Park Seong Ho, Choi Eugene K, Lee Seung Soo, Byeon Jeong-Sik, Jo Ji-Yun, Kim Young Hoon, Lee Kyoung Ho, Ha Hyun Kwon, Han Joon Koo
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Radiology. 2007 Jul;244(1):157-64. doi: 10.1148/radiol.2441060794. Epub 2007 May 16.
To prospectively evaluate the reliability and accuracy of optical colonoscopy and computed tomographic (CT) colonography in polyp measurement, by using direct measurement as the reference standard, and to understand the basis for measurement discrepancy between both modalities.
Eighty-six simulated polyps that ranged from 3 to 15 mm were constructed by using pig colons obtained from an abattoir. Approval of the animal care and use committee for the study was not required. CT colonographic measurement was performed by two independent radiologists by using two-dimensional (2D) optimized multiplanar reformatted planes and three-dimensional (3D) endoluminal views. Optical colonoscopic measurement was performed by two independent gastroenterologists by using open biopsy forceps. Interobserver agreement, measurement error, measurement discrepancy defined as the result of subtracting the optical colonoscopic measurement from the CT colonographic measurement, and false-mismatch (ie, designation of matched polyps as mismatched between both modalities) rates according to different matching criteria were analyzed.
Intraclass correlation coefficients were 0.879 (95% confidence interval: 0.780, 0.930) for optical colonoscopy, 0.979 (95% confidence interval: 0.956, 0.989) for 2D CT colonography, and 0.985 (95% confidence interval: 0.976, 0.990) for 3D CT colonography. The mean standardized polyp size +/- standard deviation for each observer was 76.3% +/- 14.7 and 85.3% +/- 18.8 for optical colonoscopy, 104.6% +/- 11.6 and 101.6% +/- 10.1 for 2D CT colonography, and 114% +/- 12.4 and 113.4% +/- 13.2 for 3D CT colonography. These values indicated that there was a statistically significant difference among the methods (P<.001). Measurement discrepancy was not proportional to polyp size. A percentage-of-error criterion showed increasing false-mismatch rates with decreasing polyp size, whereas a fixed margin-of-error criterion resulted in more uniform false-mismatch rates across polyp size.
CT colonography is more reliable and accurate than optical colonoscopy for polyp measurement. A fixed margin-of-error criterion is better than a percentage-of-error criterion for polyp matching between CT colonography and optical colonoscopy with open biopsy forceps.
以前瞻性方式，以直接测量作为参考标准，评估光学结肠镜检查和计算机断层扫描（CT）结肠成像在息肉测量方面的可靠性和准确性，并了解两种检查方式测量差异的原因。
使用从屠宰场获取的猪结肠构建86个大小在3至15毫米之间的模拟息肉。本研究无需动物护理和使用委员会的批准。由两名独立的放射科医生使用二维（2D）优化多平面重组平面和三维（3D）腔内视图进行CT结肠成像测量。由两名独立的胃肠病学家使用开放式活检钳进行光学结肠镜检查测量。分析了观察者间的一致性、测量误差、将CT结肠成像测量结果减去光学结肠镜检查测量结果所得的测量差异，以及根据不同匹配标准的假不匹配（即两种检查方式将匹配的息肉判定为不匹配）率。
光学结肠镜检查的组内相关系数为0.879（95%置信区间：0.780，0.930），2D CT结肠成像为0.979（95%置信区间：0.956，0.989），3D CT结肠成像为0.985（95%置信区间：0.976，0.990）。每位观察者的息肉平均标准化大小±标准差，光学结肠镜检查分别为76.3%±14.7和85.3%±18.8，2D CT结肠成像分别为104.6%±11.6和101.6%±10.1，3D CT结肠成像分别为114%±12.4和113.4%±13.2。这些值表明不同方法之间存在统计学显著差异（P<0.001）。测量差异与息肉大小不成比例。误差百分比标准显示，息肉尺寸越小，假不匹配率越高，而固定误差范围标准在不同息肉大小下导致的假不匹配率更为均匀。
在息肉测量方面，CT结肠成像比光学结肠镜检查更可靠、更准确。对于使用开放式活检钳的CT结肠成像和光学结肠镜检查之间的息肉匹配，固定误差范围标准优于误差百分比标准。
