Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population
Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population
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DOI：
10.1136/gut.2008.156448
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发表时间：
2009-02-01
期刊：
影响因子：
24.5
通讯作者：
Kolligs, F. T.
中科院分区：
文献类型：
--
作者：
Graser, A.;Stieber, P.;Kolligs, F. T.
背景与目的：本前瞻性研究旨在比较CT结肠造影术(CTC)、结肠镜(OC)、乙状结肠镜(FS)、粪便免疫化学检测(FIT)和粪便潜血检测(FOBT)五种不同筛查方法在诊断晚期结肠癌中的表现特点。方法：普通风险成人提供FOBT和FIT的粪便标本，以节段性非盲法OC为参考标准进行当日低剂量多层螺旋CT和OC检查。计算了每种单项试验以及FS和大便联合试验的灵敏度和特异度。结果：在完成CTC(平均辐射剂量，4.5mSv)和OC的307名受试者中，共检出221个腺瘤；269名患者提供了FOBT和FIT的粪便样本。OC、CTC、FS、FIT和FOBT诊断晚期结肠癌的敏感性分别为100%(95%CI 88.4%~100%)、96.7%(82.8%~99.9%)、83.3%(95%CI 65.3%~94.4%)、32%(95%CI 14.9%~53.5)和20%(95%CI 6.8%~40.7%)。FS与FOBT或FIT联合应用不会导致敏感度的相应增加。45例晚期腺瘤中12例小于10 mm。46%的患者倾向于CTC，37%的患者倾向于OC(p<；0.001)。结论：高分辨率和低剂量的CTC用于结直肠癌筛查是可行的，对息肉5 mm的敏感性可与OC相媲美。对于拒绝全肠道准备和OC或CTC的患者，FS应优先于大便检查。然而，在进行粪便测试的情况下，建议使用FIT而不是FOBT。
Background and aims: This prospective trial was designed to compare the performance characteristics of five different screening tests in parallel for the detection of advanced colonic neoplasia: CT colonography (CTC), colonoscopy (OC), flexible sigmoidoscopy (FS), faecal immunochemical stool testing (FIT) and faecal occult blood testing (FOBT).Methods: Average risk adults provided stool specimens for FOBT and FIT, and underwent same-day low-dose 64-multidetector row CTC and OC using segmentally unblinded OC as the standard of reference. Sensitivities and specificities were calculated for each single test, and for combinations of FS and stool tests. CTC radiation exposure was measured, and patient comfort levels and preferences were assessed by questionnaire.Results: 221 adenomas were detected in 307 subjects who completed CTC (mean radiation dose, 4.5 mSv) and OC; 269 patients provided stool samples for both FOBT and FIT. Sensitivities of OC, CTC, FS, FIT and FOBT for advanced colonic neoplasia were 100% (95% CI 88.4% to 100%), 96.7% (82.8% to 99.9%), 83.3% (95% CI 65.3% to 94.4%), 32% (95% CI 14.9% to 53.5) and 20% (95% CI 6.8% to 40.7%), respectively. Combination of FS with FOBT or FIT led to no relevant increase in sensitivity. 12 of 45 advanced adenomas were smaller than 10 mm. 46% of patients preferred CTC and 37% preferred OC (p < 0.001).Conclusions: High-resolution and low-dose CTC is feasible for colorectal cancer screening and reaches sensitivities comparable with OC for polyps >5 mm. For patients who refuse full bowel preparation and OC or CTC, FS should be preferred over stool tests. However, in cases where stool tests are performed, FIT should be recommended rather than FOBT.