コンピュータトモグラフィによる結腸内視鏡検査 (仮想結腸内視鏡検査):大腸直腸新生病の検出のための標準結腸内視鏡検査とマルチセンター比較
Peter B Cotton1, Valerie L Durkalski, Benoit C Pineau
1Department of Gastroenterology, The Digestive Disease Center, Medical University of South Carolina, Charleston 29425, USA. cottonp@musc.edu
JAMA
|April 15, 2004
まとめ
コンピュータートモグラフィー・コロノグラフィー (CTC) は,大腸直腸病変の検出において,従来のコロノスコピーよりも低い精度を示した. 臨床使用には,CTCの技術と訓練のさらなる改善が必要である.
科学分野:
- メディカルイマージング (医学イメージング)
- 胃腸内科 胃腸内科
- 腫瘍学 腫瘍学
背景:
- 従来の結腸鏡検査は結腸直腸癌の検出の標準ですが,侵襲的です.
- コンピュータートモグラフィック・コロノグラフィー (CTC) またはバーチャル・コロノスコーピーは,専門医センターで有望な結果を示しています.
- 複数のセンターでのCTCの精度を評価することは,そのより広範な適用のために不可欠です.
研究 の 目的:
- 従来の結腸鏡検査と比較して,CTCの診断精度を評価する.
- 大規模でマルチセンターのコホートで結腸直腸腫瘍の検出におけるCTCの有効性を決定する.
- 病変検出率や参加者の好みなど,二次的アウトカムを評価する.
主な方法:
- 50歳以上の615人の参加者を対象とした非ランダム化,評価者盲検の非劣等性研究です.
- CTCは,標準コロノスコーピーの直前,マルチスライススキャナーを使用して実施されました.
- 病変の検出に対する感度および特異性は,≥6mmおよび≥10mmでした.
主要な成果:
- ≥6mmの病変に対するCTC感度は39.0%,≥10mmの病変に対するCTC感度は55.0%で,従来の結腸鏡検査 (99.0%および100%) よりも著しく低かった.
- CTCの特異性は90.5% (≥6mm) と96.0% (≥10mm) であったが,従来のコロノスコピーの特異性は100%であった.
- CTCは8つの癌のうち2つの癌を見逃し,時間とともに改善することなく,センターによって正確性が大きく変化しました.
結論:
- 現在のCTC方法は,最適以下な精度があるため,広範な臨床採用の準備ができていません.
- CTCの技術と放射線科医の研修に大幅な改善が必要である.
- 結腸直腸がんスクリーニングにおけるCTCの診断性能を向上させるためにさらなる研究が必要である.
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