Layer G, Riemann J F
Zentralinstitut für Diagnostische und Interventionelle Radiologie, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Deutschland,
Radiologe. 2013 Sep;53(9):775-82. doi: 10.1007/s00117-012-2445-6.
Colorectal cancer (CRC) is responsible for 27,000 deaths and 65,000 new cancers in Germany each year, although this should be unnecessary as CRC is preventable because it is possible to remove the precursors, harmless polyps and adenomas. However, only 2.5 % of people in health insurance make use of screening colonoscopy annually so that it becomes necessary to check out other screening tests. The most commonly used test is the Guaiak-based test for fecal occult blood (gFOBT) which is highly specific but not very sensitive (only approximately 10 %). New immunological stool tests are more sensitive but the specificity is reduced from 90 % to approximately 80 %. Virtual colonoscopy based on computed tomography (CT) or magnetic resonance imaging (MRI) is comparable to endoscopy for diagnostics with overall accuracy rates of approximately 80-90 % for polyps larger than 5 mm but for radiation protection reasons CT is not usable in Germany and MRI is internationally not adequately established by large study trials. For the future there is much hope in molecular blood tests. It is of great importance that every physician is aware of the different tests, their strengths and weaknesses and advises all patients to use the different screening possibilities.
在德国，结直肠癌（CRC）每年导致27000人死亡，新增65000例癌症病例，尽管这其实本可避免，因为CRC是可预防的，因为可以切除其癌前病变，即无害的息肉和腺瘤。然而，只有2.5%参加医保的人每年进行结肠镜筛查，因此有必要研究其他筛查测试。最常用的测试是基于愈创木脂的粪便潜血试验（gFOBT），其特异性很高，但灵敏度不高（仅约10%）。新的免疫粪便检测灵敏度更高，但特异性从90%降至约80%。基于计算机断层扫描（CT）或磁共振成像（MRI）的虚拟结肠镜检查在诊断方面与内镜检查相当，对于大于5毫米的息肉，总体准确率约为80 - 90%，但出于辐射防护的原因，CT在德国不可用，而且在国际上，MRI尚未通过大型研究试验得到充分验证。未来，分子血液检测大有希望。至关重要的是，每位医生都要了解不同的检测方法及其优缺点，并建议所有患者利用各种筛查可能性。
