Methodology and Clinical Significance of the Colorectal Exfoliated ...

[Abstract]

Background and ObjectiveColorectal cancer is one of the most commonly occurring malignancies in the world. The treatment of early-stage tumors decreases the overall mortality of colorectal cancers. The key to early discovery of colorectal cancer is to screen in the average-risk population. The generally used methods of screening and early diagnosis of colorectal cancer are fecal occult blood test (FOBT) and colonoscopy. FOBT is non-invasive but with relatively high false-positive and high false-negative rate. In comparison, colonoscopy is the gold standard of diagnosis of colorectal cancer but with the disadvantage of invasion and high cost. Nowadays, detection of colorectal exfoliated cells and their gene mutations may provide another non-invasive way of screening and early diagnosis of colorectal cancer. However, the extraction rate of exfoliated cells from stool is not so high and the extraction process is too complicated. Therefore, the method of extracting exfoliated cells from stool has not been widely applied. We attempt to improve the approaches of isolating and extracting exfoliated cells from stool, further to evaluate the roles of exfoliated cells in diagnosis of colorectal cancer.Materials and Methods1. To evaluate the effect of preservative solution of intestinal cells. Eight patients with colorectal cancer entered in the study. Three stool samples were taken from every patient and were given different treatments. Then the same isolation and extraction process of exfoliated cells was done in every stool sample, after that, HE stain and observations with microscope were done at last.2. Further verification of methodology of exfoliated cells. Ten patients with colorectal cancer entered in the study. Two different ways of collecting intestinal exfoliated cells were used in every patient. Then the same isolation and extraction process of exfoliated cells was done in every stool sample, after that, HE dyeing and Observations with microscope were done at last.3. Analysis of the extraction rate of the intestinal exfoliated cells from different part of the stool samples. Ten patients with colorectal cancer entered in the study. Both samples from inside the stool and outside the stool were taken from every patient. Then the same isolation and extraction process of exfoliated cells was done in every stool sample, after that, HE dyeing and observations with microscope were done at last.4. Detection rate of exfoliated cells in different times of stool after intake of 3000ml laxation. Seventeen patients randomly selected entered in the study. After they took 3000ml laxation, the second, third, fourth and fifth times of stool were collected respectively. Then the same isolation and extraction process of exfoliated cells was done in every stool sample, after that, HE dyeing and observations with microscope were done at last.5. Isolation and extraction of exfoliated cells from patients with upper gastrointestinal cancers. Twenty-two patients with upper gastrointestinal cancers entered in the study. Stool sample was collected from every patient. Then the same isolation and extraction process of exfoliated cells was done in every stool sample, after that, HE dyeing and observations with microscope were done at last.6. Evaluate the methodology of colorectal exfoliated cells in stool and the clinical significance in patients with colorectal cancer. Forty-one patients with colorectal cancer, thirty-four patients with colorectal adenoma and twenty healthy volunteers entered in the study. Naturally defecated stool and stool after intake of laxation were collected from every object. Then the same isolation and extraction process of exfoliated cells and fecal occult blood test were done in every stool sample, after that, HE dyeing and observations with microscope were done at last.Results1. After three days in the room temperature, exfoliated cells could be isolated and extracted in the stool with preservative solution, by contrast, no exfoliated cells could be detected in the stool without preservative solution.2. The extraction of exfoliated cells from stool taken under colonoscopy was in accordance with the extraction result from the same stool blended with the naturally defecated feces of the same patient.3. Of ten patients with colorectal cancer, exfoliated cells were extracted from four samples from the inside of the stool and the extraction rate was 40%; exfoliated cells were extracted from outside of the stool and the extraction rate was 50%. No significant difference was found between the two group of samples (X~2=0.202, P=0.653>0.05).4. The best extraction results of the exfoliated cells found from the second stool after intake of laxation was 12.5%(2/16), that from the third stool sample was 5.88%(1/17), that from the forth stool sample was 56.25%(9/16) and that from the fifth stool sample was 40.00%(6/15).5. No exfoliated malignant cells were found from stool of the twenty-two patients with esophageal carcinomas and gastric cancers.6. The detection rate of exfoliated cells from naturally defecated feces was 46.34%(19/41), while that from feces after laxation was 36.59%(15/41). The detection rate was 68.29%(28/41) if both kinds of stool samples were isolated and extracted. The detection rate was significantly higher in two kinds of stool samples together than in single stool sample. 7. Exfoliated cytology and fecal occult blood test. Cytology was positive in twenty-eight (68.29%) of forty-one patients with colorectal cancer and fecal occult blood test was positive in thirty-one (75.61%) of forty-one patients with colorectal cancer. No significant difference was found between the sensitivities of fecal occult blood test and exfoliated cells test (X~2=0.544,P>0.05), but significant differences were found between the complementary method and the FOBT (X~2=4.479,P

Title: Methodology and Clinical Significance of the Colorectal Exfoliated Cells in Stool in Colorectal Cancers

Category: Cancer Research

Filename: Methodology and Clinical Significance of the Colorectal Exfoliated Cells in Stool in Colorectal Cancers.pdf

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