The natural history of aberrant crypt foci

Gastrointest Endosc. 2008 Jun;67(7):1097-102. doi: 10.1016/j.gie.2007.08.048. Epub 2008 Feb 21.


Background: Aberrant crypt foci (ACF) are the putative precursors to colorectal adenomas and may be useful as biomarkers. Knowledge of their natural history is essential to understanding their potential utility.

Objective: Our purpose was to examine ACF detection 1 year after initial observation.

Design: We conducted a multicenter study of ACF by using a standardized protocol. ACF in the rectum were assessed and subjects returned 1 year later to evaluate the natural history of the lesions.

Setting: Ancillary study to the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial.

Results: Of 78 subjects enrolled, 64 (82%) returned for a repeat examination 1 year later. The mean age was 71 years, 70% were male, and 54% had a history of adenomatous polyps. At the initial examination, 66% of subjects had at least 1 ACF detected in the rectum, with a mean of 2.1 +/- 2.3 per person. One year later, 60% of these subjects had at least 1 of the original ACF reidentified, but only 43% of all ACF were reidentified. A total of 56% of subjects had new ACF identified.

Limitations: These results are generated from the pilot phase. Improvements or change in technique over time could have influenced the results.

Conclusions: A total of 60% of subjects who had ACF continued to have at least one ACF 1 year later, but less than half the specific ACF could be reidentified, and more than 50% of subjects had new ACF. These results imply a considerable dynamic to ACF detection over a 1-year period of observation.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adenoma / diagnosis
  • Adenoma / pathology*
  • Aged
  • Aged, 80 and over
  • Biopsy, Needle / methods*
  • Biopsy, Needle / statistics & numerical data
  • Cell Transformation, Neoplastic / pathology
  • Colonic Polyps / pathology
  • Colonoscopy / methods
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / pathology*
  • Endoscopy, Gastrointestinal / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Immunohistochemistry
  • Intestinal Mucosa / pathology
  • Male
  • Middle Aged
  • Monitoring, Physiologic / methods
  • Precancerous Conditions / diagnosis
  • Precancerous Conditions / pathology*
  • Sensitivity and Specificity
  • Sigmoidoscopy / methods
  • Time Factors