Screening for colorectal cancer in Chinese: Comparison of fecal occult blood test, flexible sigmoidoscopy, and colonoscopy
Screening for colorectal cancer in Chinese: Comparison of fecal occult blood test, flexible sigmoidoscopy, and colonoscopy
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DOI：
10.1053/gast.2003.50090
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发表时间：
2003-03-01
期刊：
影响因子：
29.4
通讯作者：
Chung, SCS
中科院分区：
文献类型：
--
作者：
Sung, JJY;Chan, FKL;Chung, SCS
背景与目的：粪便隐血检查（FOBT）、乙状结肠镜检查（FS）和结肠镜检查是结肠直肠癌最常用的筛查方法。本研究的目的是比较这三种筛查方法在普通华人人群中的准确性和安全性。方法：通过健康展览从公众中招募50岁以上的无症状成年人。所有入组受试者均在镇静状态下接受FOBT和全结肠镜检查。记录晚期结肠病变（定义为大于或等于10mm的腺瘤、绒毛状腺瘤、伴有中度或重度不典型增生的腺瘤或浸润性癌）。左结肠和直肠远端40cm处病变作为FS表现。结果：共纳入505名受试者（56%为女性，平均年龄+/- SD， 56.5 +/- 5.4岁），其中476名（94.3%）完成了结肠镜检查。63名受试者（12.5%）被记录为晚期结肠肿瘤，其中45例在远端结肠，26例在近端结肠。在385例远端结肠正常的受试者中，14例（3.6%）在近端结肠有晚期病变，仅用FS就会遗漏。FOBT对晚期结肠病变的敏感性和特异性分别为14.3%和79.2%，对FS的敏感性和特异性分别为77.8%和83.9%。FOBT联合FS不能显著改善FS单独治疗的结果。在505例结肠镜检查患者和148例息肉切除术患者中，没有出现穿孔，只有一例息肉切除术后出血。结论：结肠镜检查是一种安全、准确的筛查结直肠肿瘤的方法。
Background & Aims: Fecal occult blood testing (FOBT), flexible sigmoidoscopy (FS), and colonoscopy are the most commonly recommended screening tests for colorectal cancer. The aim of this study was to compare the accuracy and safety of these 3 screening procedures in a general population of ethnic Chinese. Methods: Asymptomatic adults older than 50 years were recruited from the general public through health exhibitions. All enrolled subjects were offered FOBT and full colonoscopy under sedation. Advanced colonic lesions (defined as adenoma greater than or equal to10 mm, villous adenoma, adenoma with moderate or severe dysplasia, or invasive cancer) were recorded. Lesions at the distal 40 cm in the left colon and rectum were taken as findings of FS. Results: A total of 505 subjects (56% women; mean age +/- SD, 56.5 +/- 5.4 years) were enrolled, and 476 (94.3%) had a complete colonoscopy. Advanced colonic neoplasms were documented in 63 subjects (12.5%), of which 45 had lesions in the distal colon and 26 in the proximal colon. Among the 385 subjects with a normal distal colon, 14 (3.6%) had advanced lesions in the proximal colon that would be missed by FS alone. The sensitivity and specificity of FOBT for advanced colonic lesions were 14.3% and 79.2% and the sensitivity and specificity of FS were 77.8% and 83.9%, respectively. Combining FOBT with FS would not significantly improve the results of FS alone. Among these 505 subjects who underwent colonoscopy and 148 who underwent polypectomy, there was no perforation and only one occurrence of postpolypectomy bleeding recorded. Conclusions: Colonoscopy is a safe and accurate method for the screening of colorectal neoplasms in Chinese subjects.