The aim of this study is to describe the role of endoscopy in detection and treatment of neoplastic lesions of the digestive mucosa in asymptomatic persons.Esophageal squamous cell cancer occurs in relation to nutriti...The aim of this study is to describe the role of endoscopy in detection and treatment of neoplastic lesions of the digestive mucosa in asymptomatic persons.Esophageal squamous cell cancer occurs in relation to nutritional deficiency and alcohol or tobacco consumption.Esophageal adenocarcinoma develops in Barrett's esophagus,and stomach cancer in chronic gastric atrophy with Helicobacter pylori infection.Colorectal cancer is favoured by a high intake in calories,excess weight,low physical activity.In opportunistic or individual screening endoscopy is the primary detection procedure offered to an asymptomatic individual.In organized or mass screening proposed by National Health Authorities to a population,endoscopy is performed only in persons found positive to a filter selection test.The indications of primary upper gastrointestinal endoscopy and colonoscopy in opportunistic screening are increasingly developing over the world.Organized screening trials are proposed in some regions of China at high risk for esophageal cancer;the selection test is cytology of a balloon or sponge scrapping;they are proposed in Japan for stomach cancer with photofluorography as a selection test;and in Europe,America and Japan;for colorectal cancer with the fecal occult blood test as a selection test.Organized screening trials in a country require an evaluation:the benefit of the intervention assessed by its impact on incidence and on the 5 year survival for the concerned tumor site;in addition a number of bias interfering with the evaluation have to be controlled.Drawbacks of screening are in the morbidity of the diagnostic and treatment procedures and in overdetection of none clinically relevant lesions.The strategy of endoscopic screening applies to early cancer and to benign adenomatous precursors of adenocarcinoma.Diagnostic endoscopy is conducted in 2 steps:at first detection of an abnormal area through changes in relief,in color or in the course of superficial capillaries;then characterization of the morphology of the lesion according to the Paris classification and prediction of the risk of malignancy and depth of invasion,with the help of chromoscopy,magnification and image processing with neutrophil bactericidal index or FICE.Then treatment decision offers 3 options according to histologic prediction:abstention,endoscopic resection,surgery.The rigorous quality control of endoscopy will reduce the miss rate of lesions and the occurrence of interval cancer.展开更多
Objective:The accuracy of colposcopy-guided biopsy is key to the success of colposcopic triage in cervical cancer screening programs.However,there is no widely adopted biopsy guideline up to date.Our study aimed to de...Objective:The accuracy of colposcopy-guided biopsy is key to the success of colposcopic triage in cervical cancer screening programs.However,there is no widely adopted biopsy guideline up to date.Our study aimed to determine whether multi-quadrants biopsy improves the yield of cervical lesions.Methods:Eleven population-based cervical cancer screening studies were conducted in China.Cytology,highrisk human papillomavirus(hrHPV)testing and visual inspection were performed for primary screening.Females positive on one or more tests were referred for colposcopy and biopsy.The proportion of detected cervical intraepithelial neoplasia(CIN)2+and yields by quadrant lesion-targeted biopsy or 4-quadrant random biopsy were compared.Results:Among 4,923 females included,1,606 had quadrant lesion-targeted biopsy,and 3,317 had 4-quadrant random biopsy.The cumulative CIN2+yield increased from 0.10 for only one quadrant-targeted biopsy to 0.21,0.34,and 0.58 for at most two,three and four quadrants targeted biopsies.Among hrHPV positive females with high-grade squamous intraepithelial lesion(HSIL)+cytology,the cumulative CIN2+yield of a second targeted biopsy in another quadrant was significantly increased(P<0.05).Among hrHPV-negative females,the yield of 4-quadrant random biopsies was 0.005,and the yield by lesion-targeted biopsies was 0.017.For hrHPV positive females who had 4-quadrant random biopsy,the additional CIN2+yield for HSIL+,low-grade squamous intraepithelial lesion(LSIL)cytology,or abnormal visual inspection via acetic acid and Lugol’s iodine(VIA/VILI)were 0.46,0.11,0.14.Conclusions:A 4-quadrant random biopsy is recommended only for hrHPV positive females with HSIL cytology,and is acceptable if hrHPV positive with LSIL cytology or with abnormal VIA/VILI.Our findings add evidences for an objective and practical biopsy standard to guide colposcopy in cervical cancer screening programs in low-and middle-income countries.展开更多
文摘The aim of this study is to describe the role of endoscopy in detection and treatment of neoplastic lesions of the digestive mucosa in asymptomatic persons.Esophageal squamous cell cancer occurs in relation to nutritional deficiency and alcohol or tobacco consumption.Esophageal adenocarcinoma develops in Barrett's esophagus,and stomach cancer in chronic gastric atrophy with Helicobacter pylori infection.Colorectal cancer is favoured by a high intake in calories,excess weight,low physical activity.In opportunistic or individual screening endoscopy is the primary detection procedure offered to an asymptomatic individual.In organized or mass screening proposed by National Health Authorities to a population,endoscopy is performed only in persons found positive to a filter selection test.The indications of primary upper gastrointestinal endoscopy and colonoscopy in opportunistic screening are increasingly developing over the world.Organized screening trials are proposed in some regions of China at high risk for esophageal cancer;the selection test is cytology of a balloon or sponge scrapping;they are proposed in Japan for stomach cancer with photofluorography as a selection test;and in Europe,America and Japan;for colorectal cancer with the fecal occult blood test as a selection test.Organized screening trials in a country require an evaluation:the benefit of the intervention assessed by its impact on incidence and on the 5 year survival for the concerned tumor site;in addition a number of bias interfering with the evaluation have to be controlled.Drawbacks of screening are in the morbidity of the diagnostic and treatment procedures and in overdetection of none clinically relevant lesions.The strategy of endoscopic screening applies to early cancer and to benign adenomatous precursors of adenocarcinoma.Diagnostic endoscopy is conducted in 2 steps:at first detection of an abnormal area through changes in relief,in color or in the course of superficial capillaries;then characterization of the morphology of the lesion according to the Paris classification and prediction of the risk of malignancy and depth of invasion,with the help of chromoscopy,magnification and image processing with neutrophil bactericidal index or FICE.Then treatment decision offers 3 options according to histologic prediction:abstention,endoscopic resection,surgery.The rigorous quality control of endoscopy will reduce the miss rate of lesions and the occurrence of interval cancer.
基金the Chinese Academy of Medical Sciences Initiative for Innovative Medicine(No.2016-I2M-1-019)the National Natural Science Foundation of China(No.81322040)。
文摘Objective:The accuracy of colposcopy-guided biopsy is key to the success of colposcopic triage in cervical cancer screening programs.However,there is no widely adopted biopsy guideline up to date.Our study aimed to determine whether multi-quadrants biopsy improves the yield of cervical lesions.Methods:Eleven population-based cervical cancer screening studies were conducted in China.Cytology,highrisk human papillomavirus(hrHPV)testing and visual inspection were performed for primary screening.Females positive on one or more tests were referred for colposcopy and biopsy.The proportion of detected cervical intraepithelial neoplasia(CIN)2+and yields by quadrant lesion-targeted biopsy or 4-quadrant random biopsy were compared.Results:Among 4,923 females included,1,606 had quadrant lesion-targeted biopsy,and 3,317 had 4-quadrant random biopsy.The cumulative CIN2+yield increased from 0.10 for only one quadrant-targeted biopsy to 0.21,0.34,and 0.58 for at most two,three and four quadrants targeted biopsies.Among hrHPV positive females with high-grade squamous intraepithelial lesion(HSIL)+cytology,the cumulative CIN2+yield of a second targeted biopsy in another quadrant was significantly increased(P<0.05).Among hrHPV-negative females,the yield of 4-quadrant random biopsies was 0.005,and the yield by lesion-targeted biopsies was 0.017.For hrHPV positive females who had 4-quadrant random biopsy,the additional CIN2+yield for HSIL+,low-grade squamous intraepithelial lesion(LSIL)cytology,or abnormal visual inspection via acetic acid and Lugol’s iodine(VIA/VILI)were 0.46,0.11,0.14.Conclusions:A 4-quadrant random biopsy is recommended only for hrHPV positive females with HSIL cytology,and is acceptable if hrHPV positive with LSIL cytology or with abnormal VIA/VILI.Our findings add evidences for an objective and practical biopsy standard to guide colposcopy in cervical cancer screening programs in low-and middle-income countries.
