采用高敏免疫化学粪便隐血试验筛查家族性结直肠癌：一项初步研究。
Screening for familial colorectal cancer with a sensitive immunochemical fecal occult blood test: a pilot study.
机构信息
Department of Gastroenterology, University Hospital of Canary Islands, La Laguna, Tenerife, Spain.
出版信息
Eur J Gastroenterol Hepatol. 2009 Sep;21(9):1062-7. doi: 10.1097/MEG.0b013e3283293797.
OBJECTIVE
Colonoscopy is empirically recommended as the first choice screening strategy in first-degree relatives of patients with colorectal cancer (CRC). However, this strategy is accepted by less than 40% of the risk population and two-thirds of screened individuals and renders a normal exploration. This pilot study assessed the accuracy of a latex agglutination immunochemical fecal occult blood test (LA-FOBT) for detecting advanced colorectal neoplasm (cancer or adenomatous polyps > or =1 cm in size, with villous pattern or high grade dysplasia) in asymptomatic first-degree relatives of patients with CRC.
METHODS
One hundred and sixty-nine first-degree relatives of 135 index cases were prospectively included. All participants received a sensitive LA-FOBT (hemoglobin detection limit of 50 ng/ml buffer), and were invited to undergo colonoscopy. On the whole, 116 (69%) participants returned LA-FOBT and underwent colonoscopy.
RESULTS
LA-FOBT was positive in 19 of 116 (16%) cases. Colonoscopy detected neoplasms in 49 of 116 (42%) patients: 37 of 116 (32%) were nonadvanced adenomas and 12 of 116 (10%) advanced adenomas. LA-FOBT detected 10 of 12 (83%) advanced adenomas showing a sensitivity, specificity, positive predictive value, and negative predictive value of 83, 91, 53, and 98%, respectively. In patients with positive LA-FOBT, 1.9 colonoscopies were necessary for detecting one advanced adenoma, whereas in case of not performing this test 10 colonoscopies would be needed. Overall, approximately 80% of screening colonoscopies could be precluded using a LA-FOBT.
CONCLUSION
One-time screening with LA-FOBT successfully detects advanced colorectal adenomas and may save unnecessary colonoscopies in first-degree relatives of patients with CRC.
目的
结肠镜检查被经验性地推荐作为结直肠癌（CRC）患者一级亲属的首选筛查策略。然而，这种策略被不到 40%的风险人群和三分之二的筛查者所接受，且其检查结果为正常。本研究旨在评估乳胶凝集免疫化学粪便潜血试验（LA-FOBT）检测无症状结直肠癌患者一级亲属中结直肠进展性肿瘤（癌症或腺瘤性息肉≥1cm 大小，伴有绒毛状或高级别异型增生）的准确性。
方法
前瞻性纳入 135 例 CRC 患者的 169 名一级亲属。所有参与者均接受高敏感 LA-FOBT（血红蛋白检测限为 50ng/ml 缓冲液）检测，并被邀请行结肠镜检查。共有 116 名（69%）参与者进行了 LA-FOBT 检测并接受了结肠镜检查。
结果
LA-FOBT 在 116 例中有 19 例（16%）呈阳性。结肠镜检查在 116 例中发现了 49 例肿瘤：116 例中有 37 例（32%）为非进展性腺瘤，12 例（10%）为进展性腺瘤。LA-FOBT 检测到 12 例（83%）进展性腺瘤，其敏感性、特异性、阳性预测值和阴性预测值分别为 83%、91%、53%和 98%。在 LA-FOBT 阳性的患者中，检测到一个进展性腺瘤需要进行 1.9 次结肠镜检查，而如果不进行该检查，则需要进行 10 次结肠镜检查。总体而言，使用 LA-FOBT 可排除约 80%的筛查性结肠镜检查。
结论
LA-FOBT 一次性筛查可成功检测结直肠进展性腺瘤，可减少结直肠癌患者一级亲属不必要的结肠镜检查。
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