Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands Department of Radiology, University Medical Center, Utrecht, The Netherlands.
Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA.
Gut. 2015 Feb;64(2):342-50. doi: 10.1136/gutjnl-2014-308696. Epub 2014 Dec 2.
Colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-related deaths in Europe. The introduction of CRC screening programmes using stool tests and flexible sigmoidoscopy, have been shown to reduce CRC-related mortality substantially. In several European countries, population-based CRC screening programmes are ongoing or being rolled out. Stool tests like faecal occult blood testing are non-invasive and simple to perform, but are primarily designed to detect early invasive cancer. More invasive tests like colonoscopy and CT colonography (CTC) aim at accurately detecting both CRC and cancer precursors, thus providing for cancer prevention. This review focuses on the accuracy, acceptance and safety of CTC as a CRC screening technique and on the current position of CTC in organised population screening. Based on the detection characteristics and acceptability of CTC screening, it might be a viable screening test. The potential disadvantage of radiation exposure is probably overemphasised, especially with newer technology. At this time-point, it is not entirely clear whether the detection of extracolonic findings at CTC is of net benefit and is cost effective, but with responsible handling, this may be the case. Future efforts will seek to further improve the technique, refine appropriate diagnostic algorithms and study cost-effectiveness.
结直肠癌（CRC）是欧洲第二常见的癌症和第二大癌症相关死亡原因。使用粪便检查和乙状结肠镜检查的 CRC 筛查计划的引入，已被证明可大大降低 CRC 相关死亡率。在几个欧洲国家，基于人群的 CRC 筛查计划正在进行或正在推出。粪便检查（如粪便潜血检查）是非侵入性的，操作简单，但主要用于检测早期侵袭性癌症。更具侵入性的检查（如结肠镜检查和 CT 结肠成像）旨在准确检测 CRC 和癌前病变，从而实现癌症预防。这篇综述重点介绍 CTC 作为 CRC 筛查技术的准确性、可接受性和安全性，以及 CTC 在有组织的人群筛查中的现状。基于 CTC 筛查的检测特征和可接受性，它可能是一种可行的筛查测试。对辐射暴露的潜在不利影响可能被过分强调了，尤其是对于新技术而言。在这个时间点，尚不清楚 CTC 检测到的结外病变是否具有净收益且具有成本效益，但如果负责任地处理，可能就是这种情况。未来的研究将致力于进一步改进该技术、完善适当的诊断算法并研究成本效益。
