结直肠癌初始内镜定位错误时分期腹部计算机断层扫描和重复内镜检查的诊断效用。
Diagnostic utility of staging abdominal computerized tomography and repeat endoscopy in detecting localization errors at initial endoscopy in colorectal cancer.
机构信息
Division of General Surgery, University of Toronto, Toronto, ON, Canada.
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
出版信息
Surg Endosc. 2018 Jul;32(7):3303-3310. doi: 10.1007/s00464-018-6051-1. Epub 2018 Jan 23.
BACKGROUND
Colonoscopy has a reported localization error rate as high as 21% in detecting colorectal neoplasms. Preoperative repeat endoscopy has been shown to be protective against localization errors. There is a paucity of literature assessing the utility of staging computerized tomography (CT) and repeat endoscopy as diagnostic tools for detecting localization errors following initial endoscopy. The objective of this study is to determine the diagnostic characteristics of staging CT and repeat endoscopy in correcting localization errors at initial endoscopy.
METHODS
A retrospective cohort study was conducted at a large tertiary academic center between January 2006 and August 2014. All patients undergoing surgical resection for CRC were identified. Group comparisons were conducted between (1) patients that underwent only staging CT (staging CT group), and (2) patients that underwent staging CT and repeat endoscopy (repeat endoscopy group). The primary outcome was localization error correction rate for errors at initial endoscopy.
RESULTS
594 patients were identified, 196 (33.0%) in the repeat endoscopy group, and 398 (77.0%) patients in the staging CT group. Error rates for each modality were as follows: initial endoscopy 8.8% (95% CI 6.5-11.0), staging CT 9.3% (95% CI 6.5-11.0), and repeat endoscopy 2.6% (95% CI 0.3-4.7); p < 0.01. Repeat endoscopy was superior to staging CT in correcting localization errors for left-sided / rectal lesions (81.2% vs. 33.3%; p < 0.01), right-sided lesions (80.0% vs. 54.5%; p = 0.21), and overall lesions (80.8% vs. 42.3%; p < 0.01). Repeat endoscopy compared to staging CT demonstrated relative risk reduction of 66.7% (95% CI 22-86%), absolute risk reduction of 38.5% (95% CI 14.2-62.8%), and odds ratio of 0.18 (95% CI 0.05-0.61) for correcting errors at initial endoscopy.
CONCLUSIONS
Repeat endoscopy in colorectal cancer is superior to staging CT as a diagnostic tool for correcting localization-based errors at initial endoscopy.
背景
结肠镜检查在检测结直肠肿瘤方面的定位误差率高达 21%。术前重复内镜检查已被证明可以防止定位错误。目前，评估分期计算机断层扫描（CT）和重复内镜检查作为诊断工具用于检测初始内镜检查后定位错误的文献很少。本研究的目的是确定分期 CT 和重复内镜检查在纠正初始内镜检查时定位错误的诊断特征。
方法
本研究为 2006 年 1 月至 2014 年 8 月在一家大型三级学术中心进行的回顾性队列研究。所有接受结直肠癌手术切除的患者均被确定。对仅接受分期 CT 检查的患者（分期 CT 组）和接受分期 CT 和重复内镜检查的患者（重复内镜检查组）进行组间比较。主要结局为初始内镜检查时定位错误的校正率。
结果
共确定了 594 例患者，重复内镜检查组 196 例（33.0%），分期 CT 组 398 例（77.0%）。每种方法的错误率如下：初始内镜检查 8.8%（95%CI 6.5-11.0），分期 CT 9.3%（95%CI 6.5-11.0），重复内镜检查 2.6%（95%CI 0.3-4.7）；p<0.01。重复内镜检查在纠正左侧/直肠病变（81.2%比 33.3%；p<0.01）、右侧病变（80.0%比 54.5%；p=0.21）和整体病变（80.8%比 42.3%；p<0.01）的定位错误方面优于分期 CT。与分期 CT 相比，重复内镜检查的相对风险降低了 66.7%（95%CI 22-86%），绝对风险降低了 38.5%（95%CI 14.2-62.8%），校正初始内镜检查错误的优势比为 0.18（95%CI 0.05-0.61）。
结论
在结直肠癌中，重复内镜检查作为一种诊断工具，优于分期 CT，可纠正初始内镜检查中的基于定位的错误。
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