CT Colonography Versus Optical Colonoscopy for Screening Asymptomatic Patients for Colorectal Cancer: A Patient, Intervention, Comparison, Outcome (PICO) Analysis
CT Colonography Versus Optical Colonoscopy for Screening Asymptomatic Patients for Colorectal Cancer: A Patient, Intervention, Comparison, Outcome (PICO) Analysis
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DOI：
10.1016/j.acra.2009.01.008
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发表时间：
2009-05-01
影响因子：
4.8
通讯作者：
Kielar, Ania Z.
中科院分区：
文献类型：
--
作者：
El-Maraghi, Robert H.;Kielar, Ania Z.
理由和目标。美国放射学会最近批准使用计算机断层扫描结肠成像（CTC）进行结肠癌筛查。随着技术和后处理软件的进步，计算机断层结肠成像研究的质量得到了提高，新技术正在开发，以减少辐射暴露，提高患者对该程序的接受程度。结直肠癌筛查的目的是通过识别和清除症状前病变来降低恶性肿瘤的发生率。本研究的目的是回答临床问题：在结肠癌平均风险的无症状患者中，CTC是否等同于光学结肠镜（OC）检测具有临床意义的息肉？材料和方法。使用患者、干预、比较干预、结局（皮科）检索策略进行了系统性文献综述，以评价CTC与OC的比较。PubMed检索使用医学主题词，包括术语“计算机断层扫描结肠造影”、“结肠镜检查“、“筛查”和“息肉”。检索到的每一篇文章都使用循证医学中心的诊断研究有效性等级来分配一个证据等级。皮科检索标准和摘要审查确定了16项相关研究。使用循证医学中心的效度等级，有三个1c级研究，两个2a级研究，三个2b级研究，四个3b级研究，两个4级研究和两个5级研究。所有相关研究表明，CTC对临床相关息肉（>5 mm）的敏感性和特异性均高于OC。大多数证据表明，CTC是OC的可接受替代方案，特别是在不愿意或不能接受OC的患者组中。美国放射学学院成像网络的大型多中心研究结果尚未公布。该试验于2007年提交了初步结果，表明CTC的敏感性和特异性很高，与OC相当。
Rationale and Objectives. The American College of Radiology has recently endorsed the use of computed tomographic colonography (CTC) for colon cancer screening. With advances in technology and postprocessing software, the quality of computed tomographic colonographic studies has improved, and new techniques are being developed to reduce radiation exposure and increase patient acceptance of the procedure. The aim of colorectal cancer screening is to reduce the incidence of malignancy by identifying and removing presymptomatic lesions. The aim of this study was to answer the clinical question: In an asymptomatic patient at average risk for colon cancer, is CTC equivalent to optical colonoscopy (OC) for detecting clinically significant polyps?Materials and Methods. A systematic literature review was conducted to evaluate CTC compared to OC, using the patient, intervention, comparison intervention, outcome (PICO) search strategy. The PubMed search used Medical Subject Headings, including the terms "computed tomography colonography," "colonoscopy, " "screening," and "polyp." Each of the retrieved articles was assigned a level of evidence using the Centre for Evidence-Based Medicine's hierarchy of validity for diagnostic studies.Results. PICO search criteria and review of abstracts identified 16 relevant studies. Using the Centre for Evidence-Based Medicine's hierarchy of validity, there were three level 1c studies, two level 2a studies, three level 2b studies, four level 3b studies, two level 4 studies, and two level 5 studies. All relevant studies demonstrated that CTC had high or moderately high per patient and per polyp sensitivity and specificity compared to OC for clinically relevant polyps (>5 mm).Conclusions. The majority of evidence suggests that CTC is an acceptable alternative to OC, particularly in the group of patients who are either unwilling or unable to undergo OC. The results of the large, multicenter American College of Radiology Imaging Network study are pending. This trial presented preliminary results in 2007 suggesting that the sensitivity and specificity of CTC are high and comparable to those of OC.