Screening for colorectal neoplasia with CT colonography: Initial experience from the 1st year of coverage by third-party payers
Screening for colorectal neoplasia with CT colonography: Initial experience from the 1st year of coverage by third-party payers
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DOI：
10.1148/radiol.2412052007
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发表时间：
2006-11-01
期刊：
影响因子：
19.7
通讯作者：
Pfau, Patrick R.
中科院分区：
文献类型：
--
作者：
Pickhardt, Perry J.;Taylor, Andrew J.;Pfau, Patrick R.
用途：为了评估我们的经验，在第一年的计算机断层扫描（CT）结肠镜检查筛查，因为当地第三方支付coverage.Materials和Methods的启动：这符合健康保险责任法案的研究是由机构审查委员会批准的，知情同意书被免除。在2005年4月27日结束的1年期间，连续1110名成年人（585名女性，525名男性;平均年龄58.1岁）接受了初次CT结肠造影筛查。超过99%的人被管理式护理协议所覆盖。CT结肠成像解释与初级三维息肉检测，并在2小时内发布最终结果。大息肉（>= 10-mm）的患者在同一天进行光学结肠镜检查，中等大小（6-9- mm）病变的患者可以选择立即进行光学结肠镜检查或短期CT结肠镜监测。在77例（6.9%）患者中发现了中等大小的病变，其中31例（40%）选择光学结肠镜检查，46例（60%）选择CT结肠造影监测。在71例随后接受光学结肠镜检查的患者中，有65例发现了一致性病变（阳性预测值，91.5%）。在71例光学结肠镜检查中，有61例（86%）与CT结肠成像在同一天进行，从而避免了重复肠道准备的需要。CT结肠造影阳性结果的实际内镜转诊率为6.4%（71/1110例患者）。从初级保健医生和他们的病人增加了整个studyperiod.Conclusion：作为一个主要的结直肠癌筛查工具，CT结肠成像覆盖的第三方支付者有一个可以接受的低内镜转诊率和光学结肠镜检查的阳性结果的高度一致性的需求。
Purpose: To evaluate our experience in the 1st year of computed tomographic (CT) colonography screening since the initiation of local third-party payer coverage.Materials and Methods: This HIPAA-compliant study was approved by the institutional review board, and informed consent was waived. Over a 1-year period that ended on April 27, 2005, 1110 consecutive adults (585 women, 525 men; mean age, 58.1 years) underwent primary CT colonography screening. More than 99% were covered by managed care agreements. CT colonographic interpretation was performed with primary three-dimensional polyp detection, and the final results were issued within 2 hours. Patients with large (>= 10-mm) polyps were referred for same-day optical colonoscopy, and patients with medium-sized (6-9- mm) lesions had the option of immediate optical colonoscopy or short-term CT colonography surveillance.Results: Large colorectal polyps were identified at CT colonography in 43 (3.9%) of 1110 patients. Medium-sized lesions were identified in 77 (6.9%) patients, 31 (40%) of whom chose optical colonoscopy and 46 (60%) of whom chose CT colonography surveillance. Concordant lesions were identified in 65 of 71 patients who underwent subsequent optical colonoscopy (positive predictive value, 91.5%). Sixty-one (86%) of 71 optical colonoscopic procedures were performed on the same day as CT colonography, thereby avoiding the need for repeat bowel preparation. The actual endoscopic referral rate for positive findings at CT colonography was 6.4% (71 of 1110 patients). The demand for CT colonography screening from primary care physicians and their patients increased throughout the study period.Conclusion: As a primary colorectal screening tool, CT colonography covered by third-party payers has an acceptably low endoscopic referral rate and a high concordance of positive findings at optical colonoscopy.