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ABSTRACT: Aberrant crypt foci (ACF) are putative precursors of colorectal adenomas and have been postulated as a potential biomarker for colorectal cancer. Few studies have followed subjects after ACF removal to monitor recurrence. Subjects enrolled in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial were recruited for a study of ACF. A standardized protocol using magnified endoscopy and mucosal staining with methylene blue was implemented to detect rectal ACF. After removal of all baseline ACF, subjects returned 1 year later and recurrent ACF were observed and biopsied. A total of 434 of 505 (86%) subjects observed at baseline returned for the year 1 exam. The mean number of ACF at year 1 was strongly correlated with the number at baseline; subjects with 0, 1, 2 to 3, 4 to 6, and 7+ ACF at baseline had a mean of 1.2, 1.4, 1.7, 3.0, and 5.5 ACF, respectively, at year 1. ACF prevalence and mean count at year 1 (61% and 1.93, respectively), were only slightly lower than the corresponding values at year 0 (69% and 2.25, respectively). The locations of ACF at year 1 and baseline were significantly correlated. Of 96 ACF assessed for histology, 70 (73%) were hyperplastic and none were dysplastic. After removal of ACF at baseline, ACF counts 1 year later were only slightly reduced and were significantly correlated with the baseline ACF count. The results of this study do not support a role for ACF in clinical practice.
Cancer Prevention Research 07/2010; 3(7):839-43. · 4.91 Impact Factor
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Matthew G Mutch,
Robert E Schoen,
James W Fleshman,
Christopher J N Rall,
Sarah Dry,
David Seligson, Aline Charabaty,
David Chia,
Asad Umar,
Jaye Viner,
Ernest Hawk,
Paul F Pinsky
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ABSTRACT: Aberrant crypt foci (ACF) are the putative precursor of colorectal adenomas. However, there are limited data available on the prevalence and risk factors for ACF.
Subjects from the Prostate, Lung, Colorectal and Ovarian cancer screening trial were recruited for an ACF study, with subjects with adenoma history being oversampled. By using a standardized protocol of magnified chromoendoscopy with methylene blue staining (up to the middle rectal fold), ACF were photo-documented and removed for histologic evaluation.
A total of 505 (66% male; 55% > or =70 y) subjects from 4 institutions were examined; 42% had no adenoma, 32% had nonadvanced distal adenoma, and 25% had advanced distal adenoma at the baseline Prostate, Lung, Colorectal and Ovarian cancer screening trial examination (8.2 years before ACF examination on average). A total of 68% of this population had 1 or more ACF, 43% had 1 to 3, 19% had 4 to 6, and 5% had 7 or more. Baseline adenoma status was not associated with ACF prevalence (range, 66%-69%) or mean number of ACF (range, 3.1-3.5). Of 143 endoscopic ACF examined histologically, 68.5% were confirmed to be ACF. In a logistic model, current (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.2-5.6) and former smoking (OR, 1.6; 95% CI, 1.1-2.5) were associated with higher ACF prevalence; a body mass index greater than 30 was associated with lower prevalence (OR, 0.53; 95% CI, 0.35-0.8). Age, sex, family history of colorectal cancer, and aspirin/nonsteroidal anti-inflammatory drug use were not associated significantly with ACF prevalence.
ACF prevalence and number were not associated with adenoma history, and only 68.5% of endoscopic ACF were confirmed histologically. These results raise concern about the use of ACF as a surrogate marker of colorectal cancer risk.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 05/2009; 7(5):568-74. · 5.64 Impact Factor
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Matthew G Mutch,
Robert E Schoen Mph,
James W Fleshman,
Christopher Jn Rall,
Sarah Dry,
David Seligson, Aline Charabaty,
David Chia,
Asad Umar Dvm,
Jaye Viner,
Ernest Hawk,
Paul F Pinsky
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ABSTRACT: INTRODUCTION:: Aberrant crypt foci (ACF) are the putative precursor of colorectal adenomas. However, there are limited data available on prevalence and risk factors for ACF. METHODS:: Subjects from the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial were recruited for an ACF study, with subjects with adenoma history being over-sampled. Using a standardized protocol of magnified chromoendscopy with methylene blue staining (up to the middle rectal fold), ACF were photodocumented and removed for histologic evaluation. RESULTS:: 505 (66% male, 55% = 70 years) subjects from 4 institutions were examined; 42% had no adenoma, 32% had non-advanced distal adenoma and 25% had advanced distal adenoma at baseline PLCO examination (8.2 years prior to ACF exam on average). 68% of this population had =1 ACF, 43% had 1-3, 19% had 4-6, and 5% had =7. Baseline adenoma status was not associated with ACF prevalence (range 66-69%) or mean number (range 3.1-3.5). Of 143 endoscopic ACF examined histologically, 68.5% were confirmed to be ACF. In a logistic model, current (OR=2.6; 95% CI 1.2-5.6) and former smoking (OR=1.6; 95% CI 1.1-2.5) were associated with higher ACF prevalence; a BMI> 30 was associated with lower prevalence (OR=0.53; 95% CI 0.35-0.8). Age, gender, family history of colorectal cancer, and aspirin/NSAID use were not significantly associated with ACF prevalence. CONCLUSIONS:: ACF prevalence and number were not associated with adenoma history and only 68.5% of endoscopic ACF were confirmed histologically. These results raise concern about the use of ACF as a surrogate marker of colorectal cancer risk.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 02/2009; · 5.64 Impact Factor
