Assessment of volumetric growth rates of small colorectal polyps with CT colonography: a longitudinal study of natural history.
Assessment of volumetric growth rates of small colorectal polyps with CT colonography: a longitudinal study of natural history.
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DOI：
10.1016/s1470-2045(13)70216-x
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发表时间：
2013-07
期刊：
影响因子：
--
通讯作者：
Cash BD
中科院分区：
文献类型：
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作者：
Pickhardt PJ;Kim DH;Pooler BD;Hinshaw JL;Barlow D;Jensen D;Reichelderfer M;Cash BD
小肠息肉的自然历史是一个重要的领域，主要的证据差距仍然存在。我们报告了一项前瞻性试验的结果，该试验通过纵向CT结肠镜（CTC）评估体内生长速率来评估小（6-9毫米）结肠直肠息肉的行为。对243名自愿无症状成人（平均间隔2.3年，范围1-7年）在筛查CTC时首次检测到的306个小（6-9毫米）息肉进行体内CTC监测。初始和监测CTC时的体积和线性息肉测量与组织学亚组相关。对132例ctc后结肠镜病变进行组织学检查。试验注册（ClinicalTrials.gov标识号：NCT00204867）应用息肉体积阈值每年±20%的变化来分类生长，22%（68/306）的息肉进展，50%（153/306）稳定，28%（85/306）回归，包括10%（32/306）的表观分辨率。91%（21/23）的晚期腺瘤进展，37%（31/84）的非晚期腺瘤进展，8%（15/198）的其他病变进展（p<0.0001）。与在初始CTC筛查（无监测）中发现并切除的6-9毫米息肉相比，CTC监测中生长的息肉代表晚期腺瘤的比值比为15.6 （95%CI, 7.6-31.7）。确诊的晚期腺瘤（n=23）的平均息肉体积变化为+77%/年，确诊的非晚期腺瘤（n=84）的平均息肉体积变化为+16%/年，所有确诊的非肿瘤性或未切除的息肉的平均息肉体积变化为-13%/年（p<0.0001）。在CTC监测下，息肉的绝对体积为180mm3，确诊为晚期肿瘤，敏感性为92%(22/24)，特异性为94% (266/282)，PPV为58% (22/38)，NPV为99%（266/268）。一般来说，体积变化放大了小的或不存在的线性大小变化，随访时只有16例6-9毫米息肉（6%）超过10毫米。结肠小息肉的体积生长评估是确定临床重要性的有力生物标志物。晚期腺瘤表现出比非晚期腺瘤更快的生长，而大多数其他小息肉随着时间的推移保持稳定或消退。这些发现可能允许较少侵入性的监测策略，保留息肉切除病变显示显著增长。正在进行的研究将最终提供更多关于未切除的小息肉最终命运的信息。
The natural history of small colorectal polyps is an important area for which major evidence gaps persist. We report the results of a prospective trial assessing the behavior of small (6-9 mm) colorectal polyps through in vivo growth rates at longitudinal CT colonography (CTC) evaluation. In vivo CTC surveillance was performed on 306 small (6-9 mm) polyps initially detected at screening CTC in 243 consenting asymptomatic adults (mean interval, 2.3 years; range, 1-7 years). Volumetric and linear polyp measurements at initial and surveillance CTC were correlated with histologic subgroups. Histology was established in 132 lesions at post-CTC colonoscopy. The trial is registered (ClinicalTrials.gov Identifier: NCT00204867) Applying a polyp volume threshold of ±20% change per year to categorize growth, 22% (68/306) of all polyps progressed, 50% (153/306) were stable, and 28% (85/306) regressed, including apparent resolution in 10% (32/306). 91% (21/23) of proven advanced adenomas progressed, compared with 37% (31/84) of proven non-advanced adenomas, and 8% (15/198) of all other lesions (p<0.0001). Odds ratio for a growing polyp at CTC surveillance to represent an advanced adenoma was 15.6 (95%CI, 7.6-31.7) compared with 6-9 mm polyps detected and removed at initial CTC screening (without surveillance). Mean polyp volume change was +77%/year for proven advanced adenomas (n=23), +16%/year for proven non-advanced adenomas (n=84), and -13%/year for all proven non-neoplastic or unresected polyps (p<0.0001). An absolute polyp volume >180 mm3 at surveillance CTC identified proven advanced neoplasia with a sensitivity of 92% (22/24), specificity of 94% (266/282), PPV of 58% (22/38), and NPV of 99% (266/268). In general, volume changes amplified small or absent linear size changes, as only sixteen 6-9 mm polyps (6%) exceeded 10 mm at follow-up. Volumetric growth assessment of small colorectal polyps represents a powerful biomarker for determining clinical importance. Advanced adenomas demonstrate more rapid growth than non-advanced adenomas, whereas most other small polyps remain stable or regress over time. These findings may allow for less invasive surveillance strategies, reserving polypectomy for lesions that demonstrate significant growth. Ongoing research will eventually provide more information regarding the ultimate fate of unresected small polyps without significant growth.