Endoscopic and Histopathology Characteristics in Patients with Esophageal High-Grade Intraepithelial Neoplasia

2018 ◽  
Vol 36 (5) ◽  
pp. 384-393 ◽  
Author(s):  
Huai-Ming Sang ◽  
Jiu-Liang Cao ◽  
Muhammad Djaleel Soyfoo ◽  
Wei-Ming Zhang ◽  
Jian-Xia Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Curative Resection ◽  
Narrow Band Imaging ◽  
Histological Grade ◽  
Intraepithelial Neoplasia ◽  
Lesion Size ◽  
High Grade ◽  
Independent Risk Factors ◽  
Endoscopic Characteristics ◽  
Endoscopic Forceps Biopsy

Background/Aims: To correlate the endoscopic characteristics with the histopathology of specimens of esophageal high-grade intraepithelial neoplasia obtained by endoscopic submucosal dissection (ESD). Methods: This was a retrospective study developed from January 2010 to December 2015. The study included 169 patients who underwent ESD and were diagnosed with esophageal high-grade intraepithelial neoplasia according to endoscopic forceps biopsy, Lugol staining, endoscopic ultrasonography, computed tomography, and Narrow-Band Imaging. The demographic, endoscopic, and histopathologic characteristics were analyzed. Results: A total of 19 cases (11.2%) had a change in diagnosis after histopathology exam and 16 (9.5%) needed a change in established treatment. An increase in the severity of disease was correlated with a lesion size > 2 cm, less than 4 samples in biopsy, and depressed or excavated patterns (p < 0.05). One hundred forty patients (82.8%) underwent curative resection. Lesions with leukoplakia (p < 0.001) and negative Lugol staining (p = 0.028) were independent risk factor for non-curative resection. Conclusion: This study confirms that lesion size > 2 cm, depressed and excavated patterns, and ≤4 biopsy samples are independent risk factors for histological grade changes compared to pre-endoscopic treatment diagnosis. Similarly, leukoplakia and no Lugol staining of lesions are independent risk factors for non-curative resection.

scholarly journals Quality Assessment of Endoscopic Forceps Biopsy Samples under Magnifying Narrow Band Imaging for Histological Diagnosis of Cervical Intraepithelial Neoplasia: A Feasibility Study

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 360
Author(s):  
Kunihisa Uchita ◽  
Hideki Kobara ◽  
Kenji Yorita ◽  
Yuriko Shigehisa ◽  
Chihiro Kuroiwa ◽  
...  
Keyword(s):  
Cervical Intraepithelial Neoplasia ◽  
Narrow Band ◽  
Narrow Band Imaging ◽  
Intraepithelial Neoplasia ◽  
Final Diagnosis ◽  
Punch Biopsy ◽  
High Grade ◽  
Current Standard ◽  
Forceps Biopsy ◽  
Endoscopic Forceps Biopsy

The current standard for diagnosing cervical intraepithelial neoplasia (CIN) is colposcopy followed by punch biopsy. We have developed flexible magnifying endoscopy with narrow band imaging (ME-NBI) for the diagnosis of CIN. Here, we investigated the feasibility of targeted endoscopic forceps biopsy (E-Bx) under guidance of ME-NBI for the diagnosis of CIN. We prospectively enrolled 32 consecutive patients with confirmed or suspected high-grade CIN undergoing cervical conization. Next to colposcopy, the same patients underwent ME-NBI just before conization. ME-NBI was performed, and 30 E-Bx samples were taken from lesions suspicious for high-grade CIN and 15 from non-suspicious mucosa. We recalled 82 punch biopsy (P-Bx) specimens taken from lesions suspicious for high-grade CIN under colposcopic examination before enrollment. The proportion of sufficient biopsy samples, which had an entire mucosal layer with subepithelial tissue, for the diagnosis of CIN was evaluated by both methods. Performance of targeted E-Bx for the final diagnosis of at least high-grade CIN was calculated. Seventeen P-Bx specimens were unavailable. The proportion of sufficient samples with E-Bx was 84%, which was similar to that with P-Bx (87%) (p = 0.672). The sensitivity, specificity, and accuracy of ME-NBI using E-Bx was 92%, 81%, and 88%, respectively. In conclusion, ME-NBI-guided E-Bx samples were feasible for histological diagnoses of CIN, and further investigation of its diagnostic accuracy is warranted.

Development of invasive disease in 433 women treated for vulvar, vaginal or perianal intraepithelial neoplasia

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 5043-5043
Author(s):  
M. K. Fehr ◽  
K. J. Dedes ◽  
S. Heinzl ◽  
M. D. Mueller ◽  
M. Baumann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Case Series ◽  
Intraepithelial Neoplasia ◽  
Invasive Disease ◽  
Malignant Potential ◽  
Initial Diagnosis ◽  
Laser Evaporation ◽  
High Grade

5043 Background: The incidence of intraepithelial neoplasia (IN) of the lower anogenital tract is increasing. Due to small case-series, the malignant potential of treated high-grade IN is not well defined and risk factors for progression are not established. Methods: Patients with IN of the vulva (VIN), vagina (VAIN) and perianal skin (PAIN) were identified in the electronic databases of three university colposcopy clinics. Inclusion criteria were biopsy proven IN grade 2–3 (high-grade) and no history of vaginal, vulvar or anorectal cancer. Excluded were patients with the diagnosis of invasive disease within one year from initial diagnosis of IN. Results: 442 patients were identified from 1977 to 2005 with a mean follow up of 69.9 ± 56.1 months. Initial diagnosis was VIN III in 75.3%, VIN II in 17.2%, VAIN II in 4.3%, VAIN III in 2%, and PAIN II/III in 1.1% of patients. Mean age at initial diagnosis was 47.1 ± 14.1 (range, 18–102). Initial treatment was biopsy and laser evaporation in 61.5%, surgical excision in 32.8%, and other locally destructive methods in 3.1% of patients. 9 patients refused any treatment (2.0%). In the 433 treated patients, recurrent disease (e.g. diagnosed >1 year after initial diagnosis) occurred in 32.2%. In patients with a follow up longer than 5 years, 14.4 % were still experiencing recurrences. In multivariate analysis, immunosuppression (OR: 2.33, 95% CI 1.06–5.06, p = 0.035) was associated with recurrence but not smoking, age or histological grade. Progression to invasive disease occurred in 3.8% of treated patients within a mean time of 7.9 ± 6.8 years (range, 1.3–24.5). In multivariate analysis, immunosuppression (OR:3.31, 95% CI 1.01–10.93, p = 0.049) and smoking (OR:3.12, 95% CI 1.07–9.08, p = 0.037) were independent risk factors for progression. Conclusions: Anogenital IN is a chronic disease in a substantial proportion of patients. The malignant potential is remarkably high despite repeated treatments. Therefore, long lasting surveillance is mandatory, especially in immunosuppressed or smoking patients. No significant financial relationships to disclose.

Prostate Cancer Diagnosis Among Men With Isolated High-Grade Intraepithelial Neoplasia Enrolled Onto a 3-Year Prospective Phase III Clinical Trial of Oral Toremifene

2013 ◽  
Vol 31 (5) ◽  
pp. 523-529 ◽  
Author(s):  
Samir S. Taneja ◽  
Ronald Morton ◽  
Gary Barnette ◽  
Paul Sieber ◽  
Michael L. Hancock ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Placebo Group ◽  
Cancer Detection ◽  
Prostate Biopsy ◽  
Intraepithelial Neoplasia ◽  
Phase Iii ◽  
Baseline Risk ◽  
High Grade ◽  
Free Survival

PurposeProstate cancer (PCa) prevention remains an appealing strategy for the reduction of overtreatment and secondary adverse effects. We evaluated the efficacy of toremifene citrate 20 mg in PCa prevention among men with isolated high-grade prostatic intraepithelial neoplasia (HGPIN) on biopsy.Patients and MethodsOne thousand five hundred ninety men with HGPIN, or HGPIN and atypia, and no PCa on prostate biopsy were randomly assigned 1:1 to receive toremifene citrate 20 mg or placebo in a 3-year phase III, double-blind, multicenter trial. Men underwent annual biopsy until cancer detection or study end. Efficacy analysis was performed in 1,467 men who underwent at least one on-study biopsy. Baseline risk factors were evaluated to determine influence on cancer detection.ResultsCancer was detected in 34.7% and 32.3% of men in the placebo and treatment groups, respectively, with no observed difference (P = .39, log-rank test) in PCa-free survival. The 3-year Kaplan-Meier PCa-free survival estimate was 54.9% (99% CI, 43.3% to 66.5%) in the placebo group and 59.5% (99% CI, 48.1% to 70.9%) in the treatment group. Exploration of baseline risk factors demonstrated no subset in which a risk reduction was observed. In the placebo group, 17.9%, 12.9%, and 13.6% of men at risk at the beginning of years 1, 2, and 3, respectively, were diagnosed with PCa.ConclusionAlthough toremifene 20 mg did not lower the PCa detection rate, men with isolated HGPIN have a high likelihood of eventual PCa diagnosis, demonstrating they are ideal candidates for inclusion in chemoprevention trials and require surveillance by periodic prostate biopsy.

Risk factors for recurrent high grade vaginal intraepithelial neoplasia and progression to carcinoma

2014 ◽  
Vol 133 ◽  
pp. 191
Author(s):  
J.G. Cohen ◽  
S. Mehta ◽  
B.J. Rimel ◽  
C. Walsh ◽  
A.J. Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intraepithelial Neoplasia ◽  
High Grade ◽  
Vaginal Intraepithelial Neoplasia

Endoscopic submucosal dissection (ESD) for anal high-grade intraepithelial neoplasia: a case report

2018 ◽  
Vol 56 (05) ◽  
pp. 495-498 ◽  
Author(s):  
Daniel Neureiter ◽  
Josef Holzinger ◽  
Tobias Kiesslich ◽  
Eckhard Klieser ◽  
Frieder Berr ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Narrow Band Imaging ◽  
Anal Carcinoma ◽  
Intraepithelial Neoplasia ◽  
High Grade ◽  
Recurrence Rates ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Very High

AbstractAnal intraepithelial neoplasia (AIN) is a precursor of anal carcinoma. Conventional therapy is based on topical and local ablative approaches. However, the recurrence rates are very high, leading to repetitive treatment sessions and need for long-term surveillance. Endoscopic submucosal dissection (ESD) is an established treatment for malignant early neoplasias of the gastrointestinal tract, especially in the esophagus, stomach, and colorectum. Japanese centers have reported few cases of ESD for early anal carcinoma. We report a case of high-grade AIN diagnosed with magnifying narrow-band imaging and chromoendoscopy that was resected R0 with ESD en bloc.

scholarly journals Risk factors associated with pain in patients with venous malformations of the extremities

2018 ◽  
Vol 24 (1) ◽  
pp. 56-62 ◽  
Author(s):  
Li Hu ◽  
Hui Chen ◽  
Xi Yang ◽  
Yongying Wang ◽  
Hao Gu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Univariate Analysis ◽  
Lesion Size ◽  
Common Symptom ◽  
Type Ii ◽  
Venous Malformations ◽  
Average Pain ◽  
Independent Risk Factors

Pain is a common symptom and the major complaint in patients with venous malformations of the extremities, which may lead to joint dysfunction and even walking disabilities. Therefore, this study aimed to investigate determined independent risk factors for pain in these patients. We retrospectively collected data for 168 patients with venous malformations of the extremities from January 16, 2013 to August 13, 2015. They were categorized into painful and painless groups according to the symptom and pain scores. Associations between pain and candidate factors were determined using univariate and multivariate analyses. A total of 125 (74.4%) patients with an average pain score of 4.4 were included in the painful group. In univariate analysis, age, lesion size, tissue involvement, and phleboliths were associated with pain. In the multivariate analysis, only type-II tissue involvement (adjusted odds ratio 4.57; p = 0.001) and phleboliths (adjusted odds ratio 2.44; p = 0.039) were identified as the independent risk factors. In conclusion, this study revealed that prevalence of pain in patients with venous malformations of the extremities was high. Patients who presented with type-II tissue involvement and phleboliths are more likely to suffer from pain.

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