非泻剂 CT 结肠成像用于筛查结直肠癌家族史患者的结直肠肿瘤。
Noncathartic CT colonography to screen for colorectal neoplasia in subjects with a family history of colorectal cancer.
机构信息
From the Humanitas Clinical and Research Center (L.F., L.L., A.P., L.B., A.M.) and Digestive Endoscopy Unit (N.P., A.R.), Istituto Clinico Humanitas, Milan, Italy; Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Via Morosini 30, Rome 00153, Italy (C.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.); and Department of Medical Biotechnology and Translational Medicine, University of Milan, Italy (A.M.).
出版信息
Radiology. 2014 Mar;270(3):784-90. doi: 10.1148/radiol.13130373. Epub 2013 Nov 22.
PURPOSE
To prospectively assess the diagnostic performance of noncathartic computed tomographic (CT) colonography in the detection of clinically relevant colorectal lesions (≥6 mm polyps or masses) in a well-defined cohort of first-degree relatives of patients with colorectal cancer (CRC), using colonoscopy and histologic review as the standard of reference.
MATERIALS AND METHODS
Institutional review board approval was obtained, and all subjects provided written informed consent. Consecutive patients admitted with CRC (index cases) were prospectively evaluated, and those who agreed to contact their first-degree relatives who were at least 40 years old were included. Available first-degree relatives were invited to undergo noncathartic CT colonography (200 mL of diatrizoate meglumine and diatrizoate sodium). Colonoscopy was performed the following day, and findings from CT colonography were disclosed for each segment. Sensitivity, specificity, and positive and negative predictive values of CT colonography were assessed for detecting subjects with any lesion at least 6 mm, any lesion at least 10 mm, and advanced neoplasia at least 6 mm. Colonoscopy with segmental unblinding and histologic diagnosis were used as the standard of reference. Matching between findings from CT colonography and colonoscopy was allowed when lesions were located in the same or adjacent colon segments and when the size difference was 50% or less.
RESULTS
Three hundred four first-degree relatives (median age, 47 years; age range, 40-79 years; 46.7% women) identified from 221 index cases were included. Overall, CT colonography helped identify 17 of 22 subjects with polyps measuring at least 6 mm (sensitivity, 0.77; 95% confidence interval [CI]: 0.59, 0.95) and helped correctly classify as negative 278 of 282 subjects without lesions measuring at least 6 mm (specificity, 0.99; 95% CI: 0.97, 1.00). CT colonography helped detect eight of nine subjects with polyps measuring at least 10 mm as well as eight of nine subjects with advanced neoplasia measuring at least 6 mm (sensitivity, 0.89 for both). Per-subject positive and negative predictive values for lesions measuring at least 6 mm were 0.81 (17 of 21 subjects; 95% CI: 0.65, 0.97) and 0.98 (282 of 287 subjects; 95% CI: 0.96, 0.99), respectively.
CONCLUSION
Noncathartic CT colonography is an effective screening method in first-degree relatives of patients with CRC.
目的
前瞻性评估非肠道准备 CT 结肠成像在检测结直肠癌（CRC）患者一级亲属中临床相关结直肠病变（≥6mm 息肉或肿块）的诊断性能，以结肠镜检查和组织学检查为参考标准。
材料与方法
获得机构审查委员会批准，所有患者均提供书面知情同意书。连续评估因 CRC 入院的患者（索引病例），并纳入同意联系至少 40 岁一级亲属的患者。邀请所有可及的一级亲属进行非肠道准备 CT 结肠成像（200mL 泛影葡胺和泛影酸钠）。次日行结肠镜检查，对 CT 结肠成像的每一段进行检查。评估 CT 结肠成像检测任何 6mm 以上、任何 10mm 以上及进展性肿瘤≥6mm 病变的敏感性、特异性、阳性预测值和阴性预测值。使用分段盲法结肠镜检查和组织学诊断作为参考标准。当病变位于同一或相邻结肠段，且大小差异小于或等于 50%时，允许 CT 结肠成像与结肠镜检查结果相匹配。
结果
从 221 例索引病例中发现 304 名一级亲属（中位年龄 47 岁；年龄范围 40-79 岁；46.7%为女性）。总体而言，CT 结肠成像帮助确定了 22 名至少 6mm 息肉患者中的 17 名（敏感性为 0.77；95%置信区间：0.59-0.95），正确分类了 282 名无至少 6mm 病变的患者中的 278 名（特异性为 0.99；95%置信区间：0.97-1.00）。CT 结肠成像还帮助发现了 9 名至少 10mm 息肉患者中的 8 名和 9 名至少 6mm 进展性肿瘤患者中的 8 名（敏感性均为 0.89）。每例患者至少 6mm 病变的阳性和阴性预测值分别为 0.81（21 名患者中的 17 名；95%置信区间：0.65-0.97）和 0.98（287 名患者中的 282 名；95%置信区间：0.96-0.99）。
结论
非肠道准备 CT 结肠成像对结直肠癌患者一级亲属是一种有效的筛查方法。
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