title: Aberrant crypt foci as predictors of colorectal neoplasia on repeat colonoscopy.
abstract: OBJECTIVE
  To estimate the risk for colorectal neoplasia detected on repeat colonoscopy in relation to aberrant crypt foci (ACF) frequency reported during the previous baseline examination.
  
  
  METHODS
  From July 2003 until December 2008, patients had a colonoscopy with an ACF study using a magnifying colonoscope. The distal 20 cm section of colon was sprayed with Methylene Blue to ascertain the ACF frequency, the independent variable. Patients were categorized into low and high ACF count using the median as the cut point. Data collected from consenting patients included age, gender, height, weight, ethnicity, smoking history, family history of colorectal cancer (CRC), and personal history of colorectal neoplasia. A follow-up colonoscopy was performed at an interval as dictated by clinical surveillance guidelines. The main outcome was surveillance detected advanced colorectal neoplasia (SDAN) detected on repeat colonoscopy. Logistic Regression was used to calculate risk of SDAN on repeat colonoscopy in relation to baseline ACF count.
  
  
  RESULTS
  74 patients had a baseline ACF exam and a repeat surveillance colonoscopy. The median ACF was six and thus a high ACF count was >6 ACF and a low ACF count was ≤6 ACF. Patients diagnosed with SDAN were more likely to have had a high ACF number at baseline compared to patients without these lesions at follow-up (adjusted odds ratio = 12.27; 95% confidence interval: 2.00-75.25) controlling for age, sex, smoking, history of prior adenoma, family history of colon cancer, obesity, and time interval to surveillance exam. A sub analysis of our results demonstrated that this relationship was observed in 48 patients who were undergoing a surveillance colonoscopy for a previous adenoma and not those receiving surveillance for a family history of neoplasia.
  
  
  CONCLUSIONS
  Increased number of ACF in the distal colorectum was independently associated with substantial risk for future advanced neoplasia. This relationship was observed in patients undergoing surveillance for previous adenomas. Thus, ACF may serve as potential biomarkers in patients with adenomas to help identify patients who may need additional surveillance.
authors.affiliation: Carole and Ray Neag Comprehensive Cancer Center, University of Connecticut Health Center, Farmington, CT 06030-1845, USA. joseph.anderson@dartmouth.edu
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Anderson
authors.forename: Helen
authors.initials: H
authors.lastname: Swede
authors.forename: Tarun
authors.initials: T
authors.lastname: Rustagi
authors.forename: Petr
authors.initials: P
authors.lastname: Protiva
authors.forename: Devon
authors.initials: D
authors.lastname: Pleau
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Brenner
authors.forename: Thiruchandurai V
authors.initials: TV
authors.lastname: Rajan
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Heinen
authors.forename: Joel B
authors.initials: JB
authors.lastname: Levine
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Rosenberg
mesh_terms: D058739:Aberrant Crypt Foci / Q000175:diagnosis* / Q000473:pathology*; D000236:Adenoma / Q000175:diagnosis / Q000473:pathology; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors