Screening for colon malignancy with colonoscopy.
Screening for colon malignancy with colonoscopy.
复制标题
通过结肠镜检查筛查结肠恶性肿瘤。
DOI：
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发表时间：
1991
影响因子：
9.8
通讯作者：
F. Smith
中科院分区：
文献类型：
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作者：
D. Lieberman;F. Smith
过去20年来，人们一直主张对无症状个体进行结肠恶性肿瘤筛查，希望降低结肠癌死亡率。虽然乙状结肠镜检查是目前筛查建议的一个重要组成部分，但从未研究过该试验在无症状受试者中的敏感性。本研究的目的是通过进行完整的结肠镜检查来确定无症状人群中息肉和癌症的患病率和位置。我们希望通过确定有多少腺瘤或癌症患者在远端60 cm处有“索引”腺瘤性息肉来评估筛查性乙状结肠镜检查到60 cm的敏感性。105例50岁以上的健康男性门诊患者，粪便潜血检查阴性，既往无结肠病理史，进行了完整的结肠镜检查。仔细检查远端60 cm，然后对盲肠进行全结肠检查。43名患者（41%）有腺瘤性息肉，其中只有19名患者在远端60 cm处有指标腺瘤性息肉。因此，乙状结肠镜检查的敏感性为44%。腺瘤的患病率随着年龄的增长而增加。根据远端60 cm的结果，将患者分配至三组之一。第1组（n = 65）在远端60 cm没有息肉，但其中18例（28%）在近端结肠有腺瘤性息肉。在21例仅远端60 cm增生性息肉的患者（第2组）中，6例患者（29%）有近端腺瘤。在第3组中，19例远端60 cm腺瘤患者中有8例（42%）也有近端腺瘤性息肉。我们的结论是腺瘤性息肉在大便潜血阴性的无症状男性中很常见。在该患者人群中，乙状结肠镜检查至60 cm的敏感性仅为44%，表明这是一种检测腺瘤性息肉患者的不敏感试验。
Screening of asymptomatic individuals for colon malignancy has been advocated for the past 20 yr in the hopes of reducing colon cancer mortality. Although sigmoidoscopy is an important element of current screening recommendations, the sensitivity of this test in asymptomatic subjects has never been studied. The purpose of this study was to determine the prevalence and location of polyps and cancers in an asymptomatic population by performing full colonoscopy. We wished to assess the sensitivity of screening flexible sigmoidoscopy to 60 cm by determining how many patients with adenomas or cancer had "index" adenomatous polyps in the distal 60 cm. One hundred five healthy male outpatients, over 50 yr old, with negative examinations for occult blood in stools and no prior history of colon pathology, had full colonoscopy. Careful examination of the distal 60 cm was performed, followed by a full colon examination to the cecum. Forty-three patients (41%) had adenomatous polyps, and only 19 of these patients had an index adenomatous polyp in the distal 60 cm. Therefore, the sensitivity of sigmoidoscopy was 44%. The prevalence of adenomas increased with age. Patients were assigned to one of three groups based on the findings in the distal 60 cm. Group 1 (n = 65) had no polyps in the distal 60 cm, but 18 of these patients (28%) had adenomatous polyps in the proximal colon. Among 21 patients with only hyperplastic polyps in the distal 60 cm (group 2), six patients (29%) had proximal adenomas. In group 3, eight of 19 patients (42%) with adenomas in the distal 60 cm also had proximal adenomatous polyps. We conclude that adenomatous polyps are common in asymptomatic men who have negative tests for fecal occult blood. Sigmoidoscopy to 60 cm had a sensitivity of only 44% in this patient population, suggesting that this is an insensitive test for the detection of patients with adenomatous polyps.