Can patients at high risk for significant colorectal neoplasms and having normal quantitative faecal occult blood test postpone elective colonoscopy?
Can patients at high risk for significant colorectal neoplasms and having normal quantitative faecal occult blood test postpone elective colonoscopy?
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DOI：
10.1111/j.1365-2036.2009.04202.x
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发表时间：
2010-02-15
影响因子：
7.6
通讯作者：
Niv, Y.
中科院分区：
文献类型：
--
作者：
Hazazi, R.;Rozen, P.;Niv, Y.
背景在预定的时间间隔内选择性筛查和监测结肠镜检查的常见原因是大肠癌（CRC）或晚期腺瘤（AAP）的家族史或个人史。定量、人血红蛋白（Hb）特异性、免疫化学粪便潜血试验（I-FOBT）可检测出血。AimTo在癌症或晚期腺瘤高危患者的择期结肠镜检查前确定I-FOBT对CRC或AAP的敏感性。（555例CRC家族史，445例既往肿瘤监测），他们在选择性结肠镜检查前准备了三次I-FOBT。I-FOBTs定量为ngHb/mL缓冲液的OC-MICRO仪器和结果>= 50 ngHb/mL被认为positive.ResultsAt结肠镜检查，8例CRC，64人有AAP。CRC和/或AAP的敏感性最高，为65.3%，（95% CI 54.3，76.3），当三种I-FOBT中的任何一种>= 50 ngHb时特异性为87.5%（95% CI 86.4，90.5）识别所有的CRC和62%的AAPs.ConclusionsAll癌症或AAP被检测到每三I-FOBT阳性结肠镜检查（47/154），因此，84.6%（846例患者）此时可能不需要结肠镜检查。I-FOBT筛查可能为高危患者提供有效的监督，延迟不必要的选择性结肠镜检查。这种有利的评价需要风险群体的确认和成本效益研究。
BackgroundCommon reasons for elective screening and surveillance colonoscopy, at predetermined intervals, are family or personal history of colorectal cancer (CRC) or advanced adenoma (AAP). Quantified, human haemoglobin (Hb)-specific, immunochemical faecal occult blood tests (I-FOBT) detect bleeding.AimTo determine I-FOBT sensitivity for CRC or AAP before elective colonoscopy in patients at high-risk of cancer or advanced adenoma.MethodsProspective double-blind study of 1000 ambulatory asymptomatic high-risk patients (555 family history of CRC, 445 surveillance for past neoplasm), who prepared three I-FOBTs before elective colonoscopy. I-FOBTs quantified as ngHb/mL of buffer by OC-MICRO instrument and results >= 50 ngHb/mL considered positive.ResultsAt colonoscopy, eight patients had CRC, 64 others had AAP. Sensitivity for CRC and/or AAP was the highest, 65.3% (95% CI 54.3, 76.3), when any of the three I-FOBTs was >= 50 ngHb (15.4%), with specificity of 87.5% (95% CI 86.4, 90.5) identifying all CRCs and 62% of AAPs.ConclusionsAll cancers or an AAP were detected every third I-FOBT-positive colonoscopy (47/154), so colonoscopy was potentially not needed at this time in 84.6% (846 patients). I-FOBT screening might provide effective supervision of high-risk patients, delaying unnecessary elective colonoscopies. This favourable evaluation needs confirmation and cost-benefit study by risk-group.