Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252, USA.
Radiology. 2011 May;259(2):429-34. doi: 10.1148/radiol.11101702. Epub 2011 Feb 25.
To estimate the relative yield of therapeutic flexible sigmoidoscopy compared with complete optical colonoscopy for isolated left-sided polyps (≥6 mm in diameter) identified at screening computed tomographic (CT) colonography.
This retrospective institutional review board-approved and HIPAA-compliant study included a review of CT colonographic screening results in 6570 consecutive asymptomatic adults (3551 women, 3019 men; mean age, 56.8 years ± 7.3 [standard deviation]). Of 887 (13.5%) patients with cases positive for nondiminutive polyps (≥6 mm), a subset of 171 patients met the inclusion criteria (a) of having left-sided-only lesions of 6 mm or larger identified at CT colonography (rectum-to-splenic flexure) and (b) of undergoing subsequent evaluation with complete optical colonoscopy. CT colonography-optical colonoscopy concordance and proximal-versus-distal diagnostic yield at optical colonoscopy were assessed. The 95% confidence intervals (CIs) were calculated for relevant results.
From the study group of 171 patients, a total of 234 left-sided lesions of 6 mm or larger were prospectively reported at CT colonography, of which 222 (94.9%; 95% CI: 91.3%, 97.0%) were confirmed as true-positive findings at optical colonoscopy. With optical colonoscopy, an additional 17 benign left-sided polyps of 6 mm or larger (13 small, four large) were found in 11 patients, resulting in a total left-sided yield of 239 nondiminutive lesions, including 137 small polyps (6-9 mm) and 102 large lesions (≥10 mm), 160 neoplasms, 82 advanced adenomas, and seven cancers. Evaluation of the colon proximal to the splenic flexure in this cohort yielded eight small and two large benign polyps in nine patients but no proximal cancers or histologically advanced lesions.
For patients with left-sided-only polyps detected at CT colonography, the additional yield of complete optical colonoscopy beyond the expected reach of flexible sigmoidoscopy is very low and may not justify the added costs, potential risks, and procedural time.
评估治疗性软性乙状结肠镜相对于全结肠镜对单独左半结肠息肉（直径≥6mm）的相对检出率，这些息肉是在筛查用计算机断层（CT）结肠成像术（CTC）中发现的。
本研究为回顾性机构审查委员会批准并符合 HIPAA 规定的研究，纳入了 6570 例连续无症状成年人（3551 名女性，3019 名男性；平均年龄 56.8 岁±7.3[标准差]）的 CTC 筛查结果。887 例（13.5%）非小息肉（≥6mm）患者中，有 171 例患者符合以下纳入标准：（a）CT 结肠成像术（直肠至脾曲）发现仅左侧直径≥6mm 的病变；（b）随后进行全结肠镜检查。评估了 CTC-结肠镜检查的一致性以及结肠镜检查的近端-远端诊断检出率。计算了相关结果的 95%置信区间（CI）。
在 171 例患者的研究组中，共有 234 例左半结肠直径≥6mm 的病变在 CTC 结肠成像术上被前瞻性报告，其中 222 例（94.9%；95%CI：91.3%，97.0%）在结肠镜检查中被确认为阳性发现。结肠镜检查还在 11 例患者中发现了 17 例直径≥6mm 的左半结肠良性息肉（13 例小息肉，4 例大息肉），导致左半结肠病变的总检出率为 239 例非小息肉，包括 137 例小息肉（6-9mm）和 102 例大息肉（≥10mm）、160 个肿瘤、82 个高级别腺瘤和 7 例癌症。对这组患者脾曲近端结肠的评估发现，9 例患者中有 8 个小息肉和 2 个大息肉为良性，但没有近端癌症或组织学上的高级别病变。
对于在 CTC 结肠成像术上发现的仅左半结肠息肉患者，全结肠镜检查的额外检出率远低于软性乙状结肠镜检查，可能无法证明增加的成本、潜在风险和操作时间是合理的。
