Accuracy of CT colonography for detection of large adenomas and cancers.
Accuracy of CT colonography for detection of large adenomas and cancers.
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DOI：
10.1056/nejmoa0800996
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发表时间：
2008-09-18
期刊：
影响因子：
--
通讯作者：
Limburg PJ
中科院分区：
文献类型：
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作者：
Johnson CD;Chen MH;Toledano AY;Heiken JP;Dachman A;Kuo MD;Menias CO;Siewert B;Cheema JI;Obregon RG;Fidler JL;Zimmerman P;Horton KM;Coakley K;Iyer RB;Hara AK;Halvorsen RA Jr;Casola G;Yee J;Herman BA;Burgart LJ;Limburg PJ
CT结肠造影（CTC）是结直肠癌（CRC）筛查的非侵入性选择。CTC作为无症状成人筛查工具的准确性尚未得到很好的定义。国家CT结肠造影试验在15个研究中心招募了2600名年龄≥ 50岁的无症状受试者。使用标准肠道准备、粪便/液体标记、机械吹气、≥16排CT扫描仪采集CTC图像。经过培训的CTC放射科医生报告了所有直径≥ 5 mm的病变。结肠镜检查根据每个中心的既定临床方案进行，并作为参考标准。通过CTC检测结肠镜检查发现的大（≥10 mm）、组织学证实的腺瘤和腺癌患者是主要终点;还评价了较小（6-9 mm）结直肠病变的检测。完整的数据可用于2531（97%）参与者。对于大腺瘤和癌症，每个患者的敏感性、特异性、阳性和阴性预测值以及受试者工作特征曲线下面积的估计值分别为0.90 ±0.03、0.86 ± 0.02、0.23 ± 0.02、0.99 ± 0.01和0.89 ± 0.02。90%的灵敏度表明CTC未能在10%的患者中检测到≥ 10 mm的病变。大腺瘤或癌的每息肉灵敏度为0.84 ± 0.04。检测腺瘤≥ 6 mm患者的每例患者敏感性估计值为0.78。在这项针对无症状成人的研究中，CTC筛查发现了90%的腺瘤和直径≥ 10 mm的癌症患者。这些发现增加了关于CTC在平均风险CRC筛查中的作用的已发表数据。
CT Colonography (CTC) is a non-invasive option for colorectal cancer (CRC) screening. The accuracy of CTC as a screening tool among asymptomatic adults has not been well defined. The National CT Colonography Trial recruited 2600 asymptomatic participants, age ≥ 50 years, at 15 study centers. CTC images were acquired using standard bowel preparation, stool/fluid tagging, mechanical insufflation, ≥16 row CT scanners. Trained CTC radiologists reported all lesions ≥ 5 mm in diameter. Colonoscopy was performed according to established clinical protocols at each center and served as the reference standard. Detection by CTC of patients with large (≥10 mm), histologically-confirmed adenomas and adenocarcinomas which were detected by colonoscopy was the primary endpoint; detection of smaller (6–9 mm) colorectal lesions was also evaluated. Complete data were available for 2531 (97%) participants. For large adenomas and cancers the per patient estimates for sensitivity, specificity, positive and negative predictive values and area under the receiver operating characteristic curve were 0.90 ±0.03, 0.86 ± 0.02, 0.23 ± 0.02, 0.99 ±<0.01 and 0.89 ± 0.02, respectively. The sensitivity of 90% indicates that CTC failed to detect a lesion ≥10mm in 10% of patients. Per-polyp sensitivity for large adenomas or cancers was 0.84 ± 0.04. Per-patient sensitivity estimates in detecting patients with adenomas ≥ 6 mm, was 0.78. In this study of asymptomatic adults, CTC screening identified 90% of patients with adenomas and cancers ≥ 10 mm in diameter. These findings augment published data regarding the role of CTC in average-risk CRC screening.