Sali Lapo, Grazzini Grazia, Mascalchi Mario
Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, 50134, Florence, Italy.
Cancer Prevention and Research Institute (ISPO), Via Cosimo il Vecchio 2, 50139, Florence, Italy.
Clin J Gastroenterol. 2017 Aug;10(4):312-319. doi: 10.1007/s12328-017-0744-1. Epub 2017 Apr 26.
Computed tomographic colonography (CTC) is a minimally invasive imaging examination for the colon, and is safe, well tolerated and accurate for the detection of colorectal cancer (CRC) and advanced adenoma. While the role of CTC as a primary test for population screening of CRC is under investigation, the fecal occult blood test (FOBT) has been recommended for population screening of CRC in Europe. Subjects with positive FOBT are invited to undergo total colonoscopy, which has some critical issues, such as suboptimal compliance, contraindications and the possibility of an incomplete exploration of the colon. Based on available data, the integration of CTC in FOBT-based population screening programs for CRC may fall into three scenarios. First, CTC is recommended in FOBT-positive subjects when colonoscopy is refused, incomplete or contraindicated. For these indications CTC should replace double-contrast barium enema. Second, conversely, CTC is not currently recommended as a second-level examination prior to colonoscopy in all FOBT-positive subjects, as this strategy is most probably not cost-effective. Finally, CTC may be considered instead of colonoscopy for surveillance after adenoma removal, but specific studies are needed.
计算机断层结肠成像（CTC）是一种用于结肠的微创成像检查，对于检测结直肠癌（CRC）和高级别腺瘤安全、耐受性良好且准确。虽然CTC作为CRC人群筛查的主要检查方法的作用正在研究中，但在欧洲，粪便潜血试验（FOBT）已被推荐用于CRC的人群筛查。FOBT呈阳性的受试者会被邀请接受全结肠镜检查，而全结肠镜检查存在一些关键问题，如依从性欠佳、有禁忌证以及结肠检查可能不完整。基于现有数据，将CTC纳入基于FOBT的CRC人群筛查项目可能有三种情况。首先，当结肠镜检查被拒绝、不完整或有禁忌证时，推荐对FOBT阳性的受试者进行CTC检查。对于这些适应证，CTC应替代双重对比钡灌肠。其次，相反地，目前不建议对所有FOBT阳性的受试者在结肠镜检查前进行CTC二级检查，因为这种策略很可能不具有成本效益。最后，对于腺瘤切除后的监测，可以考虑用CTC替代结肠镜检查，但需要进行具体研究。
