Computed Tomography Colonography vs Colonoscopy for Colorectal Cancer Surveillance After Surgery.
Computed Tomography Colonography vs Colonoscopy for Colorectal Cancer Surveillance After Surgery.
复制标题
计算机断层扫描结肠镜检查与结肠镜检查用于术后结直肠癌监测。
DOI：
10.1053/j.gastro.2017.11.025
复制
发表时间：
2018
期刊：
影响因子：
29.4
通讯作者：
Ross,EricA
中科院分区：
文献类型：
--
作者：
Weinberg,DavidS;Pickhardt,PerryJ;Bruining,DavidH;Edwards,Kristin;Fletcher,JoelG;Gollub,MarcJ;Keenan,EileenM;Kupfer,SoniaS;Li,Tianyu;Lubner,SamJ;Markowitz,ArnoldJ;Ross,EricA
背景与目的结直肠癌（CRC）治愈性手术后监测的建议包括术后1年的腹部-骨盆计算机断层扫描（CT）和光学结肠镜检查（OC）。CT结肠镜（CTC）用于CRC筛查时，可有效识别≥10mm的结直肠息肉和癌症。我们进行了一项前瞻性研究，以确定CTC联合CT是否可以替代OC在CRC监测中的作用。我们的研究纳入了5个三级医疗学术中心的231例切除的0-III期结直肠癌患者。手术后大约1年，参与者接受门诊CTC + CT，随后当天进行OC。CTC结果显示后，内镜显示顺序结肠段，重新检查不一致的发现。主要结果是CTC在以内窥镜检查为参考标准的结直肠腺瘤和癌症检测中的表现。结果在231名参与者中，116名（50.2%）患有任何大小或组织学上由OC确定的息肉，15.6%为常规腺瘤和/或≥6 mm的锯齿状息肉。未发现腔内肿瘤。CTC检测≥6 mm息肉患者的敏感性为44.0% (95% CI, 30.2-57.8)，特异性为93.4% （95% CI, 89.7-97.0）。CTC检测≥10 mm息肉的灵敏度为76.9% (95% CI, 54.0-99.8)，特异性为89.0% （95% CI, 84.8-93.1）。当仅考虑腺瘤性息肉时，发现类似的值。≥6 mm的腺瘤CTC的阴性预测值为90.7% (95% CI, 86.7-94.5)，≥10 mm的腺瘤CTC的阴性预测值为98.6% （95% CI, 97.0-100）。结论在结直肠癌切除术后1年的监测人群中，CTC对息肉≥6 mm患者的检测效果不如OC。临床试验。gov注册号：NCT02143115。
Background & AimsRecommendations for surveillance after curative surgery for colorectal cancer (CRC) include a 1-year post-resection abdominal-pelvic computed tomography (CT) scan and optical colonoscopy (OC). CT colonography (CTC), when used in CRC screening, effectively identifies colorectal polyps ≥10 mm and cancers. We performed a prospective study to determine whether CTC, concurrent with CT, could substitute for OC in CRC surveillance.MethodsOur study enrolled 231 patients with resected stage 0–III CRC, identified at 5 tertiary care academic centers. Approximately 1 year after surgery, participants underwent outpatient CTC plus CT, followed by same-day OC. CTC results were revealed after endoscopic visualization of sequential colonic segments, which were re-examined for discordant findings. The primary outcome was performance of CTC in the detection of colorectal adenomas and cancers using endoscopy as the reference standard.ResultsOf the 231 participants, 116 (50.2%) had polyps of any size or histology identified by OC, and 15.6% had conventional adenomas and/or serrated polyps ≥6 mm. No intra-luminal cancers were detected. CTC detected patients with polyps of ≥6 mm with 44.0% sensitivity (95% CI, 30.2–57.8) and 93.4% specificity (95% CI, 89.7–97.0). CTC detected polyps ≥10 mm with 76.9% sensitivity (95% CI, 54.0–99.8) and 89.0% specificity (95% CI, 84.8–93.1). Similar values were found when only adenomatous polyps were considered. The negative predictive value of CTC for adenomas ≥6 mm was 90.7% (95% CI, 86.7–94.5) and for adenomas ≥10 mm the negative predictive value was 98.6% (95% CI, 97.0–100).ConclusionsIn a CRC surveillance population 1 year following resection, CTC was inferior to OC for detecting patients with polyps ≥6 mm. Clinical Trials.gov Registration Number: NCT02143115.