Jung Yoon Suk, Park Chan Hyuk, Kim Nam Hee, Park Jung Ho, Park Dong Il, Sohn Chong Il
Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
J Gastroenterol Hepatol. 2017 May;32(5):1003-1010. doi: 10.1111/jgh.13634.
To guide selection of optimal screening strategies for advanced colorectal neoplasia (ACRN), we evaluated the screening performances of sigmoidoscopy, fecal immunochemical test (FIT), and the Asia-Pacific Colorectal Screening (APCS) system, as well as combinations of these techniques.
We reviewed the records of participants who had undergone a colonoscopy and FIT as part of a comprehensive health-screening program. Results of sigmoidoscopy were estimated from lesions under colonoscopic examination. The screening strategies were classified as sigmoidoscopy-based, FIT-based, and APCS-based. The sensitivity and reduction of number needed to colonoscope (NNScope) of each screening strategy were assessed.
Of 23 023 participants, 398 (1.7%) had ACRN. To predict the presence of ACRN, sigmoidoscopy was the most effective method (odds ratio [OR]: 22.96, 95% confidence interval [CI]: 18.26-29.07), followed by FIT (OR: 7.18, 95% CI: 5.28-9.68) and APCS (high risk [≥4] OR: 2.59, 95% CI: 1.87-3.58; moderate risk [2-3] OR: 1.66, 95% CI: 1.28-2.17). Regarding sigmoidoscopy-based strategies, "sigmoidoscopy positive alone" and "sigmoidoscopy positive or APCS ≥4" were optimal strategies (reduction of NNScope: 79-86%; sensitivity: 73-78%). In the case of FIT-based strategies, "FIT positive or APCS ≥4" was the optimal strategy (reduction of NNScope: 72%; sensitivity: 37%). With regard to the APCS system only, "APCS ≥2" and "APCS ≥4" were recommended as sensitivity-preferred and reduction in NNScope-preferred strategies, respectively.
The performance in ACRN prediction differs among screening methods (sigmoidoscopy, FIT, and APCS). Among the various single or combined screening strategies, several specific strategies can be chosen depending on medical resources, financial budgets, and screenee preference.
为指导晚期结直肠肿瘤（ACRN）最佳筛查策略的选择，我们评估了乙状结肠镜检查、粪便免疫化学检测（FIT）、亚太结直肠癌筛查（APCS）系统以及这些技术组合的筛查性能。
我们回顾了作为综合健康筛查项目一部分接受结肠镜检查和FIT的参与者的记录。乙状结肠镜检查结果根据结肠镜检查下的病变情况进行估计。筛查策略分为基于乙状结肠镜检查、基于FIT和基于APCS的策略。评估了每种筛查策略的敏感性和结肠镜检查所需人数的减少情况（NNScope）。
在23023名参与者中，398人（1.7%）患有ACRN。为预测ACRN的存在，乙状结肠镜检查是最有效的方法（优势比[OR]：22.96，95%置信区间[CI]：18.26 - 29.07），其次是FIT（OR：7.18，95% CI：5.28 - 9.68）和APCS（高风险[≥4] OR：2.59，95% CI：1.87 - 3.58；中度风险[2 - 3] OR：1.66，95% CI：1.28 - 2.17）。对于基于乙状结肠镜检查的策略，“单纯乙状结肠镜检查阳性”和“乙状结肠镜检查阳性或APCS≥4”是最佳策略（NNScope减少：79 - 86%；敏感性：73 - 78%）。在基于FIT的策略中，“FIT阳性或APCS≥4”是最佳策略（NNScope减少：72%；敏感性：37%）。仅就APCS系统而言，“APCS≥2”和“APCS≥4”分别被推荐为敏感性优先和NNScope减少优先的策略。
不同筛查方法（乙状结肠镜检查、FIT和APCS）在预测ACRN方面的性能存在差异。在各种单一或联合筛查策略中，可以根据医疗资源、财务预算和受检者偏好选择几种特定策略。
