Accuracy of CT colonography for detection of large adenomas and cancers

被引：741

作者：

Johnson, C. Daniel ^{[1
]}

Chen, Mei-Hsiu ^{[2
]}

Toledano, Alicia Y. ^{[3
]}

Heiken, Jay P. ^{[4
]}

Dachman, Abraham ^{[5
]}

Kuo, Mark D. ^{[6
]}

Menias, Christine O. ^{[4
]}

Siewert, Betina ^{[7
]}

Cheema, Jugesh I. ^{[8
]}

Obregon, Richard G. ^{[9
]}

Fidler, Jeff L. ^{[10
]}

Zimmerman, Peter ^{[11
]}

Horton, Karen M. ^{[12
]}

Coakley, Kevin ^{[13
]}

Iyer, Revathy B. ^{[14
]}

Hara, Amy K. ^{[1
]}

Halvorsen, Robert A., Jr. ^{[15
]}

Casola, Giovanna ^{[16
]}

Yee, Judy ^{[17
,18
]}

Herman, Benjamin A. ^{[2
]}

Burgart, Lawrence J. ^{[19
]}

Limburg, Paul J. ^{[10
]}

机构：

[1] Mayo Clin Arizona, Scottsdale, AZ 85259 USA

[2] Brown Univ, Ctr Stat Sci, Providence, RI 02912 USA

[3] Biostat Consulting, Toronto, ON, Canada

[4] Washington Univ, Mallinckrodt Inst Radiol, St Louis, MO 63130 USA

[5] Univ Chicago, Chicago, IL 60637 USA

[6] Scottsdale Med Imaging, Scottsdale, AZ USA

[7] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA

[8] Yale Univ, New Haven, CT USA

[9] Radiol Imaging Assoc, Denver, CO USA

[10] Mayo Clin Rochester, Rochester, MN USA

[11] Univ Calif Los Angeles, Los Angeles, CA USA

[12] Johns Hopkins Univ, Baltimore, MD USA

[13] Mem Med Ctr, Springfield, IL 62781 USA

[14] Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA

[15] Virginia Commonwealth Univ, Richmond, VA USA

[16] Univ Calif San Diego, San Diego, CA 92103 USA

[17] Univ Calif San Francisco, San Francisco, CA 94143 USA

[18] Vet Affairs Med Ctr, San Francisco, CA 94121 USA

[19] Abbott NW Hosp, Minneapolis, MN 55407 USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2008年 / 359卷 / 12期

关键词：

D O I：

10.1056/NEJMoa0800996

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Computed tomographic (CT) colonography is a noninvasive option in screening for colorectal cancer. However, its accuracy as a screening tool in asymptomatic adults has not been well defined. Methods: We recruited 2600 asymptomatic study participants, 50 years of age or older, at 15 study centers. CT colonographic images were acquired with the use of standard bowel preparation, stool and fluid tagging, mechanical insufflation, and multidetector-row CT scanners (with 16 or more rows). Radiologists trained in CT colonography reported all lesions measuring 5 mm or more in diameter. Optical colonoscopy and histologic review were performed according to established clinical protocols at each center and served as the reference standard. The primary end point was detection by CT colonography of histologically confirmed large adenomas and adenocarcinomas (10 mm in diameter or larger) that had been detected by colonoscopy; detection of smaller colorectal lesions (6 to 9 mm in diameter) was also evaluated. Results: Complete data were available for 2531 participants (97%). For large adenomas and cancers, the mean (+/-SE) per-patient estimates of the sensitivity, specificity, positive and negative predictive values, and area under the receiver-operating-characteristic curve for CT colonography were 0.90+/-0.03, 0.86+/-0.02, 0.23+/-0.02, 0.99+/-<0.01, and 0.89+/-0.02, respectively. The sensitivity of 0.90 (i.e., 90%) indicates that CT colonography failed to detect a lesion measuring 10 mm or more in diameter in 10% of patients. The per-polyp sensitivity for large adenomas or cancers was 0.84+/-0.04. The per-patient sensitivity for detecting adenomas that were 6 mm or more in diameter was 0.78. Conclusions: In this study of asymptomatic adults, CT colonographic screening identified 90% of subjects with adenomas or cancers measuring 10 mm or more in diameter. These findings augment published data on the role of CT colonography in screening patients with an average risk of colorectal cancer. (ClinicalTrials.gov number, NCT00084929; American College of Radiology Imaging Network [ACRIN] number, 6664.).

引用

页码：1207 / 1217

页数：11

共 26 条

[1] Statistical methods for the estimation of sensitivity and specificity of site-specific diagnostic tests [J].