二样便免疫化学测试作为一种工具来避免症状患者的结肠镜检查:一个前性的多中心队列研究
Sarah Moen1, Pieter H A Wisse1, Fleur Marijnissen1
1Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands.
Endoscopy
|July 6, 2025
概括
两样便免疫化学测试 (FIT) 显示在排除显著结肠病变方面具有很高的准确性. 然而,它错过了太多的晚期瘤是唯一的测试,以避免症状患者的结肠镜检查.
科学领域:
- 胃肠病学 胃肠病学
- 诊断医学 诊断医学
- 结肠直肠癌查 结肠直肠癌查
背景情况:
- 大多数肠道症状的结肠镜检查显示没有显著的病变,导致不必要的手术.
- 便免疫化学测试 (FIT) 是减少不必要的结肠镜检查的潜在工具.
研究的目的:
- 评估两样FIT在识别症状患者显著结直肠病变方面的表现.
- 确定两个样本FIT的敏感性和负预测值 (NPV) 对于晚期瘤,晚期状息肉和结肠炎.
主要方法:
- 被转诊进行结肠镜检查的有症状的患者提供了两个FIT样本,分别来自肠道排便.
- 收集了结肠镜和病理学数据来评估FIT的表现.
- 灵敏度和NPV在各种截止值下计算,重点是最低的血红蛋白检测极限 (>1.7μg Hb/g).
主要成果:
- 两个样本的FIT显示了先进瘤 (95.6%) 和结直肠癌 (CRC) (99.7%) 的高NPV,敏感度分别为71.7%和93.9%.
- 对于晚期瘤的敏感性增加到84.6%的患者与警报症状,如直肠流血或贫血.
- 对炎症性肠病的NPV和敏感性分别为99.3%和83.3%.
结论:
- 两个样本的FIT提供了高的NPV,但错过了很大一部分 (28.3%) 的晚期瘤.
- 虽然FIT对于确定有症状的个体需要进行结肠镜检查是有用的,但仅仅FIT不足以排除所有重大病变.
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