Colorectal malignant polyps: a modern approach

Saraiva, Sofia

doi:10.20524/aog.2021.0681

Cited by 7 publications

(6 citation statements)

References 69 publications

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“…It is also important to note that rectal cancer most often develops within a pre-existing benign area of neoplasia, so the surface may retain the appearance of a benign lesion of comparable size. This may remain the case even after a considerable proportion has undergone malignant transformation [96]. NIR ICG evaluation penetrates several millimetres into tissue providing beyond-the-mucosa assessment, differing greatly to other light-based endoscopic assessment methods [97].…”

Section: Beyond Cancer/not Cancer Labellingmentioning

confidence: 99%

Intraoperative near infrared functional imaging of rectal cancer using artificial intelligence methods - now and near future state of the art

Boland,

Hardy,

Moynihan

et al. 2024

Eur J Nucl Med Mol Imaging

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Colorectal cancer remains a major cause of cancer death and morbidity worldwide. Surgery is a major treatment modality for primary and, increasingly, secondary curative therapy. However, with more patients being diagnosed with early stage and premalignant disease manifesting as large polyps, greater accuracy in diagnostic and therapeutic precision is needed right from the time of first endoscopic encounter. Rapid advancements in the field of artificial intelligence (AI), coupled with widespread availability of near infrared imaging (currently based around indocyanine green (ICG)) can enable colonoscopic tissue classification and prognostic stratification for significant polyps, in a similar manner to contemporary dynamic radiological perfusion imaging but with the advantage of being able to do so directly within interventional procedural time frames. It can provide an explainable method for immediate digital biopsies that could guide or even replace traditional forceps biopsies and provide guidance re margins (both areas where current practice is only approximately 80% accurate prior to definitive excision). Here, we discuss the concept and practice of AI enhanced ICG perfusion analysis for rectal cancer surgery while highlighting recent and essential near-future advancements. These include breakthrough developments in computer vision and time series analysis that allow for real-time quantification and classification of fluorescent perfusion signals of rectal cancer tissue intraoperatively that accurately distinguish between normal, benign, and malignant tissues in situ endoscopically, which are now undergoing international prospective validation (the Horizon Europe CLASSICA study). Next stage advancements may include detailed digital characterisation of small rectal malignancy based on intraoperative assessment of specific intratumoral fluorescent signal pattern. This could include T staging and intratumoral molecular process profiling (e.g. regarding angiogenesis, differentiation, inflammatory component, and tumour to stroma ratio) with the potential to accurately predict the microscopic local response to nonsurgical treatment enabling personalised therapy via decision support tools. Such advancements are also applicable to the next generation fluorophores and imaging agents currently emerging from clinical trials. In addition, by providing an understandable, applicable method for detailed tissue characterisation visually, such technology paves the way for acceptance of other AI methodology during surgery including, potentially, deep learning methods based on whole screen/video detailing.

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Section: Beyond Cancer/not Cancer Labellingmentioning

confidence: 99%

Intraoperative near infrared functional imaging of rectal cancer using artificial intelligence methods - now and near future state of the art

Boland,

Hardy,

Moynihan

et al. 2024

Eur J Nucl Med Mol Imaging

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“…Thus, malignant polyps should be suspected when using WLE. The keys to prediction or observation of malignant polyps include their morphology, size, and location [ 6 ]. Therefore, although WLE may be less sensitive than other T1 CRC detection methods, its high specificity makes it valuable for the initial identification and suspicion of malignant polyps.…”

Section: Endoscopic Prediction and Evaluation Of T1 Crcmentioning

confidence: 99%

Approaches and considerations in the endoscopic treatment of T1 colorectal cancer

Jung

2024

Korean J Intern Med

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The detection of early colorectal cancer (CRC) is increasing through the implementation of screening programs. This increased detection enhances the likelihood of minimally invasive surgery and significantly lowers the risk of recurrence, thereby improving patient survival and reducing mortality rates. T1 CRC, the earliest stage, is treated endoscopically in cases with a low risk of lymph node metastasis (LNM). The advantages of endoscopic treatment compared with surgery include minimal invasiveness and limited tissue disruption, which reduce morbidity and mortality, preserve bowel function to avoid colectomy, accelerate recovery, and improve cost-effectiveness. However, T1 CRC has a risk of LNM. Thus, selection of the appropriate treatment between endoscopic treatment and surgery, while avoiding overtreatment, is challenging considering the potential for complete resection, LNM, and recurrence risk.

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“…In another study, it was shown that even in high-risk MP, a high proportion of patients do not have evidence of residual disease in the bowel wall or in the draining lymph nodes [56]. It seems prudent to recommend surgical resection only if 2 or more high risk histological features are present (risk of nodal metastasis: 23.3%); in cases where only one risk feature is present, the estimated risk of nodal metastasis is 4.5% [71].…”

Section: Management Of Malignant Colorectal Polyp (Mp)mentioning

confidence: 99%

Modern approach in the management of malignant colorectal polyp

Kumar Shrestha

2023

Colonoscopy - Diagnostic and Therapeutic Advances

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Malignant colorectal polyp refers to the polyp in which the neoplastic lesion invades into but not beyond the submucosa. The morphological features and surface patterns of the malignant polyps are examined by the white-light and image-enhanced endoscopy, which help to predict the depth of invasion of neoplastic lesions. The deep submucosal invasion is associated with a high risk of residual cancer and lymph node metastasis. The image-enhanced endoscopy is useful in identifying the malignant polyp amenable for endoscopic resection or require formal oncological surgery. After the endoscopic resection of the polyp, the thorough histopathological assessment is required to determine the possibility of residual tumor, recurrence, and lymph node involvement. The presence of high-risk features (deep submucosal invasion, poor differentiation, lymphovascular invasion, <1 mm resection margin, piecemeal resection, and tumor budding) indicates a need for surgical resection with lymph node clearance. In low-risk cases, the endoscopic resection is considered adequate and further surveillance is advised. The final decision about the endoscopic resection versus surgical resection of malignant polyp needs to be individualized and should be based not only on polyp related characteristics but also on comorbidities, local resources, expertise availability, and patient’s preference.

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Colorectal malignant polyps: a modern approach

Cited by 7 publications

References 69 publications

Intraoperative near infrared functional imaging of rectal cancer using artificial intelligence methods - now and near future state of the art

Intraoperative near infrared functional imaging of rectal cancer using artificial intelligence methods - now and near future state of the art

Approaches and considerations in the endoscopic treatment of T1 colorectal cancer

Modern approach in the management of malignant colorectal polyp

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