Colonoscopic screening of persons with suspected risk factors for colon cancer: II. Past history of colorectal neoplasms.
Colonoscopic screening of persons with suspected risk factors for colon cancer: II. Past history of colorectal neoplasms.
复制标题
对疑似结肠癌危险因素的人群进行结肠镜筛查：II．
DOI：
10.1016/0016-5085(89)91551-5
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发表时间：
1989
期刊：
影响因子：
29.4
通讯作者：
Jewell,NP
中科院分区：
文献类型：
--
作者：
Grossman,S;Milos,ML;Tekawa,IS;Jewell,NP
建议所有患有结直肠腺瘤或癌的人进行结肠镜筛查。人们认为这些人罹患其他无症状结直肠肿瘤的风险增加，去除这些肿瘤将降低结直肠癌的发病率和死亡率。在这项前瞻性研究中，对 544 名无症状受试者进行了初步结肠镜检查，这些受试者过去有结直肠指数病变史，范围从小管状腺瘤到浸润性癌症。在 402 名最严重指标病变为腺瘤的受试者中，通过结肠镜检查检测到肿瘤的患病率；超过硬质乙状结肠镜的范围，随着年龄、男性、黑人种族以及指数腺瘤的数量和大小而增加。在 142 名最严重指标病变为浸润性癌症的受试者中，结肠镜检查结果与年龄和白人种族略有相关。在一个由 133 名受试者组成的亚组中，其最严重的指标病变是单个小（<10 毫米）管状腺瘤，并且没有一级亲属患有结直肠癌，在结肠镜检查中发现晚期结肠肿瘤（管状腺瘤直径≥10 毫米；管状绒毛状、绒毛状或严重发育不良腺瘤；或浸润性癌症）的患病率仅为 3%，不高于一般人群的预期。其余 411 名患有晚期或多指标病变的受试者亚组的晚期肿瘤患病率为 8% 至 18%。这些发现表明，对于唯一危险因素是单个小管状腺瘤的人，可以修改当前的筛查指南，以推荐比结肠镜检查成本更低、侵入性更小的技术。
Colonoscopic screening has been recommended for all persons who have had a colorectal adenoma or carcinoma. Such persons have been assumed to be at increased risk of having additional, asymptomatic colorectal neoplasms, the removal of which would reduce morbidity and mortality from colorectal cancer. In this prospective study, initial colonoscopy was performed on 544 asymptomatic subjects with past histories of colorectal index lesions ranging from small tubular adenomas to invasive cancers. In 402 subjects whose worst index lesion was an adenoma, the prevalence of neoplasms detected at colonoscopy; above the reach of the rigid sigmoidoscope, increased with age, male sex, black race, and the number and size of their index adenomas. In 142 subjects whose worst index lesion was invasive cancer, colonoscopy findings were marginally related to age and white race. A subgroup of 133 subjects whose worst index lesion was a single, small (<10 mm) tubular adenoma and who had no first-degree relatives with colorectal cancer had only a 3% prevalence of advanced colonic neoplasms (tubular adenomas ≥10 mm in diameter; tubulovillous, villous, or severely dysplastic adenomas; or invasive cancers) found on colonoscopy—no greater than would,be expected in the general population. Subgroups of the remaining 411 subjects, who had advanced or multiple index lesions, had prevalences of advanced neoplasms ranging from 8% to 18%. These findings indicate that for persons whose only risk factor is a single small tubular adenoma, current screening guidelines could be modified to recommend techniques less costly and less invasive than colonoscopy.