Rectal mucosal microvascular blood supply increase is associated with colonic neoplasia

Clin Cancer Res. 2009 May 1;15(9):3110-7. doi: 10.1158/1078-0432.CCR-08-2880. Epub 2009 Apr 21.

Abstract

Purpose: Endoscopic examination has proven effective in both detecting and preventing colorectal cancer; however, only about a quarter of eligible patients undergo screening. Even if the compliance rate increased, limited endoscopic capacity and cost would be prohibitive. There is a need for an accurate method to target colonoscopy to those most at risk of harboring colonic neoplasia. Exploiting field carcinogenesis seems to be a promising avenue. Our group recently reported that an early increase in blood supply (EIBS) is a reliable marker of field carcinogenesis in experimental models. We now investigate whether in situ detection of EIBS in the rectum can predict neoplasia elsewhere in the colon.

Experimental design: We developed a novel polarization-gated spectroscopy fiber-optic probe that allows depth-selective interrogation of microvascular blood content. Using the probe, we examined the blood content in vivo from the rectal mucosa of 216 patients undergoing screening colonoscopy.

Results: Microvascular blood content was increased by approximately 50% in the endoscopically normal rectal mucosa of patients harboring advanced adenomas when compared with neoplasia-free patients irrespective of lesion location. Demographic factors and nonneoplastic lesions did not confound this observation. Logistic regression using mucosal oxyhemoglobin concentration and patient age resulted in a sensitivity of 83%, a specificity of 82%, and an area under the receiver operating characteristic curve of 0.88 for the detection of advanced adenomas.

Conclusions: Increased microvascular blood supply in the normal rectal mucosa is associated with the presence of clinically significant neoplasia elsewhere in the colon, supporting the development of rectal EIBS as a colon cancer risk-stratification tool.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adenoma / blood supply*
  • Adenoma / diagnosis
  • Area Under Curve
  • Biomarkers, Tumor*
  • Colonic Neoplasms / blood supply*
  • Colonic Neoplasms / diagnosis
  • Colonic Polyps / diagnosis
  • Endoscopy, Gastrointestinal
  • Female
  • Humans
  • Intestinal Mucosa / blood supply*
  • Male
  • Microcirculation
  • Middle Aged
  • Prognosis
  • Rectum / blood supply*
  • Rectum / pathology
  • Risk Factors

Substances

  • Biomarkers, Tumor