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Year : 2018  |  Volume : 7  |  Issue : 3  |  Page : 175-183

Assessing tumor angiogenesis in colorectal cancer by quantitative contrast-enhanced endoscopic ultrasound and molecular and immunohistochemical analysis

1 Research Center of Gastroenterology and Hepatology, Craiova, Romania
2 Human Genomics Laboratory, Craiova, Romania
3 Department of Research Methodology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
4 Department of Pathology, Emergency County Hospital, Craiova, Romania
5 Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, Craiova, Romania
6 Department of Surgery, University of Medicine and Pharmacy of Craiova, Craiova, Romania
7 Research Center of Gastroenterology and Hepatology, Craiova, Romania; Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Clinical Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
8 Research Center of Gastroenterology and Hepatology, Craiova, Romania; Department of Endoscopy, Copenhagen University Hospital Herlev, Denmark

Correspondence Address:
Dan Ionuţ Gheonea
University of Medicine and Pharmacy of Craiova, Craiova
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/eus.eus_7_17

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Background and Objectives: Data on contrast-enhanced endoscopic ultrasound (CE-EUS) for colorectal cancer (CRC) evaluation are scarce. Therefore, we aimed to assess the vascular perfusion pattern in CRC by quantitative CE-EUS and compare it to immunohistochemical and genetic markers of angiogenesis. Patients and Methods: We performed a retrospective analysis of CE-EUS examinations of 42 CRC patients, before any therapy. CE-EUS movies were processed using a dedicated software. Ten parameters were automatically generated from the time-intensity curve (TIC) analysis: peak enhancement (PE), rise time (RT), mean transit time, time to peak (TTP), wash-in area under the curve (WiAUC), wash-in rate (WiR), wash-in perfusion index (WiPI), wash-out AUC (WoAUC), and wash-in and wash-out AUC (WiWoAUC). The expression levels of the vascular endothelial growth factor receptor 1 (VEGFR1) and VEGFR2 genes were assessed from biopsy samples harvested during colonoscopy. Microvascular density and vascular area were calculated after CD31 and CD105 immunostaining. Results: Forty-two CE-EUS video sequences were analyzed. We found positive correlations between the parameters PE, WiAUC, WiR, WiPI, WoAUC, WiWoAUC, and N staging (Spearman r = 0.437, r = 0.336, r = 0.462, r = 0.437, r = 0.358, and r = 0.378, respectively, P < 0.05), and also between RT and TTP and CD31 vascular area (r = 0.415, and r = 0.421, respectively, P < 0.05). VEGFR1 and VEGFR2 expression did not correlate with any of the TIC parameters. Conclusions: CE-EUS with TIC analysis enables minimally invasive assessment of CRC angiogenesis and may provide information regarding the lymph nodes invasion. However, further studies are needed for defining its role in the evaluation of CRC patients.

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