Grading of distal colorectal adenomas as predictors for proximal colonic neoplasia and choice of endoscope in population screening: experience from the Norwegian Colorectal Cancer Prevention study (NORCCAP)
Grading of distal colorectal adenomas as predictors for proximal colonic neoplasia and choice of endoscope in population screening: experience from the Norwegian Colorectal Cancer Prevention study (NORCCAP)
复制标题
作者：
Gondal, G;Grotmol, T;Hoff, G
背景和目的：本研究的目的是评估灵活乙状结肠镜（FS）筛查中易于测量的临床变量的效用，这些变量可能预测近端晚期肿瘤（PAN）。方法：我们研究了1833名活检证实的FS腺瘤患者，他们随后接受了全结肠镜检查。结果:共有387名（21%）受试者患有近端结肠肿瘤（PCN）， 85名（5%）受试者患有PAN。在单因素比较中，PAN的风险增加了三倍以上，远端腺瘤的存在大于或等于10毫米直径或含有细纤维成分，远端腺瘤的多样性，严重的不典型增生，或年龄大于或等于60岁，使PAN的风险增加了两倍以上。远端腺瘤的存在大于或等于10mm，绒毛性和多样性仍然是近端肿瘤风险增加的预测变量，而性别和严重的不典型增生则失去了其重要性。如果只对患有多发性（bbb1）腺瘤或FS的任何高风险腺瘤的患者推荐结肠镜检查，我们将减少1209例（66%）结肠镜检查，但会错过32例（38%）PAN患者和217例（56%）PCN患者。通过使用60厘米的内窥镜而不是普通的结肠镜，9名（2%）晚期肿瘤患者（包括3名癌症患者）将被遗漏。结论：本研究支持将“任何腺瘤”定义为FS阳性，有资格进行结肠镜检查的概念。我们建议使用普通结肠镜而不是60厘米乙状结肠镜进行FS筛查检查。
Background and aims: The purpose of this study was to evaluate the utility of easily measured clinical variables at flexible sigmoidoscopy (FS) screening that might predict a proximal advanced neoplasm (PAN).Methods: We studied 1833 subjects with biopsy verified adenomas at FS who subsequently underwent full colonoscopy.Results: A total of 387 (21%) subjects had proximal colonic neoplasms (PCN) and 85 (5%) had PAN, In univariate comparison, the risk of PAN increased more than threefold in the presence of a distal adenoma measuring either greater than or equal to 10 mm in diameter or containing villous components, Multiplicity of distal adenomas, severe dysplasia, or age greater than or equal to60 years increased the risk of PAN more than twofold, In the multivariate model, the presence of a distal adenoma greater than or equal to10 mm, villousness, and multiplicity maintained their significance as predictive variables for increased risk of proximal neoplasms, whereas sex and severe dysplasia lost their significance. By recommending colonoscopy only to individuals with multiple (>1) adenomas or any high risk adenoma at FS, we would have reduced the number of colonoscopies by 1209 (66%) but would have missed 32 (38%) participants with PAN and 217 (56%) with PCN. By using a 60 cm endoscope instead of an ordinary colonoscope at FS, nine (2%) participants with advanced neoplasms, including three patients with cancer, would have been missed.Conclusion: The present study supports the concept of defining "any adenoma" as a positive FS, qualifying for colonoscopy. We recommend the use of an ordinary colonoscope instead of a 60 cm sigmoidoscope for FS screening examinations.