Assessing tumor angiogenesis in colorectal cancer by quantitative contrast-enhanced endoscopic ultrasound and molecular and immunohistochemical analysis

Abstract

Background and Objectives:Data on contrast-enhanced endoscopic ultrasound (CE-EUS) for colorectal cancer (CRC) evaluation are scarce. Therefore, we aimed to assess the vascular perfusion pattern in CRC by quantitative CE-EUS and compare it to immunohistochemical and genetic markers of angiogenesis.Patients and Methods:We performed a retrospective analysis of CE-EUS examinations of 42 CRC patients, before any therapy. CE-EUS movies were processed using a dedicated software. Ten parameters were automatically generated from the time-intensity curve (TIC) analysis: peak enhancement (PE), rise time (RT), mean transit time, time to peak (TTP), wash-in area under the curve (WiAUC), wash-in rate (WiR), wash-in perfusion index (WiPI), wash-out AUC (WoAUC), and wash-in and wash-out AUC (WiWoAUC). The expression levels of the vascular endothelial growth factor receptor 1 (VEGFR1) and VEGFR2 genes were assessed from biopsy samples harvested during colonoscopy. Microvascular density and vascular area were calculated after CD31 and CD105 immunostaining.Results:Forty-two CE-EUS video sequences were analyzed. We found positive correlations between the parameters PE, WiAUC, WiR, WiPI, WoAUC, WiWoAUC, and N staging (Spearman r = 0.437, r = 0.336, r = 0.462, r = 0.437, r = 0.358, and r = 0.378, respectively, P < 0.05), and also between RT and TTP and CD31 vascular area (r = 0.415, and r = 0.421, respectively, P < 0.05). VEGFR1 and VEGFR2 expression did not correlate with any of the TIC parameters.Conclusions:CE-EUS with TIC analysis enables minimally invasive assessment of CRC angiogenesis and may provide information regarding the lymph nodes invasion. However, further studies are needed for defining its role in the evaluation of CRC patients.

Progress in endoscopic treatment of hemorrhoids

“…Finally, the visualization of the anorectosigmoid region during endoscopy of the patient prior to treatment, identifies other colorectal diseases that may be contributing to the symptoms such as bleeding, especially colorectal neoplasia. [ 63 , 64 , 65 ] In the United States, a cohort study based on blood in the stool reported that the incidence of diverticulosis, polyps or multiple polyps, mucosal abnormalities/colitis, tumors, and solitary ulcers were significantly increased in the patients undergoing endoscopy. [ 66 ] In addition, anorectal diseases such as hemorrhoids are very common in patients with intestinal diseases.…”

Anti-Angiogenic Treatment in Pseudomyxoma Peritonei—Still a Strong Preclinical Rationale

“…The median score for Ki67 staining was 4 (min–max 3–5) in the high-grade (HG) and 2 (min–max 1–4) in the low-grade (LG) group; for Hif1α, the median score was 2.5 (min–max 1–4) for HG and 2 (min–max 1–5) for LG ( Table 1 and Figure 1 ). The measurement of microvessel density (MVD) is a widely accepted method for assessing angiogenic activity through counting positive staining by anti-CD31 and anti-CD105 [ 10 ]. The median MVD assessed by quantifying presence of CD31 staining was 15.5 (min–max 9–28) in the HG and 19.5 (min–max 6–27) in the LG group.…”

Preoperative rectal tumor embolization as an adjunctive tool for bloodless abdominoperineal excision: A case report

“…Under normal conditions, the evaluation of blood supply in the distal rectum and mesorectum shows a predominance of blood vessels within the rectal wall[ 8 ]. In rectal cancer patients contrast-enhanced endoscopic ultrasound imaging usually reveals well vascularized masses with inhomogeneous enhancement of the contrast resulting from necrotic areas[ 9 ]. In the reported case, although atypical, a hypervascularized mass, with a predominance of blood vessels in the mesorectum was observed, as demonstrated by imaging exams.…”