMedCrossRef

Mutch MG, Schoen RE, Fleshman JW et al (2009) A multicenter study of prevalence and risk factors for aberrant crypt foci. Clin Gastroenterol Hepatol 7:568–574

Stevens RG, Swede H, Heinen CD et al (2007) Aberrant crypt foci in patients with a positive family history of sporadic colorectal cancer. Cancer Lett 248:262–268PubMedCrossRef

10.

Swede H, Rohan TE, Yu H et al (2009) Number of aberrant crypt foci associated with adiposity and IGF1 bioavailability. Cancer Causes Control 20:653–661PubMedCrossRef

11.

Hurlstone DP, Karajeh M, Sanders DS, Drew SK, Cross SS (2005) Rectal aberrant crypt foci identified using high-magnification-chromoscopic colonoscopy: biomarkers for flat and depressed neoplasia. Am J Gastroenterol 100:1283–1289PubMedCrossRef

12.

Cho NL, Redston M, Zauber AG et al (2008) Aberrant crypt foci in the adenoma prevention with celecoxib trial. Cancer Prev Res (Phila) 1:21–31CrossRef

13.

Anderson JC, Pleau DC, Rajan TV et al (2010) Increased frequency of serrated aberrant crypt foci among smokers. Am J Gastroenterol 105:1648–1654

14.

Schoen RE, Gerber LD, Margulies C (1997) The pathologic measurement of polyp size is preferable to the endoscopic estimate. Gastrointest Endosc 46:492–496PubMedCrossRef

15.

Rosenberg DW, Yang S, Pleau DC et al (2007) Mutations in BRAF and KRAS differentially distinguish serrated versus non-serrated hyperplastic aberrant crypt foci in humans. Cancer Res 67:3551–3554PubMedCrossRef

16.

O’Brien MJ, Yang S, Clebanoff JL et al (2004) Hyperplastic (serrated) polyps of the colorectum: relationship of CpG island methylator phenotype and K-ras mutation to location and histologic subtype. Am J Surg Pathol 28:423–434PubMedCrossRef

17.

Martinez ME, Baron JA, Lieberman DA et al (2009) A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology 136:832–841PubMedCrossRef

18.

Adler DG, Gostout CJ, Sorbi D, Burgart LJ, Wang L, Harmsen WS (2002) Endoscopic identification and quantification of aberrant crypt foci in the human colon. Gastrointest Endosc 56:657–662PubMedCrossRef

19.

Nascimbeni R, Villanacci V, Mariani PP et al (1999) Aberrant crypt foci in the human colon: frequency and histologic patterns in patients with colorectal cancer or diverticular disease. Am J Surg Pathol 23:1256–1263PubMedCrossRef

20.

Seike K, Koda K, Oda K et al (2006) Assessment of rectal aberrant crypt foci by standard chromoscopy and its predictive value for colonic advanced neoplasms. Am J Gastroenterol 101:1362–1369PubMedCrossRef

21.

Shpitz B, Bomstein Y, Mekori Y et al (1998) Aberrant crypt foci in human colons: distribution and histomorphologic characteristics. Hum Pathol 29:469–475PubMedCrossRef

22.

Takayama T, Katsuki S, Takahashi Y et al (1998) Aberrant crypt foci of the colon as precursors of adenoma and cancer. N Engl J Med 339:1277–1284PubMedCrossRef

23.

Pinsky PF, Fleshman J, Mutch M et al (2010) One year recurrence of aberrant crypt foci. Cancer Prev Res (Phila) 3:839–843

24.

Anderson JC, Alpern Z, Sethi G et al (2005) Prevalence and risk of colorectal neoplasia in consumers of alcohol in a screening population. Am J Gastroenterol 100:2049–2055PubMedCrossRef

25.

Anderson JC, Messina CR, Dakhllalah F et al (2007) Body mass index: a marker for significant colorectal neoplasia in a screening population. J Clin Gastroenterol 41:285–290PubMedCrossRef

26.

Stein B, Anderson JC, Rajapakse R, Alpern ZA, Messina CR, Walker G (2010) Body mass index as a predictor of colorectal neoplasia in ethnically diverse screening population. Dig Dis Sci 55:2945–2952

27.

Anderson JC, Attam R, Alpern Z et al (2003) Prevalence of colorectal neoplasia in smokers. Am J Gastroenterol 98:2777–2783PubMedCrossRef

28.

Anderson JC, Latreille M, Messina C et al (2009) Smokers as a high-risk group: data from a screening population. J Clin Gastroenterol 43:747–752PubMedCrossRef

29.

Kim J, Ng J, Arozulllah A et al (2008) Aberrant crypt focus size predicts distal polyp histopathology. Cancer Epidemiol Biomarkers Prev 17:1155–1162PubMedCrossRef

30.

Gupta AK, Pinsky P, Rall C et al (2009) Reliability and accuracy of the endoscopic appearance in the identification of aberrant crypt foci. Gastrointest Endosc 70:322–330PubMedCrossRef

Title: Aberrant crypt foci as predictors of colorectal neoplasia on repeat colonoscopy
Authors: Joseph C. Anderson
Helen Swede
Tarun Rustagi
Petr Protiva
Devon Pleau
Bruce M. Brenner
Thiruchandurai V. Rajan
Christopher D. Heinen
Joel B. Levine
Daniel W. Rosenberg
Publication date: 01-02-2012
Publisher: Springer Netherlands
Published in: Cancer Causes & Control / Issue 2/2012
Print ISSN: 0957-5243
Electronic ISSN: 1573-7225
DOI: https://doi.org/10.1007/s10552-011-9884-7

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2012

What factors affect the odds of NSW cancer patients presenting with localised as opposed to more advanced cancer?

Risk of esophageal cancer in diabetes mellitus: a meta-analysis of observational studies

Seaweed intake and urinary sex hormone levels in preschool Japanese children

Maternal smoking during pregnancy, genetic polymorphisms of metabolic enzymes, and childhood acute leukemia: the ESCALE Study (SFCE)

Does hormone replacement therapy and use of oral contraceptives increase the risk of non-melanoma skin cancer?

Case–control study of smoking and non-melanoma skin cancer

Keynote webinar | Spotlight on antibody–drug conjugates in cancer