Rectal mucosal microvascular blood supply increase is associated with colonic neoplasia.
OBJECTIVE
Endoscopic examination has proven effective in both detecting and preventing colorectal cancer; however, only about a quarter of eligible patients undergo screening. Even if the compliance rate increased, limited endoscopic capacity and cost would be prohibitive. There is a need for an accurate method to target colonoscopy to those most at risk of harboring colonic neoplasia. Exploiting field carcinogenesis seems to be a promising avenue. Our group recently reported that an early increase in blood supply (EIBS) is a reliable marker of field carcinogenesis in experimental models. We now investigate whether in situ detection of EIBS in the rectum can predict neoplasia elsewhere in the colon.


METHODS
We developed a novel polarization-gated spectroscopy fiber-optic probe that allows depth-selective interrogation of microvascular blood content. Using the probe, we examined the blood content in vivo from the rectal mucosa of 216 patients undergoing screening colonoscopy.


RESULTS
Microvascular blood content was increased by approximately 50% in the endoscopically normal rectal mucosa of patients harboring advanced adenomas when compared with neoplasia-free patients irrespective of lesion location. Demographic factors and nonneoplastic lesions did not confound this observation. Logistic regression using mucosal oxyhemoglobin concentration and patient age resulted in a sensitivity of 83%, a specificity of 82%, and an area under the receiver operating characteristic curve of 0.88 for the detection of advanced adenomas.


CONCLUSIONS
Increased microvascular blood supply in the normal rectal mucosa is associated with the presence of clinically significant neoplasia elsewhere in the colon, supporting the development of rectal EIBS as a colon cancer risk-stratification tool.
Gomes
Andrew J
AJ
Biomedical Engineering Department, Northwestern University, IL, USA. a-gomes@northwestern.edu
Roy
Hemant K
HK
Turzhitsky
Vladimir
V
Kim
Young
Y
Rogers
Jeremy D
JD
Ruderman
Sarah
S
Stoyneva
Valentina
V
Goldberg
Michael J
MJ
Bianchi
Laura K
LK
Yen
Eugene
E
Kromine
Alexey
A
Jameel
Mohammed
M
Backman
Vadim
V
D000236:Adenoma / Q000098:blood supply* / Q000175:diagnosis; D019540:Area Under Curve; D014408:Biomarkers, Tumor; D003110:Colonic Neoplasms / Q000098:blood supply* / Q000175:diagnosis; D003111:Colonic Polyps / Q000175:diagnosis; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000098:blood supply*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011379:Prognosis; D012007:Rectum / Q000098:blood supply* / Q000473:pathology; D012307:Risk Factors
D014408:Biomarkers, Tumor