气钡双重造影、计算机断层结肠成像与结肠镜检查的分析：前瞻性比较

Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison.

作者信息

Rockey D C, Paulson E, Niedzwiecki D, Davis W, Bosworth H B, Sanders L, Yee J, Henderson J, Hatten P, Burdick S, Sanyal A, Rubin D T, Sterling M, Akerkar G, Bhutani M S, Binmoeller K, Garvie J, Bini E J, McQuaid K, Foster W L, Thompson W M, Dachman A, Halvorsen R

机构信息

Duke University Medical Center, Durham, NC 27710, USA.

出版信息

Lancet. 2005;365(9456):305-11. doi: 10.1016/S0140-6736(05)17784-8.

DOI:10.1016/S0140-6736(05)17784-8

PMID:15664225

Abstract

BACKGROUND

The usefulness of currently available colon imaging tests, including air contrast barium enema (ACBE), computed tomographic colonography (CTC), and colonoscopy, to detect colon polyps and cancers is uncertain. We aimed to assess the sensitivity of these three imaging tests.

METHODS

Patients with faecal occult blood, haematochezia, iron-deficiency anaemia, or a family history of colon cancer underwent three separate colon-imaging studies--ACBE, followed 7-14 days later by CTC and colonoscopy on the same day. The primary outcome was detection of colonic polyps and cancers. Outcomes were assessed by building an aggregate view of the colon, taking into account results of all three tests.

FINDINGS

614 patients completed all three imaging tests. When analysed on a per-patient basis, for lesions 10 mm or larger in size (n=63), the sensitivity of ACBE was 48% (95% CI 35-61), CTC 59% (46-71, p=0.1083 for CTC vs ACBE), and colonoscopy 98% (91-100, p<0.0001 for colonoscopy vs CTC). For lesions 6-9 mm in size (n=116), sensitivity was 35% for ACBE (27-45), 51% for CTC (41-60, p=0.0080 for CTC vs ACBE), and 99% for colonoscopy (95-100, p<0.0001 for colonoscopy vs CTC). For lesions of 10 mm or larger in size, the specificity was greater for colonoscopy (0.996) than for either ACBE (0.90) or CTC (0.96) and declined for ACBE and CTC when smaller lesions were considered.

INTERPRETATION

Colonoscopy was more sensitive than other tests, as currently undertaken, for detection of colonic polyps and cancers. These data have important implications for diagnostic use of colon imaging tests.

摘要

背景

目前可用的结肠成像检查，包括气钡双重造影灌肠（ACBE）、计算机断层结肠成像（CTC）和结肠镜检查，在检测结肠息肉和癌症方面的有效性尚不确定。我们旨在评估这三种成像检查的敏感性。

方法

有粪便潜血、便血、缺铁性贫血或结肠癌家族史的患者接受三项独立的结肠成像研究——先进行ACBE，7至14天后进行CTC，同一天进行结肠镜检查。主要结局是检测结肠息肉和癌症。通过综合考虑所有三项检查的结果来评估结局。

结果

614例患者完成了所有三项成像检查。按患者个体分析时，对于大小为10毫米或更大的病变（n = 63），ACBE的敏感性为48%（95%可信区间35 - 61），CTC为59%（46 - 71，CTC与ACBE比较，p = 0.1083），结肠镜检查为98%（91 - 100，结肠镜检查与CTC比较，p < 0.0001）。对于大小为6至9毫米的病变（n = 116），ACBE的敏感性为35%（27 - 45），CTC为51%（41 - 60，CTC与ACBE比较，p = 0.0080），结肠镜检查为99%（95 - 100，结肠镜检查与CTC比较，p < 0.0001）。对于大小为10毫米或更大的病变，结肠镜检查的特异性（0.996）高于ACBE（0.90）或CTC（0.96），当考虑较小病变时，ACBE和CTC的特异性下降。