Dataset Information

Flexible colonoscopy in mice to evaluate the severity of colitis and colorectal tumors using a validated endoscopic scoring system.

ABSTRACT: The use of modern endoscopy for research purposes has greatly facilitated our understanding of gastrointestinal pathologies. In particular, experimental endoscopy has been highly useful for studies that require repeated assessments in a single laboratory animal, such as those evaluating mechanisms of chronic inflammatory bowel disease and the progression of colorectal cancer. However, the methods used across studies are highly variable. At least three endoscopic scoring systems have been published for murine colitis and published protocols for the assessment of colorectal tumors fail to address the presence of concomitant colonic inflammation. This study develops and validates a reproducible endoscopic scoring system that integrates evaluation of both inflammation and tumors simultaneously. This novel scoring system has three major components: 1) assessment of the extent and severity of colorectal inflammation (based on perianal findings, transparency of the wall, mucosal bleeding, and focal lesions), 2) quantitative recording of tumor lesions (grid map and bar graph), and 3) numerical sorting of clinical cases by their pathological and research relevance based on decimal units with assigned categories of observed lesions and endoscopic complications (decimal identifiers). The video and manuscript presented herein were prepared, following IACUC-approved protocols, to allow investigators to score their own experimental mice using a well-validated and highly reproducible endoscopic methodology.

SUBMITTER: Kodani T

PROVIDER: S-EPMC3940705 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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Flexible colonoscopy in mice to evaluate the severity of colitis and colorectal tumors using a validated endoscopic scoring system.

Kodani Tomohiro T Rodriguez-Palacios Alex A Corridoni Daniele D Lopetuso Loris L Di Martino Luca L Marks Brian B Pizarro James J Pizarro Theresa T Chak Amitabh A Cominelli Fabio F

Journal of visualized experiments : JoVE 20131016 80

The use of modern endoscopy for research purposes has greatly facilitated our understanding of gastrointestinal pathologies. In particular, experimental endoscopy has been highly useful for studies that require repeated assessments in a single laboratory animal, such as those evaluating mechanisms of chronic inflammatory bowel disease and the progression of colorectal cancer. However, the methods used across studies are highly variable. At least three endoscopic scoring systems have been publish ...[more]

PMID: 24193215

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Project description:BackgroundVariability in endoscopic assessment necessitates rigorous investigation of descriptors for scoring severity of ulcerative colitis (UC).ObjectiveTo evaluate variation in the overall endoscopic assessment of severity, the intra- and interindividual variation of descriptive terms and to create an Ulcerative Colitis Endoscopic Index of Severity which could be validated.DesignA two-phase study used a library of 670 video sigmoidoscopies from patients with Mayo Clinic scores 0-11, supplemented by 10 videos from five people without UC and five hospitalised patients with acute severe UC. In phase 1, each of 10 investigators viewed 16/24 videos to assess agreement on the Baron score with a central reader and agreed definitions of 10 endoscopic descriptors. In phase 2, each of 30 different investigators rated 25/60 different videos for the descriptors and assessed overall severity on a 0-100 visual analogue scale. κ Statistics tested inter- and intraobserver variability for each descriptor. A general linear mixed regression model based on logit link and β distribution of variance was used to predict overall endoscopic severity from descriptors.ResultsThere was 76% agreement for 'severe', but 27% agreement for 'normal' appearances between phase I investigators and the central reader. In phase 2, weighted κ values ranged from 0.34 to 0.65 and 0.30 to 0.45 within and between observers for the 10 descriptors. The final model incorporated vascular pattern, (normal/patchy/complete obliteration) bleeding (none/mucosal/luminal mild/luminal moderate or severe), erosions and ulcers (none/erosions/superficial/deep), each with precise definitions, which explained 90% of the variance (pR(2), Akaike Information Criterion) in the overall assessment of endoscopic severity, predictions varying from 4 to 93 on a 100-point scale (from normal to worst endoscopic severity).ConclusionThe Ulcerative Colitis Endoscopic Index of Severity accurately predicts overall assessment of endoscopic severity of UC. Validity and responsiveness need further testing before it can be applied as an outcome measure in clinical trials or clinical practice.

Project description:BackgroundThe high incidence and mortality rate of colorectal cancer require new technologies to improve its early diagnosis. This study aims at extracting the medical needs related to the endoscopic technology and the colonoscopy procedure currently used for colorectal cancer diagnosis, essential for designing these demanded technologies.MethodsSemi-structured interviews and an online survey were used.ResultsSix endoscopists were interviewed and 103 were surveyed, obtaining the demanded needs that can be divided into: a) clinical needs, for better polyp detection and classification (especially flat polyps), location, size, margins and penetration depth; b) computer-aided diagnosis (CAD) system needs, for additional visual information supporting polyp characterization and diagnosis; and c) operational/physical needs, related to limitations of image quality, colon lighting, flexibility of the endoscope tip, and even poor bowel preparation.ConclusionsThis study shows some undertaken initiatives to meet the detected medical needs and challenges to be solved. The great potential of advanced optical technologies suggests their use for a better polyp detection and classification since they provide additional functional and structural information than the currently used image enhancement technologies. The inspection of remaining tissue of diminutive polyps (< 5 mm) should be addressed to reduce recurrence rates. Few progresses have been made in estimating the infiltration depth. Detection and classification methods should be combined into one CAD system, providing visual aids over polyps for detection and displaying a Kudo-based diagnosis suggestion to assist the endoscopist on real-time decision making. Estimated size and location of polyps should also be provided. Endoscopes with 360° vision are still a challenge not met by the mechanical and optical systems developed to improve the colon inspection. Patients and healthcare providers should be trained to improve the patient's bowel preparation.

Project description:PurposeSeveral nephrometry scoring systems have been developed based on two-dimensional computerized tomography images to quantify anatomical features of renal tumors. We have developed an accurate three-dimensional nephrometry scoring system to respond to the urgent need for advanced systems based on three-dimensional images.Materials and methodsWe retrospectively reviewed 135 patients who underwent partial nephrectomy in our institution. Stereoscopic models were reconstructed from preoperative computerized tomography images and three-dimensional scores were assigned directly on stereoscopic models. All tumors were analyzed for following features: tumor volume; endophytic tumor proportion; renal vascular variations; tumor's relationships with urinary collecting system or renal sinus; longitudinal distance from tumor to equatorial plane. Correlation between three-dimensional score and warm ischemic time was calculated compared with existing classical nephrometry scoring systems. The value of nephrometry scoring systems predicting longer warm ischemic time was explored by receiver operating characteristic curves.ResultsMean tumor volume was 31.25 ml; endophytic volume was less than 50% in 42 cases, more than 50% in 79 cases, and 100% in 14 cases; mean longitudinal distance from tumor to equatorial plane was 1.41 cm; 30 patients (22.2%) presented renal vascular variations; 18 cases (13.3%) involved both urinary collecting system and sinus. Mean three-dimensional score was 8.3. Variance analysis and covariance analysis revealed warm ischemic time a significant association with all evaluated tumor features. Furthermore, three-dimensional scores most highly correlated with warm ischemic time (rs = 0.64, p < 0.001), followed by R.E.N.A.L. scores (rs = 0.21, p = 0.012), centrality index (rs = - 0.20, p = 0.019) and Preoperative Aspects and Dimensions Used for Anatomy score (rs = 0.20, p = 0.019). Area under curve of above nephrometry scoring systems was 0.91, 0.67, 0.68 and 0.67 respectively (p < 0.05).ConclusionsThe three-dimensional scoring system developed in this study was a highly-accurate system to quantify the anatomical features of renal tumors. It was identified to have a value in predicting duration of warm ischemic time.

Dataset Information

Flexible colonoscopy in mice to evaluate the severity of colitis and colorectal tumors using a validated endoscopic scoring system.

Publications

Flexible colonoscopy in mice to evaluate the severity of colitis and colorectal tumors using a validated endoscopic scoring system.

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