Seth N. Glick

Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology.

In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer. CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized. In 2006 to 2007, the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average-risk adults. In this update of each organizations guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy. When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that primarily is effective at early cancer detection and a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps. It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening.

Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi‐Society Task Force on Colorectal Cancer, and the American College of Radiology*†

In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer. CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized. In 2006 to 2007, the American Cancer Society, the US Multi Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average‐risk adults. In this update of each organizations guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy. When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps and a screening test that primarily is effective at early cancer detection. It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening.

Revised Colorectal Screening Guidelines: Joint Effort of the American Cancer Society, U.S. Multisociety Task Force on Colorectal Cancer, and American College of Radiology

Elizabeth G. McFarland, MD Bernard Levin, MD David A. Lieberman, MD Perry J. Pickhardt, MD C. Daniel Johnson, MD Seth N. Glick, MD Durado Brooks, MD, MPH Robert A. Smith, PhD Editor’s Note: This editorial refers to the 2008 revised colorectal screening guidelines jointly published by the American Cancer Society (ACS) and the American Gastroenterology Association. The full guidelines are reprinted, with permission from the ACS, online at http://radiology.rsnajnls.org/content /full/248/3/717/DC1. Subsequent to publication in CA A Cancer Journal for Clinicians, an erratum was issued regarding the listing of authors of the original report (CA Cancer J Clin, 2008;58:160).

Gastric involvement by omental cakes: Radiographic findings

Six cases of malignancy (3 ovarian, 1 endometrial, 1 cecal, and 1 breast) were collected in which upper gastrointestinal (UGI) examinations revealed mass effect, nodularity, flattening, and/or spiculated mucosal folds on the greater curvature of the stomach due to contiguous spread of tumor from the greater omentum. Carcinoma of the transverse colon invading the stomach via the gastrocolic ligament may produce identical radiographic findings. In 3 cases, however, barium enema (BE) examinations revealed simultaneous involvement of the transverse colon by omental tumor as well as other evidence of intraperitoneal seeding. When a UGI examination suggests gastric involvement by omental metastases or so-called omental “cakes,” a BE should be performed to demonstrate associated colonic involvement and to rule out a carcinoma of the transverse colon as the cause of these radiographic findings.

Radiologic features of esophagitis.

The radiographic features of 31 cases of esophagitis confirmed by endoscopy and biopsy were studied by double-contrast techniques. The morphologic findings are analyzed and the changes noted in the infectious and peptic types of esophagitis are contrasted.

Appendiceal filling by double-contrast barium enema

The barium enema is a safe and useful diagnostic modality in the evaluation of patients with suspected acute appendicitis. Complete appendiceal filling with barium virtually excludes this diagnosis. Frequently positive diagnostic information is obtained. Only 1 study in the literature documents the frequency of normal appendiceal filling by barium enema. The authors utilized the singlecontrast technique. We recorded the frequency of normal appendiceal filling with the double-contrast technique and then compared our data with the previously published study to determine if there is a significant clinical disadvantage to the doublecontrast technique when acute appendicitis is a diagnostic consideration.

Squamous cell metastases to the gastric cardia

Three patients with squamous cell carcinoma metastasized to the gastric cardia (1 from the esophagus, 1 from the hypopharynx, and 1 of unknown origin) are described. Two patients presented after apparent successful treatment of the primary malignancy. In all 3 cases the lesion appeared as a large solitary submucosal mass in the region of the gastric cardia. Squamous metastases should be considered in the radiographic differential diagnosis of a large submucosal gastric mass. Metastasis to the proximal stomach from carcinoma of the esophagus may be more common than suspected. Contrast evaluation of this area may be indicated in both the initial evaluation and the routine follow-up in these patients.

Giant hyperplastic polyps of the gastric remnant simulating carcinoma

Large hyperplastic polyps of the gastric remnant were detected in 2 male patients who had undergone Billroth II gastrojejunostomy for peptic ulcer disease 13 and 18 years earlier. Both patients presented with iron deficiency anemia due to chronic occult gastrointestinal bleeding. The clinical and radiographic findings were initially suggestive of gastric stump malignancy, and one of the resected hyperplastic polyps contained foci of carcinoma in situ. We illustrate the radiographic and pathologic features of these lesions together with a review of the pertinent literature.

Association of Meckel's diverticulum and Crohn's disease

A significant association between Meckels diverticulum and Crohns disease has been suggested in the clinical literature. Ten patients with both entities demonstrated radiographically as well as cases reported in the literature were analyzed to determine the relevance of this association to radiologic evaluation. The Meckels diverticulum in most cases was an incidental finding whereas the Crohns disease usually accounted for the patients clinical symptoms. Recognition of this association should prevent unnecessary laparotomy for an incidental Meckels diverticulum and improve the radiographic diagnosis of coexistent Crohns disease.

Emphysematous cholecystitis: pitfalls in its plain film diagnosis

The clinical and radiographic findings of emphysematous cholecystitis are usually characteristic. However, on occasion the radiographic findings may be simulated by other processes. In such circumstances accurate diagnosis can usually be rapidly established by a variety of simple radio-graphic maneuvers and procedures. Five illustrative cases are presented herein and the pertinent literature is reviewed.