Background Aberrant crypt foci of the colon are possible precursorsof adenoma and cancer, but these lesions have been studied mainlyin surgical specimens from patients who already had colon cancer.
Methods Using magnifying endoscopy, we studied the prevalence,number, size, and dysplastic features of aberrant crypt fociand their distribution according to age in 171 normal subjects,131 patients with adenoma, and 48 patients with colorectal cancer.We also prospectively examined the prevalence of aberrant cryptfoci in 11 subjects (4 normal subjects, 6 with adenoma, and1 with cancer) before and after the administration of 100 mgof sulindac three times a day for 8 to 12 months and comparedthe results with those in 9 untreated subjects (4 normal subjectsand 5 with adenoma). All 20 subjects had aberrant crypt fociat base line.
Results We identified 3155 aberrant crypt foci, 161 of whichwere dysplastic; the prevalence and number increased with age.There were significant (P<0.001) correlations between thenumber of aberrant crypt foci, the presence of dysplastic foci,the size of the foci, and the number of adenomas. After sulindactherapy, the number of foci decreased, disappearing in 7 of11 subjects. In the untreated control group, the number of fociwas unchanged in eight subjects and slightly increased in one(P<0.001 for the difference between the groups).
Conclusions Aberrant crypt foci, particularly those that arelarge and have dysplastic features, may be precursors of adenomaand cancer.
Source Information
From the Fourth Department of Internal Medicine (T.T., S.K., Y.T., M.O., S.S., J.K., K.K., Y.N.) and the Department of Public Health (H.M.), Sapporo Medical University, Sapporo; and Muroran Shinnittetsu Hospital, Muroran (S.N.) — both in Japan.
Address reprint requests to Dr. Niitsu at the Fourth Department of Internal Medicine, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, Japan.
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