Optical measurement of rectal microvasculature as an adjunct to flexible sigmoidosocopy: gender-specific implications.
Flexible sigmoidoscopy is a robust, clinically validated, and widely available colorectal cancer screening technique that is currently sanctioned by major guideline organizations. Given that endoscopic visualization is generally limited to the distal third of the colon and women tend to have a proclivity for proximal lesions, the flexible sigmoidoscopy performance is markedly inferior in women than in men. Our group has shown that by using a novel light-scattering approach, we were able to detect an early increase in blood supply (EIBS) in the distal colonic mucosa, which served as a marker of field carcinogenesis and, hence, proximal neoplasia. Therefore, we sought to ascertain whether rectal EIBS would improve flexible sigmoidoscopy, especially in women. A polarization-gated spectroscopy fiber-optic probe was used to assess EIBS in the endoscopically normal rectum (n = 366). When compared with gender-matched neoplasia-free controls, females with advanced proximal neoplasia (n = 10) had a robust (60%; P = 0.002) increase in rectal mucosal oxyhemoglobin content whereas the effect size in males was less marked (33%; P = 0.052). In women, addition of rectal oxyhemoglobin tripled the sensitivity for advanced neoplasia over flexible sigmoidoscopy alone. Indeed, the performance characteristics seemed to be excellent (sensitivity, 100%; specificity, 76.8%; positive predictive value, 32.6%; and negative predictive value, 100%). A variety of nonneoplastic factors were assessed and did not confound the relationship between rectal EIBS and advanced neoplasia. Therefore, using rectal EIBS in combination with flexible sigmoidoscopy mitigated the gender gap and may allow flexible sigmoidoscopy to be considered as a viable colorectal cancer screening test in women.
Roy
Hemant K
HK
Department of Medicine, Northshore University Health System, Evanston, IL 60201, USA. h-roy@northwestern.edu
Gomes
Andrew J
AJ
Ruderman
Sarah
S
Bianchi
Laura K
LK
Goldberg
Michael J
MJ
Stoyneva
Valentina
V
Rogers
Jeremy D
JD
Turzhitsky
Vladimir
V
Kim
Young
Y
Yen
Eugene
E
Jameel
Mohammed
M
Bogojevic
Andrej
A
Backman
Vadim
V
D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D008297:Male; D055806:Microvessels / Q000473:pathology*; D008875:Middle Aged; D012007:Rectum / Q000098:blood supply / Q000473:pathology*; D012737:Sex Factors; D012812:Sigmoidoscopy