Stephenson J A, Pancholi J, Ivan C V, Mullineux J H, Patel H, Verma R, Elabassy M
Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK.
Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK.
Clin Radiol. 2018 Sep;73(9):836.e1-836.e7. doi: 10.1016/j.crad.2018.05.013. Epub 2018 Jun 30.
To present the initial 12 months of data of a straight-to-test (STT) computed tomography colonography (CTC) protocol as the first-line investigation for change in bowel habit (CIBH) and iron deficiency anaemia (IDA) in patients over 60 referred directly from primary care.
In 12 months, 1,792 STT CTC for IDA and CIBH were performed. No colonoscopies were performed as the primary investigation in this cohort. Data from this cohort were gathered prospectively.
The colorectal cancer (CRC) detection rate was 4.9% and polyp detection rate was 13.5%. The CRC rate increased related to age (p=0.001), the CRC detection rate was 2.6% in patients aged 60-69 years, compared to 4.9%, 7.4%, and 11.4% in the 70-79, 80-89, and >90 years age groups. The CRC rate was higher in patients with IDA compared to CIBH (6.8% versus 3.9%, p=0.017). There were significantly more left-sided cancers (p=0.0165). Non-colonic cancers were found in 4.3% of patients and 6.8% had incidental findings that required further investigation and 11.9% had a new, potentially significant, incidental finding.
These results are comparable to colonoscopy in terms of diagnostic accuracy and similar to those of CTC in published multicentre trials. This exciting model of care within radiology enables earlier testing, reduces waiting times, with fewer outpatient appointments, and results in good clinician and patient satisfaction.
呈现一项直接检测（STT）计算机断层扫描结肠成像（CTC）方案最初12个月的数据，该方案作为直接从初级保健机构转诊的60岁以上患者肠道习惯改变（CIBH）和缺铁性贫血（IDA）的一线检查方法。
在12个月内，对IDA和CIBH患者进行了1792例STT CTC检查。该队列中未将结肠镜检查作为主要检查方法。前瞻性收集了该队列的数据。
结直肠癌（CRC）检出率为4.9%，息肉检出率为13.5%。CRC发生率随年龄增加而升高（p = 0.001），60 - 69岁患者的CRC检出率为2.6%，而70 - 79岁、80 - 89岁和90岁以上年龄组分别为4.9%、7.4%和11.4%。IDA患者的CRC发生率高于CIBH患者（6.8%对3.9%，p = 0.017）。左侧癌症明显更多（p = 0.0165）。4.3%的患者发现了非结肠癌症，6.8%的患者有需要进一步检查的偶然发现，11.9%的患者有新的、可能具有重要意义的偶然发现。
这些结果在诊断准确性方面与结肠镜检查相当，与已发表的多中心试验中CTC的结果相似。这种放射科令人兴奋的护理模式能够更早进行检测，减少等待时间，减少门诊预约次数，并使临床医生和患者满意度良好。
