Diagnostic utility of CT for suspected immune checkpoint inhibitor enterocolitis.
Diagnostic utility of CT for suspected immune checkpoint inhibitor enterocolitis.
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DOI：
10.1136/jitc-2020-001329
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发表时间：
2020-10
影响因子：
10.9
通讯作者：
Dougan M
中科院分区：
文献类型：
--
作者：
Durbin SM;Mooradian MJ;Fintelmann FJ;Zubiri L;Chute DF;Kambadakone A;Pisuchpen N;Reynolds KL;Dougan M
免疫检查点抑制剂 (ICI) 小肠结肠炎是一种常见的免疫相关不良事件，可能致命，尤其是在未及时诊断和治疗的情况下。目前诊断的金标准是内窥镜检查和活检，但 CT 扫描是一种可能的替代方案。本研究的主要目的是确定 CT 在评估 ICI 小肠结肠炎中的诊断性能。经机构审查委员会批准，我们对整个医疗保健系统中 2015 年至 2019 年接受 ICI 治疗的患者进行了回顾性队列研究。如果患者在 3 天内接受了腹部 CT 和内窥镜活检并进行活检，则纳入其中。从电子病历中提取放射学和病理学诊断以及临床特征。与组织诊断相比，我们计算了 CT 诊断 ICI 小肠结肠炎的敏感性、特异性、阳性预测值 (PPV) 和阴性预测值 (NPV)。在 4474 名接受筛查的患者中，有 138 名符合纳入标准。最常见的肿瘤类型是黑色素瘤（37%）和肺癌（19%）。 74% 的人接受了抗程序性细胞死亡 (PD-1)/PD-L1 疗法。 39% 的 CT 扫描显示有小肠结肠炎迹象，58% 的患者患有经活检证实的 ICI 小肠结肠炎。 CT 的敏感性和特异性分别为 50% 和 74%。 PPV 为 73%，NPV 为 52%。在确诊的 ICI 小肠结肠炎患者中，70% 出现 3 级或以上症状，91% 接受类固醇治疗，40% 接受英夫利昔单抗治疗。 CT 扫描诊断 ICI 小肠结肠炎的效果为中等到差，并且不能用活检代替内窥镜检查。
Immune checkpoint inhibitor (ICI) enterocolitis is a common immune-related adverse event and can be fatal, especially when not diagnosed and treated promptly. The current gold standard for diagnosis is endoscopy with biopsy, but CT scan is a possible alternative. The primary objective of this study is to identify the diagnostic performance of CT in the evaluation of ICI enterocolitis. With institutional review board approval, we conducted a retrospective cohort study of patients who received ICI therapy between 2015 and 2019 across a healthcare system. Patients were included if they underwent both abdominal CT and endoscopy with biopsy within 3 days. The radiological and pathological diagnoses, as well as clinical characteristics, were extracted from the electronic medical record. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CT for diagnosing ICI enterocolitis when compared with tissue diagnosis. Of the 4474 patients screened, 138 met inclusion criteria. Most common tumor types were melanoma (37%) and lung cancer (19%). Seventy-four per cent were treated with antiprogrammed cell death (PD-1)/PD-L1 therapy. Thirty-nine per cent had signs of enterocolitis on CT scan and 58% had biopsy-proven ICI enterocolitis. Sensitivity and specificity of CT were 50% and 74%, respectively. PPV was 73% and NPV was 52%. Of those with confirmed ICI enterocolitis, 70% had grade 3 or higher symptoms, 91% received steroids and 40% received infliximab. The performance of CT scan for diagnosis of ICI enterocolitis is moderate to poor and does not replace endoscopy with biopsy.
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