Using risk for advanced proximal colonic neoplasia to tailor endoscopic screening for colorectal cancer
Using risk for advanced proximal colonic neoplasia to tailor endoscopic screening for colorectal cancer
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DOI：
10.7326/0003-4819-139-12-200312160-00005
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发表时间：
2003-12-16
影响因子：
39.2
通讯作者：
Ransohoff, DF
中科院分区：
文献类型：
--
作者：
Imperiale, TF;Wagner, DR;Ransohoff, DF
背景资料：结肠镜筛查结直肠癌已被建议，因为乙状结肠镜检查错过了近一半的人与先进的近端肿瘤。目的：建立一个临床指数，分层的风险，先进的近端肿瘤，并确定一个亚组的风险非常低，其中筛查乙状结肠镜检查可能就足够了。设计：横断面研究。设置：一个公司为基础的计划，筛查结肠镜检查结直肠癌。患者：在1995年9月至2001年6月期间接受首次结肠镜检查的50岁或50岁以上的连续人群。测量：根据前1994人的信息创建了一个包含3个变量的临床指数。根据年龄、性别和远端发现进行评分。测量每个评分的晚期近端肿瘤（定义为1 cm或更大的腺瘤或绒毛组织学、重度异型增生或癌症）的风险。该指数对来自同一筛查项目的接下来1031人进行了测试。结果：在1994人中，67人（3.4%）患有晚期近端瘤变。低风险亚组（占队列的37%）的评分为0或1，风险为0.68%（95% CI，0.22%至1.57%）。在1031人的验证组中，低风险亚组（占队列的47%）中晚期近端肿瘤的风险为0.4%（置信上限为1.49%）。该指数的应用检测到92%的晚期近端肿瘤患者，如果在筛查性乙状结肠镜检查后应用，可以减少40%的结肠镜检查需求。结肠镜检查的边际效益低风险的人是小的：检测7个额外的人与先进的近端肿瘤，1217额外的结肠镜检查将requires.Conclusions：该临床指数分层的风险先进的近端肿瘤，并确定一个亚组在非常低的风险。如果在其他队列或组中得到验证，该指数可用于定制结肠直肠癌的内镜筛查。
Background: Colonoscopic screening for colorectal cancer has been suggested because sigmoidoscopy misses nearly half of persons with advanced proximal neoplasia.Objective: To create a clinical index to stratify risk for advanced proximal neoplasia and to identify a subgroup with very low risk in which screening sigmoidoscopy alone might suffice.Design: Cross-sectional study.Setting: A company-based program of screening colonoscopy for colorectal cancer.Patients: Consecutive persons 50 years of age or older undergoing first-time screening colonoscopy between September 1995 and June 2001.Measurements: A clinical index with 3 variables was created from information on the first 1994 persons. Points were assigned to categories of age, sex, and distal findings. Risk for advanced proximal neoplasia (defined as an adenoma 1 cm or larger or one with villous histology, severe dysplasia, or cancer) was measured for each score. The index was tested on the next 1031 persons from the same screening program.Results: Of 1994 persons, 67 (3.4%) had advanced proximal neoplasia. A low-risk subgroup comprising 37% of the cohort had scores of 0 or 1 and a risk of 0.68% (95% CI, 0.22% to 1.57%). Among the validation group of 1031 persons, risk for advanced proximal neoplasia in the low-risk subgroup (comprising 47% of the cohort) was 0.4% (upper confidence limit of 1.49%). Application of this index detected 92% of persons with advanced proximal neoplasms and, if applied following screening sigmoidoscopy, could reduce the need for colonoscopy by 40%. The marginal benefit of colonoscopy among low-risk persons was small: To detect 7 additional persons with advanced proximal neoplasia, 1217 additional colonoscopies would be required.Conclusions: This clinical index stratifies the risk for advanced proximal neoplasia and identifies a subgroup at very low risk. If it is validated in other cohorts or groups, the index could be used to tailor endoscopic screening for colorectal cancer.