title: Rectal mucosal microvascular blood supply increase is associated with colonic neoplasia.
abstract: 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.
authors.affiliation: Biomedical Engineering Department, Northwestern University, IL, USA. a-gomes@northwestern.edu
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Gomes
authors.forename: Hemant K
authors.initials: HK
authors.lastname: Roy
authors.forename: Vladimir
authors.initials: V
authors.lastname: Turzhitsky
authors.forename: Young
authors.initials: Y
authors.lastname: Kim
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Rogers
authors.forename: Sarah
authors.initials: S
authors.lastname: Ruderman
authors.forename: Valentina
authors.initials: V
authors.lastname: Stoyneva
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goldberg
authors.forename: Laura K
authors.initials: LK
authors.lastname: Bianchi
authors.forename: Eugene
authors.initials: E
authors.lastname: Yen
authors.forename: Alexey
authors.initials: A
authors.lastname: Kromine
authors.forename: Mohammed
authors.initials: M
authors.lastname: Jameel
authors.forename: Vadim
authors.initials: V
authors.lastname: Backman
mesh_terms: 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
chemical_list: D014408:Biomarkers, Tumor