通过刚性前视镜/直视镜对直肠癌进行高度评估的Interrater协议
Matthias Kraemer1, Sarkhan Nabiyev1, Silvia Kraemer1
1Department of General and Visceral Surgery, Coloproctology, Academic Teaching Hospital of University of Münster, Münster, Germany.
刚性直肠内镜检测直肠癌的测量具有优异的间隙可靠性,但在26%的病例中不同意12厘米的切断值. 这些测量单独不应该决定新辅助疗法的资格.
科学领域:
- 结肠直肠手术 结肠直肠手术
- 在瘤学瘤学.
- 诊断成像 诊断成像 诊断成像
背景情况:
- 目前的指导方针使用12厘米的切割值用于直肠癌中新辅助化学辐射,通过刚性内镜测量.
- 刚性内镜取决于操作者,可能会根据微小的测量差异影响治疗决策.
研究的目的:
- 评估经验丰富的检查人员之间刚性直视镜瘤高度测量的一致性.
- 为了评估瘤的触觉性和门边缘到皮肤外线距离.
- 为了确定患者的位置 (石头切割与左侧切割) 是否会影响测量.
主要方法:
- 在一个学术教学医院进行前性观察性研究.
- 包括50名直肠癌患者 (70%男性,平均年龄为72.5岁).
- 四名经验丰富的检查人员进行了瘤高度测量,并分析了瘤间的协议.
主要成果:
- 在瘤高度评估中发现了优异的interrater可靠性 (ICC=0.947).
- 尽管可靠性很高,但有26%的患者表示不同意<12cm或>12cm的身高限制.
- 在瘤的触觉性和门边缘距离方面也发现了显著的分歧.
结论:
- 刚性直肠内镜测量单独不足以确定新辅助疗法的资格.
- 普遍的身高限制忽视了生物变异性;考虑患者的身材,性别和骨盆下降.
- 为改善决策,建议采用包含盆腔解剖学的标准化MRI/CT协议.
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