"Nuovo Regina Margherita" Hospital, Rome, Italy.
Aliment Pharmacol Ther. 2010 Jan 15;31(2):210-7. doi: 10.1111/j.1365-2036.2009.04160.x. Epub 2009 Oct 8.
The impact of not referring sub-centimetre polyps identified at CT colonography upon the efficacy of colorectal cancer screening remains uncertain.
To determine the distribution of advanced neoplasia according to polyp size in a screening setting.
Published studies reporting the distribution of advanced adenomas in asymptomatic screening cohorts according to polyp size were identified by MEDLINE and EMBASE searches. Predefined outputs were the screening rates of advanced adenomas represented by diminutive (< or =5 mm), small (6-9 mm), sub-centimetre (<10 mm) and large (> or =10 mm) polyp sizes.
Data from four studies with 20 562 screening subjects met the primary inclusion criteria. Advanced adenomas were detected in 1155 (5.6%) subjects (95% CI = 5.3-5.9), corresponding to diminutive, small and large polyps in 4.6% (95% CI = 3.4-5.8), 7.9% (95% CI = 6.3-9.4) and 87.5% (95% CI = 86-89.4) of cases respectively. The frequency of advanced lesions among patients whose largest polyp was diminutive, small, sub-centimetre and large in size was 0.9%, 4.9%, 1.7% and 73.5% respectively.
Based on this systematic review, a 6-mm polyp size threshold for polypectomy referral would identify over 95% of subjects with advanced adenomas, whereas a 10-mm threshold would identify 88% of cases.
CT 结肠成像检查中未检出的亚厘米大小息肉对结直肠癌筛查效果的影响尚不确定。
确定筛查人群中息肉大小与高级别瘤变的分布关系。
通过 MEDLINE 和 EMBASE 检索，确定了报道无症状筛查队列中根据息肉大小分布高级别腺瘤的已发表研究。预设输出为用微小（≤5mm）、小（6-9mm）、亚厘米（＜10mm）和大（≥10mm）息肉大小表示的高级别腺瘤的筛查率。
四项研究的 20562 例筛查对象的数据符合主要纳入标准。在 1155 例（5.6%）受试者中发现了高级别腺瘤（95%CI=5.3-5.9），分别对应于微小、小和大息肉的检出率为 4.6%（95%CI=3.4-5.8）、7.9%（95%CI=6.3-9.4）和 87.5%（95%CI=86-89.4）。最大息肉为微小、小、亚厘米和大的患者中高级病变的频率分别为 0.9%、4.9%、1.7%和 73.5%。
基于这项系统评价，6mm 大小的息肉切除转诊阈值可以发现超过 95%的高级别腺瘤患者，而 10mm 大小的息肉切除转诊阈值可以发现 88%的病例。
