1 Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252.
2 im3D Medical Imaging Laboratory, Turin, Italy.
AJR Am J Roentgenol. 2018 Jul;211(1):25-39. doi: 10.2214/AJR.17.19495. Epub 2018 May 24.
The purpose of this study was to perform a systematic review and meta-analysis of published studies on CT colonography (CTC) in which extracolonic findings were assessed.
A systematic review of studies of screening CTC and of CTC to evaluate symptoms (1994-June 2017) was conducted to estimate the rate of extra-colonic findings and associated additional workup recommendations. The primary outcome was potentially important extracolonic findings, defined as CT Colonography Imaging Reporting and Data System (C-RADS) category E4 or as having high clinical importance (if C-RADS was not used). Secondary outcomes included likely unimportant extracolonic findings (i.e., C-RADS category E3 or similar). Random-effects and meta-regression analyses were used to generate pooled estimates and to explore risk factors for extracolonic findings related to various cohort characteristics.
Primary data were acquired from 44 studies (49,676 patients). The pooled rate of potentially important extracolonic findings was 4.9% (95% CI, 3.7-6.4%) with a high degree of heterogeneity (I = 95%). This estimate progressively declined over time (9% per year since 2006) and was significantly related to the reporting system (lower for C-RADS than for low, moderate, high clinical significance reporting). C-RADS-specific meta-analysis (32,746 patients) showed rates of potentially significant extracolonic findings in 2.8% (95% CI, 1.9-3.5%) of the cohort without symptoms and 5.2% (95% CI, 3.5-7.6%) of the cohort with symptoms and in 5.7% (95% CI, 3.3-9.8%) of seniors (≥ 65 years) versus 2.3% (95% CI, 1.2-4.5%) of those younger than 65 years. The overall pooled rates of recommended workup were 8.2% (95% CI, 6.6-10.1%) for all extracolonic findings and 4.0% (95% CI, 2.7-5.9%) for potentially important extracolonic findings.
With use of the more robust C-RADS classification, potentially important extracolonic findings at CTC occur in less than 3% of cohorts without symptoms. For all extracolonic findings, the rate of suggested or recommended additional workup is approximately 8% but decreases to 4% for potentially important extracolonic findings.
本研究旨在对评估结外发现的已发表 CT 结肠成像（CTC）研究进行系统回顾和荟萃分析。
对 1994 年至 2017 年 6 月进行的筛查 CTC 和 CTC 以评估症状的研究进行了系统回顾，以估计结外发现的发生率和相关的额外检查建议。主要结局是潜在重要的结外发现，定义为 CT 结肠成像报告和数据系统（C-RADS）第 E4 类或具有高临床重要性（如果未使用 C-RADS）。次要结局包括可能不重要的结外发现（即 C-RADS 第 E3 类或类似）。使用随机效应和荟萃回归分析生成汇总估计值，并探讨与各种队列特征相关的结外发现的危险因素。
主要数据来自 44 项研究（49676 例患者）。潜在重要的结外发现的总发生率为 4.9%（95%CI，3.7-6.4%），异质性很高（I = 95%）。这一估计值随着时间的推移逐渐下降（自 2006 年以来每年下降 9%），且与报告系统显著相关（C-RADS 报告的发生率低于低、中、高临床意义报告）。C-RADS 特异性荟萃分析（32746 例患者）显示，无症状队列中潜在有意义的结外发现发生率为 2.8%（95%CI，1.9-3.5%），有症状队列中发生率为 5.2%（95%CI，3.5-7.6%），老年人（≥65 岁）中发生率为 5.7%（95%CI，3.3-9.8%），而<65 岁者发生率为 2.3%（95%CI，1.2-4.5%）。所有结外发现的总体建议检查率为 8.2%（95%CI，6.6-10.1%），潜在重要的结外发现的建议检查率为 4.0%（95%CI，2.7-5.9%）。
使用更稳健的 C-RADS 分类，无症状患者中出现潜在重要的结外发现不到 3%。对于所有结外发现，建议或推荐进一步检查的比例约为 8%，但对于潜在重要的结外发现，这一比例降至 4%。
