计算机断层结肠镜 (虚拟结肠镜):用于检测结肠直肠瘤的标准结肠镜的多中心比较
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
概括
计算机断层结肠镜 (CTC) 显示,检测结肠直肠病变的准确性低于传统结肠镜. 对于临床使用,需要进一步改进CTC技术和培训.
科学领域:
- 医疗成像医学成像
- 胃肠病学 胃肠病学
- 在瘤学瘤学.
背景情况:
- 传统的结肠镜检查是检测结肠直肠癌的标准,但具有侵入性.
- 计算机断层结肠镜 (CTC) 或虚拟结肠镜已经显示出在专家中心的前景.
- 评估CTC在多个中心的准确性对于其更广泛的应用至关重要.
研究的目的:
- 与传统结肠镜相比,评估CTC的诊断准确性.
- 为了确定CTC在检测大肠直肠瘤中的有效性,在一个大型的多中心队列中.
- 评估二次结果,包括病变检测率和参与者偏好.
主要方法:
- 一项非随机的,评估者盲目的,非劣等性研究,涉及615名50岁以上的参与者.
- 在标准结肠镜检查之前,CTC使用多切片扫描仪进行.
- 检测病变≥6毫米和≥10毫米的灵敏度和特异性是主要结局.
主要成果:
- 对于≥6毫米的病变,CTC敏感度为39.0%,对于≥10毫米的病变为55.0%,明显低于常规结肠镜 (99.0%和100%).
- 对CTC的特异性为90.5% (≥6毫米) 和96.0% (≥10毫米),相比之下,传统结肠镜的特异性为100%.
- 在8种癌症中,CTC错过了2种癌症,并且在不同中心之间,准确性差异很大,但随着时间的推移没有得到改善.
结论:
- 目前的CTC方法由于准确度低于最佳水平,尚未准备好广泛采用临床方法.
- 需要对CTC技术和放射科医生培训进行重大改进.
- 需要进一步的研究来提高CTC对结直肠癌查的诊断性能.
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