Walleser Silke, Griffiths Alison, Lord Sarah J, Howard Kirsten, Solomon Michael J, Gebski Val
National Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia.
Clin Gastroenterol Hepatol. 2007 Dec;5(12):1439-46; quiz 1368. doi: 10.1016/j.cgh.2007.09.003.
BACKGROUND & AIMS: Computerized tomography colonography (CTC) is a highly accurate test for the detection of colorectal polyps and cancers and has been proposed as a potential alternative to colonoscopy. Bowel cancer screening using fecal occult blood testing (FOBT) and follow-up diagnostic colonoscopy is an effective intervention that currently is being implemented in screening programs internationally. Because of high false-positive rates for FOBT, concerns have been raised about patient uptake and access to colonoscopy services. This study assessed the value of CTC as an alternative to colonoscopy in FOBT-positive individuals.
A systematic review of studies comparing the accuracy of CTC and colonoscopy for the detection of lesions 10 mm or greater and cancers in nonscreening populations was conducted. A modeled economic analysis was undertaken to assess cost per life-year saved.
Five eligible studies were identified. Pooled sensitivity and specificity for the detection of lesions 10 mm or greater were 63% (95% confidence interval [CI], 55%-71%) and 95% (95% CI, 94%-97%) for CTC, and 95% (95% CI, 90%-98%) and 99.8% (95% CI, 99.5%-100%) for colonoscopy, respectively (3 studies). Pooled sensitivity and specificity for the detection of cancer were 89% (95% CI, 70%-98%) and 97% (95% CI, 95%-98%) for CTC, and 96% (95% CI, 80%-100%) and 99.7% (95% CI, 99%-100%) for colonoscopy, respectively (3 studies). The base case economic analysis showed that CTC is less effective and more costly than colonoscopy. At a low prevalence of polyps, sensitivity analysis found CTC was less effective and less costly than colonoscopy; if CTC was more sensitive than colonoscopy, CTC was more effective, at higher cost.
Overall, CTC appears less accurate, less effective, and potentially more costly than colonoscopy in individuals with a positive FOBT.
计算机断层结肠成像（CTC）是一种用于检测结直肠息肉和癌症的高度准确的检查方法，已被提议作为结肠镜检查的一种潜在替代方法。使用粪便潜血试验（FOBT）进行肠癌筛查并后续进行诊断性结肠镜检查是一种有效的干预措施，目前正在国际筛查项目中实施。由于FOBT的假阳性率较高，人们对患者接受结肠镜检查服务的情况和可及性提出了担忧。本研究评估了CTC作为FOBT阳性个体结肠镜检查替代方法的价值。
对比较CTC和结肠镜检查在非筛查人群中检测10毫米及以上病变和癌症准确性的研究进行系统评价。进行了模型化经济分析以评估每挽救一个生命年的成本。
确定了5项符合条件的研究。对于检测10毫米及以上病变，CTC的合并敏感度和特异度分别为63%（95%置信区间[CI]，55%-71%）和95%（95%CI，94%-97%），结肠镜检查分别为95%（95%CI，90%-98%）和99.8%（95%CI，99.5%-100%）（3项研究）。对于检测癌症，CTC的合并敏感度和特异度分别为89%（95%CI，70%-98%）和97%（95%CI，95%-98%），结肠镜检查分别为96%（95%CI，80%-100%）和99.7%（95%CI，99%-100%）（3项研究）。基础病例经济分析表明，CTC比结肠镜检查效果更差且成本更高。在息肉低患病率情况下，敏感度分析发现CTC比结肠镜检查效果更差但成本更低；如果CTC比结肠镜检查更敏感，那么CTC效果更好，但成本更高。
总体而言，对于FOBT阳性个体，CTC似乎比结肠镜检查准确性更低、效果更差且可能成本更高。
