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T1 colorectal polyps with at least 1 risk factor for metastasis to lymph node should be treated surgically and are considered endoscopically unresectable. Optical analysis, based on the Narrow-Band Imaging International Colorectal Endoscopic (NICE) classification system, is used to identify neoplasias with invasion of the submucosa that require endoscopic treatment. We assessed the accuracy of the NICE classification, along with other morphologic characteristics, in identifying invasive polyps that are endoscopically unresectable (have at least 1 risk factor for metastasis to lymph node).We performed a multicenter, prospective study of data collected by 58 endoscopists, from 1634 consecutive patients (examining 2123 lesions) at 17 university and community hospitals in Spain from July 2014 through June 2016. All consecutive lesions10 mm assessed with narrow-band imaging were included. The primary end point was the accuracy of the NICE classification for identifying lesions with deep invasion, using findings from histology analysis as the reference standard. Conditional inference trees were fitted for the analysis of diagnostic accuracy.Of the 2123 lesions analyzed, 89 (4.2%) had features of deep invasion and 91 (4.3%) were endoscopically unresectable. The NICE classification system identified lesions with deep invasion with 58.4% sensitivity (95% CI, 47.5-68.8), 96.4% specificity (95% CI, 95.5-97.2), a positive-predictive value of 41.6% (95% CI, 32.9-50.8), and a negative-predictive value of 98.1% (95% CI, 97.5-98.7). A conditional inference tree that included all variables found the NICE classification to most accurately identify lesions with deep invasion (P.001). However, pedunculated morphology (P.007), ulceration (P = .026), depressed areas (P.001), or nodular mixed type (P.001) affected accuracy of identification. Results were comparable for identifying lesions that were endoscopically unresectable.In an analysis of 2123 colon lesions10 mm, we found the NICE classification and morphologic features identify those with deep lesions with96% specificity-even in non-expert hands and without magnification. ClinicalTrials.gov number NCT02328066.

BACKGROUND Abdominal ultrasound (US) may provide data on the presence of esophageal varices in cirrhosis. We assess the diagnostic accuracy of this procedure. PATIENTS AND METHODS Retrospective recording of clinical data was carried out in cirrhotic patients who underwent abdominal US and upper gastrointestinal endoscopy. We compared patients with and without large varices and assessed the value of US in predicting the presence of these lesions as well as other significant variables. RESULTS Of the 353 patients included, 123 (35%) had esophageal varices. The presence of US signs of portal hypertension independently predicted the existence of esophageal varices with a sensitivity of 87.9%, a specificity of 34.9%, a positive predictive value of 40.6%, and a negative predictive value of 85.1%, which could increase to 91.5% if the patient presented plasma albumin and platelet concentrations above the mean values (3.1 g/dl and 122×10 cells/l, respectively). Plasma albumin and platelet concentrations were the two other variables with independent predictive capacity. Applying these selection criteria, up to 30% of screening endoscopies may not be necessary, and up to 43% in patients with compensated cirrhosis. In patients with decompensated cirrhosis, however, US does not have predictive capacity. The results obtained are comparable with those reported for transient elastography. CONCLUSION Abdominal US is a highly reliable technique for detecting patients with a low risk of presenting esophageal varices. Its use may avoid up to 43% of screening endoscopies in patients with compensated cirrhosis. The results obtained are similar to those observed using transient elastography.

Resumen Introduccion Las guias clinicas actuales recomiendan realizar un cribado semestral del hepatocarcinoma en pacientes cirroticos; sin embargo, desconocemos el coste de esta actividad preventiva. Objetivo Conocer el coste del cribado ecografico del hepatocarcinoma en pacientes cirroticos. Pacientes y metodo Recopilacion prospectiva de pacientes diagnosticados de cirrosis hepatica en una poblacion de 245.042 habitantes; se contabilizaron las pruebas realizadas para el cribado y diagnostico de hepatocarcinomas durante el seguimiento anual. El coste de estas pruebas se valoro segun las tarifas que abonan las entidades aseguradoras para la cobertura sanitaria de los colectivos de funcionarios publicos. Resultados Durante el 2009 se registraron 374 pacientes con cirrosis; de ellos, 99 tenian edad > 80 anos, performance status > 2 o comorbilidades asociadas. Durante el seguimiento anual se realizaron a los pacientes restantes un total de 602 visitas (ecografia abdominal y analitica), 4 TC con contraste, 9 resonancias magneticas, 2 gammagrafias, 4 punciones aspirativas, 4 radiografias y 6 ecografias con contraste. En nuestro medio, el coste total estimado de estas exploraciones fue de 37.946 €. Ello indica que el coste de un programa de cribado del hepatocarcinoma segun los criterios de seleccion indicados anteriormente es de 0,155 € por habitante y ano. Si se consideran solo los cirroticos susceptibles de cribado, el coste anual del cribado es de 138 € por paciente. Conclusion El coste de un programa de cribado ecografico del hepatocarcinoma es de 0,155 € por habitante y ano. Estos datos deben tenerse en cuenta cuando se plantean programas de ambito poblacional.

The usefulness of tumor markers in the differential diagnosis of cancer in patients with ascites remains a matter of controversy. Few studies have reported the measurement of cancer antigen 125 (CA125) and cytokeratin 19 soluble fragments (CYFRA21-1) in ascitic fluid. The aim of the present study was to evaluate the diagnostic accuracy of these tumor markers in the detection of malignant ascites.We analyzed CA125 and CYFRA21-1 from 143 consecutive undiagnosed patients with ascitis.Use of CA125 gave a sensitivity of 39.7% and a specificity of 98.8%, and CYFRA21-1 a sensitivity of 50.0% and a specificity of 97.6% in differential diagnosis of malignant ascites. For combined use of CA125 plus CYFRA21-1, sensitivity was 65.5% and specificity 96.5%. In patients with negative cytology, these two tumor markers had a sensitivity of 50% and a specificity of 96.5%.The determination of tumor markers in ascitic fluid could be useful for the diagnostic assessment of patients with ascites.