Gastroenterology Service, Walter Reed Army Medical Center, 6900 Georgia Ave., Washington, DC 20307, USA.
AJR Am J Roentgenol. 2010 Sep;195(3):677-86. doi: 10.2214/AJR.09.3779.
The purpose of this study is to evaluate the impact of extracolonic findings when screening is undertaken by CT colonography (CTC).
We performed a retrospective cohort study of patients completing a screening CTC from August 2003 to June 2006 at Walter Reed Army Medical Center. Extracolonic findings were categorized using a CTC reporting and data system that classifies findings as highly significant, likely significant, and insignificant. All final diagnoses, surgeries, malignancies, and costs of diagnostic radiology procedures were calculated for each category.
Of 2,277 patients (mean +/- SD age, 59 +/- 11 years; 60% white; 56% male) undergoing CTC, extracolonic findings were identified in 1,037 (46%) patients, with 787 (34.5%) insignificant and 240 (11.0%) significant findings. Evaluation of significant findings generated 280 radiology procedures and 19 surgeries over a mean follow-up time of 19 +/- 10 months. The total cost of the radiology studies was $113,179; the studies added approximately $50 extra per patient. Seven high-risk lesions were identified (six extracolonic malignancies and one large aortic aneurysm) in patients with significant findings. CTC also identified six intracolonic malignancies and three adenomas with high-grade dysplasia. When considering extracolonic findings, CTC increased the odds of identifying high-risk lesions by 78% (nine intracolonic lesions vs 16 intracolonic plus extracolonic lesions; p = 0.0156). Of the 16 intracolonic and extracolonic high-risk lesions, 11 (69%) underwent curative resection, and 5 of 11 (44.4%) were extracolonic.
CTC increased the odds of identifying high-risk lesions by 78%. CTC should be considered as an alternative to optical colonoscopy for colorectal cancer screening or as a onetime procedure to identify significant treatable intracolonic and extracolonic lesions.
本研究旨在评估 CT 结肠成像（CTC）筛查时结肠外表现的影响。
我们对 2003 年 8 月至 2006 年 6 月在 Walter Reed 陆军医疗中心完成 CTC 筛查的患者进行了回顾性队列研究。使用一种 CTC 报告和数据系统对结肠外表现进行分类，该系统将表现分为高度显著、可能显著和无显著意义。为每个类别计算了所有最终诊断、手术、恶性肿瘤和诊断性放射学程序的费用。
在 2277 例（平均年龄 +/- SD，59 +/- 11 岁；60%为白人；56%为男性）接受 CTC 的患者中，1037 例（46%）患者发现了结肠外表现，其中 787 例（34.5%）为无显著意义表现，240 例（11.0%）为有显著意义表现。对有显著意义表现的评估产生了 280 次放射学检查和 19 次手术，平均随访时间为 19 +/- 10 个月。放射学研究的总费用为 113179 美元；每位患者额外增加约 50 美元。在有显著意义表现的患者中发现了 7 个高危病变（6 个结肠外恶性肿瘤和 1 个大主动脉瘤）。CTC 还发现了 6 个结肠内恶性肿瘤和 3 个高级别异型增生的腺瘤。考虑到结肠外表现，CTC 使识别高危病变的可能性增加了 78%（9 个结肠内病变与 16 个结肠内加结肠外病变；p = 0.0156）。在 16 个结肠内和结肠外高危病变中，11 个（69%）接受了根治性切除，11 个中有 5 个（44.4%）为结肠外病变。
CTC 使识别高危病变的可能性增加了 78%。CTC 应被视为结直肠癌筛查的光学结肠镜检查的替代方法，或作为一次性识别有意义的可治疗性结肠内和结肠外病变的方法。
