Introduction: Colorectal cancer is the second leading cause of cancer deaths in the United States. Cancer screening rates appear to vary based on race and ethnicity. Data on incidence of colorectal neoplasia in Asian Americans are not clear. AIM: To assess the prevalence of adenomas and colon cancer in Asian Americans undergoing screening at a large urban referral practice and compare them to non Asian Americans undergoing screening colonoscopy. Material and Methods: A retrospective analysis of Asian subjects undergoing a screening colonoscopy between January 2005 and June 2010 at a large urban referral practice was done. Ethnic origin was ascertained by use of NIH ethnicity codes. Data were abstracted using standardized abstraction sheets and included: age, reason for exam, location of the lesion, pathology of the lesion. The control group was comprised of 200 consecutive nonAsian subjects undergoing screening colonoscopy from January 2010. Those with prior history colon cancer or those undergoing colonoscopy for symptom evaluation were excluded. Results: A total of 144 subjects met the inclusion criteria in the Asian group. The frequency data were analyzed using Chi-square test while continuous data were analyzed by analysis of variance. The median age of the Asian group (63) at screening was higher than controls (53). The severity and grade of polypoid lesion was higher as the age increased in Asian subjects only. Further the incidence of all lesions was higher in the Asians as compared to the non-Asians (p=< 0.001). There was a trend for advanced adenoma to be more frequent in Asians (percent vs. percent), although the difference did not reach statistical significant (p=0.092) There was no significant difference in the location of lesions in the two groups (p= 0.732 in low-risk adenomas, p= 0.348 in advanced adenomas). We analyzed a subset of the population below 60 years of age (88 Asians; 200 non-Asians). The median age in the groups was the same (53 years). The incidence of all lesions was noted to be higher in the Asian group (p= 0.031), with subset analysis revealing higher incidence of low-risk lesions (p=0.025) but no statistical difference in advanced adenomas (p= 0.741). Conclusion: There are limited data about colon cancer screening in Asian-Americans. Our study highlights that Asian-Americans had screening done at a later age as compared to the general population. The incidence of low-risk lesions was higher in the study group even when the median age was same in both groups. The incidence of advanced lesions in the Asian population is at least similar to that in the non-Asian population. Asian Americans should adhere to the current guidelines and undergo screening at the age of 50. Limitations: Small sample size, lack of data on duration of residence, dietary habits.

BackgroundCholangiocarcinoma (CCA) is difficult to diagnose. Tumor markers are insensitive and the yield of cytology is low. Fluorescent in situ hybridization (FISH) examines for chromosomal abnormalities that may occur in CCA. Reported sensitivity and specificity is 34-46% and 88-99%, respectively. It is unclear if these data can be applied in routine clinical practice.Aims1. Determine if FISH can aid in the diagnosis of CCA in patients with non-diagnostic cytology. 2. Evaluate the accuracy of FISH in a routine clinical setting.MethodsThis is a retrospective chart review of patients with biliary strictures including those with and without primary sclerosing cholangitis (PSC) who had an endoscopic retrograde cholangiopancreatography (ERCP) and brushings for both cytology and FISH analysis between2007-2010. A dominant stricture was found in 53% of those with PSC. ERCP was performed to evaluate obstructive signs/symptoms, or as part of surveillance for CCA in those with PSC. Patients with prior malignancy or positive cytology before or at the time of initial ERCP were excluded. Brushings for cytology were obtained within 1 year of FISH in 10 patients, and at the time of FISH in 46. Cytology reported as suspicious, atypical or negative was recorded as negative. FISH was positive if > 5 cells had gains of 2 or more probes. Patients were considered to have malignancy if there was radiographic progression, positive cytology, or conclusive pathology from surgery or autopsy.ResultsBrushing for FISH was obtained in 56 patients in whom cytology was non-diagnostic for malignancy. 3 were excluded as they had an inadequate sample for FISH. There were a total of 81 FISH specimen on these 53 patients, as some had multiple ERCP. PSC was the primary diagnosis in 37, while 16 underwent ERCP for signs or symptoms of a biliary stricture. Overall, 5 out of 53 had positive FISH (9.4%) and 3 of these positive patients had CCA. In the other two, one had pancreatic cancer and the other underwent liver transplantation with neoadjuvant chemo- and radiation therapy; his explant was negative for CCA. All patients with an initial negative FISH remained negative on subsequent tests. There were 5 who had negative FISH but subsequently developed CCA. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of FISH for CCA were 37.5%, 95.6%, 60%, 89.6%, and 86.8% respectively.ConclusionsIn cases of indeterminate biliary stricture and negative cytology, FISH may be performed to evaluate for CCA. FISH has an additive role in detecting CCA with modest PPV and high NPV. These findings are congruent with initial studies evaluating FISH and hence applicable to clinical practice. Those with negative FISH need intensive follow-up and there appears to be no added benefit of repeating FISH if initially negative. BackgroundCholangiocarcinoma (CCA) is difficult to diagnose. Tumor markers are insensitive and the yield of cytology is low. Fluorescent in situ hybridization (FISH) examines for chromosomal abnormalities that may occur in CCA. Reported sensitivity and specificity is 34-46% and 88-99%, respectively. It is unclear if these data can be applied in routine clinical practice. Cholangiocarcinoma (CCA) is difficult to diagnose. Tumor markers are insensitive and the yield of cytology is low. Fluorescent in situ hybridization (FISH) examines for chromosomal abnormalities that may occur in CCA. Reported sensitivity and specificity is 34-46% and 88-99%, respectively. It is unclear if these data can be applied in routine clinical practice. Aims1. Determine if FISH can aid in the diagnosis of CCA in patients with non-diagnostic cytology. 2. Evaluate the accuracy of FISH in a routine clinical setting. 1. Determine if FISH can aid in the diagnosis of CCA in patients with non-diagnostic cytology. 2. Evaluate the accuracy of FISH in a routine clinical setting. MethodsThis is a retrospective chart review of patients with biliary strictures including those with and without primary sclerosing cholangitis (PSC) who had an endoscopic retrograde cholangiopancreatography (ERCP) and brushings for both cytology and FISH analysis between2007-2010. A dominant stricture was found in 53% of those with PSC. ERCP was performed to evaluate obstructive signs/symptoms, or as part of surveillance for CCA in those with PSC. Patients with prior malignancy or positive cytology before or at the time of initial ERCP were excluded. Brushings for cytology were obtained within 1 year of FISH in 10 patients, and at the time of FISH in 46. Cytology reported as suspicious, atypical or negative was recorded as negative. FISH was positive if > 5 cells had gains of 2 or more probes. Patients were considered to have malignancy if there was radiographic progression, positive cytology, or conclusive pathology from surgery or autopsy. This is a retrospective chart review of patients with biliary strictures including those with and without primary sclerosing cholangitis (PSC) who had an endoscopic retrograde cholangiopancreatography (ERCP) and brushings for both cytology and FISH analysis between2007-2010. A dominant stricture was found in 53% of those with PSC. ERCP was performed to evaluate obstructive signs/symptoms, or as part of surveillance for CCA in those with PSC. Patients with prior malignancy or positive cytology before or at the time of initial ERCP were excluded. Brushings for cytology were obtained within 1 year of FISH in 10 patients, and at the time of FISH in 46. Cytology reported as suspicious, atypical or negative was recorded as negative. FISH was positive if > 5 cells had gains of 2 or more probes. Patients were considered to have malignancy if there was radiographic progression, positive cytology, or conclusive pathology from surgery or autopsy. ResultsBrushing for FISH was obtained in 56 patients in whom cytology was non-diagnostic for malignancy. 3 were excluded as they had an inadequate sample for FISH. There were a total of 81 FISH specimen on these 53 patients, as some had multiple ERCP. PSC was the primary diagnosis in 37, while 16 underwent ERCP for signs or symptoms of a biliary stricture. Overall, 5 out of 53 had positive FISH (9.4%) and 3 of these positive patients had CCA. In the other two, one had pancreatic cancer and the other underwent liver transplantation with neoadjuvant chemo- and radiation therapy; his explant was negative for CCA. All patients with an initial negative FISH remained negative on subsequent tests. There were 5 who had negative FISH but subsequently developed CCA. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of FISH for CCA were 37.5%, 95.6%, 60%, 89.6%, and 86.8% respectively. Brushing for FISH was obtained in 56 patients in whom cytology was non-diagnostic for malignancy. 3 were excluded as they had an inadequate sample for FISH. There were a total of 81 FISH specimen on these 53 patients, as some had multiple ERCP. PSC was the primary diagnosis in 37, while 16 underwent ERCP for signs or symptoms of a biliary stricture. Overall, 5 out of 53 had positive FISH (9.4%) and 3 of these positive patients had CCA. In the other two, one had pancreatic cancer and the other underwent liver transplantation with neoadjuvant chemo- and radiation therapy; his explant was negative for CCA. All patients with an initial negative FISH remained negative on subsequent tests. There were 5 who had negative FISH but subsequently developed CCA. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of FISH for CCA were 37.5%, 95.6%, 60%, 89.6%, and 86.8% respectively. ConclusionsIn cases of indeterminate biliary stricture and negative cytology, FISH may be performed to evaluate for CCA. FISH has an additive role in detecting CCA with modest PPV and high NPV. These findings are congruent with initial studies evaluating FISH and hence applicable to clinical practice. Those with negative FISH need intensive follow-up and there appears to be no added benefit of repeating FISH if initially negative. In cases of indeterminate biliary stricture and negative cytology, FISH may be performed to evaluate for CCA. FISH has an additive role in detecting CCA with modest PPV and high NPV. These findings are congruent with initial studies evaluating FISH and hence applicable to clinical practice. Those with negative FISH need intensive follow-up and there appears to be no added benefit of repeating FISH if initially negative.

To establish the incidence of, and identify risk factors associated with, high-risk adenomas in a population undergoing solid organ transplantation evaluation.

Despite a lack of evidence-based guidelines, the current standard of care recommends colonoscopy 4 to 6 weeks after an episode of acute diverticulitis due to the risk of an underlying malignancy. Our aim was to determine whether diverticulitis is associated with colonic malignancy or advanced adenoma at a rate greater than the general population.

Study Purpose: To determine if specific findings on endoscopic ultrasound (EUS) performed at the time of a negative/non-diagnostic fine needle aspiration (FNA) can predict an eventual cancer diagnosis.

BACKGROUND: Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) can characterize and diagnose pancreatic lesions as malignant, but cannot definitively rule out the presence of malignancy. Outcome data regarding the length of follow-up in patients with negative or nondiagnostic EUS-FNA of pancreatic lesions are not well-established. OBJECTIVE: To determine the long-term outcome and provide follow-up guidance for patients with negative EUS-FNA diagnosis of suspected pancreatic lesions based on imaging predictors. METHODS: A retrospective review of patients undergoing EUS-FNA for suspected pancreatic lesions, but with negative or nondiagnostic FNA results was conducted at a tertiary care referral medical centre. Patient demographics, EUS imaging characteristics and follow-up data were examined. RESULTS: Seventeen of 55 patients (30.9%) with negative/nondiagnostic FNA were subsequently diagnosed with pancreatic malignancy. The risk of cancer was significantly higher for patients who had associated lymph nodes on EUS (P<0.001) and vascular involvement on EUS (P=0.001). The mean time to diagnosis in the group with false-negative EUS-FNA diagnosis was 66 days. The true-negative EUS-FNA patients were followed for a mean of 403 days after negative EUS-FNA results without the development of malignancy. CONCLUSION: For patients undergoing EUS-FNA for a suspected pancreatic lesion, a negative or nondiagnostic FNA does not provide conclusive evidence for the absence of cancer. Patients for whom vascular invasion and lymphadenopathy are detected on EUS are more likely to have a true malignant lesion and should be followed closely. When a patient has been monitored for six months or more with no cancer being diagnosed, there appears to be much less chance that a pancreatic malignancy is present.