从便到范围:优化FIT值,以指导未来的胰肠囊内镜,并减少铁缺乏症贫血患者的结肠镜负担
Ian Io Lei1,2, Nicola O'Connell1, Michael Agyekum Adu-Darko3
1Institute of Precision Diagnostics & Translational Medicine, University Hospital of Coventry and Warwickshire, Clifford Bridge Rd, Coventry CV2 2DX, UK.
优化便免疫化学测试 (FIT) 值对于缺铁性贫血 (IDA) 患者可以提高成本效益. 确定了10-17μg/g的最佳FIT值范围,以指导适当的全肠囊内镜 (PCE) 使用.
科学领域:
- 胃肠病学 胃肠病学
- 诊断成像 诊断成像 诊断成像
- 卫生经济学 卫生经济学
背景情况:
- 全肠囊内镜 (PCE) 是一种用于诊断缺铁性贫血 (IDA) 的非侵入性工具.
- 在PCE后,高转换率到常规结肠镜 (CCC) 降低了成本效益和患者满意度.
- 优化便免疫化学测试 (FIT) 值可能会改善患者在IDA中对PCE的选择.
研究的目的:
- 评估FIT对IDA患者结肠直肠癌 (CRC),聚负担和CCC的预测价值.
- 确定一个最佳的FIT值,以分层IDA患者,减少不必要的结肠镜检查.
- 评估IDA诊断途径中不同FIT门的成本效益.
主要方法:
- 在1531名通过两周等待途径转诊的患者中进行了多中心,回顾性观察性研究 (CLEAR IDA).
- 结肠镜检查结果的分析和推断,使用英格兰NHS的PCE-to-colonoscopy转诊标准.
- 接收机运行特征 (ROC) 曲线分析,决策曲线分析和成本效益建模以确定最佳的FIT值.
主要成果:
- 在FIT中,CRC的诊断准确率 (AUC) 为0.78,聚为0.58,CCC为0.69.
- FIT=15μg/g是与显著增加的CCC率相关的最低值 (p=0.02).
- 在10-17.6μg/g之间确定了最佳的成本效益的FIT值范围,平衡诊断产量和资源利用.
结论:
- 对于IDA患者来说,FIT是一个不完美的分拣工具,但优化值可以提高成本效益.
- 10-17μg/g的最佳FIT值范围可以指导适当的PCE使用,并减少不必要的CCC.
- 门选择应根据当地医疗保健服务能力和资源的可用性进行调整.
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