Comparison of Targeted vs Random Biopsies for Surveillance of Ulcerative Colitis-Associated Colorectal Cancer

被引：153

作者：

Watanabe, Toshiaki ^{[1
]}

Ajioka, Yoichi ^{[2
]}

Mitsuyama, Keiichi ^{[3
]}

Watanabe, Kenji ^{[4
]}

Hanai, Hiroyuki ^{[5
,6
]}

Nakase, Hiroshi ^{[7
]}

Kunisaki, Reiko ^{[8
]}

Matsuda, Keiji ^{[9
]}

Iwakiri, Ryuichi ^{[10
]}

Hida, Nobuyuki ^{[11
]}

Tanaka, Shinji ^{[12
]}

Takeuchi, Yoshiaki ^{[13
]}

Ohtsuka, Kazuo ^{[14
]}

Murakami, Kazunari ^{[15
]}

Kobayashi, Kiyonori ^{[16
]}

Iwao, Yasushi ^{[17
]}

Nagahori, Masakazu ^{[14
]}

Iizuka, Bunei ^{[18
]}

Hata, Keisuke ^{[1
]}

Igarashi, Masahiro ^{[19
]}

Hirata, Ichiro ^{[20
]}

Kudo, Shin-ei ^{[21
]}

Matsumoto, Takayuki ^{[22
]}

Ueno, Fumiaki ^{[23
]}

Watanabe, Gen ^{[2
]}

Ikegami, Masahiro ^{[24
]}

Ito, Yoko ^{[25
]}

Oba, Koji ^{[26
,27
]}

Inoue, Eisuke ^{[28
]}

Tomotsugu, Naoki

Takebayashi, Toru ^{[29
]}

Sugihara, Kenichi ^{[30
]}

Suzuki, Yasuo ^{[31
]}

Watanabe, Mamoru ^{[14
]}

Hibi, Toshifumi ^{[32
]}

机构：

[1] Univ Tokyo, Dept Surg Oncol & Vasc Surg, Bunkyo Ku, Tokyo, Japan

[2] Niigata Univ, Grad Sch Med & Dent Sci, Chuo Ku, Niigata, Japan

[3] Kurume Univ, Sch Med, Div Gastroenterol, Inflammatory Bowel Dis Ctr,Dept Med, Kurume, Fukuoka, Japan

[4] Osaka City Univ, Grad Sch Med, Dept Gastroenterol, Abeno Ku, Osaka, Japan

[5] Ctr Gastroenterol, Minami Ku, Hamamatsu, Shizuoka, Japan

[6] IBD Res Hamamatsu South Hosp, Minami Ku, Hamamatsu, Shizuoka, Japan

[7] Kyoto Univ Hosp, Dept Gastroenterol & Hepatol, Endoscop Med, Sakyo Ku, Kyoto, Japan

[8] Yokohama City Univ, Med Ctr, Inflammatory Bowel Dis Ctr, Minami Ku, Yokohama, Kanagawa, Japan

[9] Teikyo Univ, Sch Med, Dept Surg, Itabashi Ku, Tokyo, Japan

[10] Saga Med Sch, Dept Internal Med & Gastrointestinal Endos, Saga, Japan

[11] Hyogo Coll Med, Div Internal Med, Dept Inflammatory Bowel Dis, Nishinomiya, Hyogo, Japan

[12] Hiroshima Univ Hosp, Dept Endoscopy, Minami Ku, Hiroshima, Japan

[13] Showa Univ, Sch Med, Dept Internal Med, Shinagawa Ku, Tokyo, Japan

[14] Tokyo Med & Dent Univ, Dept Gastroenterol & Hepatol, Bunkyo Ku, Tokyo, Japan

[15] Oita Univ, Dept Gastroenterol, Hasama Cho, Yuhu, Oita, Japan

[16] Kitasato Univ, Sch Med, Res & Dev Ctr New Med Frontiers, Sagamihara, Kanagawa, Japan

[17] Keio Univ, Sch Med, Ctr Prevent Med, Shinjuku Ku, Tokyo, Japan

[18] Tokyo Womens Med Univ, Dept Gastroenterol, Shinjuku Ku, Tokyo, Japan

[19] Ariake Hosp, Inst Canc, Koto Ku, Tokyo, Japan

[20] Fujita Hlth Univ, Dept Gastroenterol, Toyoake, Aichi, Japan

[21] Showa Univ, Northern Yokohama Hosp, Digest Dis Ctr, Tsuzuki Yokohama, Kanagawa, Japan

[22] Iwate Med Univ, Sch Med, Div Gastroenterol, Dept Internal Med, Morioka, Iwate, Japan

[23] Ofuna Chuo Hosp, Dept Med, Kamakura, Kanagawa, Japan

[24] Jikei Univ, Sch Med, Dept Pathol, Minato Ku, Tokyo, Japan

[25] Keio Univ, Sch Med, Ctr Clin Res, Shinjuku Ku, Tokyo, Japan

[26] Univ Tokyo, Grad Sch Med, Sch Publ Hlth, Dept Biostat,Bunkyo Ku, Tokyo, Japan

[27] Univ Tokyo, Interfac Initiat Informat Studies, Bunkyo Ku, Tokyo, Japan

[28] Natl Ctr Child Hlth & Dev, Ctr Clin Res & Dev, Setagaya Ku, Tokyo, Japan

[29] Keio Univ, Sch Med, Dept Med & Publ Hlth, Shinjuku Ku, Tokyo, Japan

[30] Tokyo Med & Dent Univ, Bunkyo Ku, Tokyo, Japan

[31] Toho Univ, Sakura Med Ctr, Dept Internal Med, Sakura, Chiba, Japan

[32] Kitasato Univ, Kitasato Inst Hosp, Ctr Adv IBD Res & Treatment, Minato Ku, Tokyo, Japan

来源：

GASTROENTEROLOGY | 2016年 / 151卷 / 06期

关键词：

Dysplasia; Random Biopsy; Colonoscopy; IBD; INFLAMMATORY-BOWEL-DISEASE; COLONOSCOPIC SURVEILLANCE; INTRAEPITHELIAL NEOPLASIA; CONVENTIONAL COLONOSCOPY; DYSPLASIA; GUIDELINES; CHROMOENDOSCOPY; CLASSIFICATION; MANAGEMENT; CONSENSUS;

D O I：

10.1053/j.gastro.2016.08.002

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

100201 [内科学];

摘要：

BACKGROUND & AIMS: A random biopsy is recommended for surveillance of ulcerative colitis (UC)-associated colorectal cancer. However, a targeted biopsy might be more effective. We conducted a randomized controlled trial to compare rates of neoplasia detection by targeted vs random biopsies in patients with UC. METHODS: We performed a study of 246 patients with UC for 7 years or more, seen at 52 institutions in Japan from October 1, 2008 through December 31, 2010. Patients were randomly assigned to the random group (4 random biopsies collected every 10 cm in addition to targeted biopsies, n = 122) or the target group (biopsies collected from locations of suspected neoplasia, n = 124). The primary end point was the number of neoplastic lesions detected in a single surveillance colonoscopy. We estimated the ratio and difference in the mean number of neoplastic lesions between the groups. We also evaluated the non-inferiority between the groups as an exploratory study. A non-inferiority margin of 0.65 (0.13 of 0.20) was considered for the ratio of the mean number of neoplastic lesions between groups. RESULTS: The mean number of biopsies found to contain neoplastic tissue per colonoscopy was 0.211 (24 of 114) in the target group and 0.168 (18 of 107) in the random group (ratio of 1.251; 95% confidence interval, 0.679-2.306). The lower limit was above the non-inferiority margin of 0.65. Neoplasias were detected in 11.4% of patients in the target group and 9.3% of patients in the random group (P = .617). Larger numbers of biopsy samples per colonoscopy were collected in the random group (34.8 vs 3.1 in the target group; P < .001), and the total examination time was longer (41.7 vs 26.6 minutes in the target group; P < .001). In the random group, all neoplastic tissues found in random biopsies were collected from areas of the mucosa with a history or presence of inflammation. CONCLUSIONS: In a randomized controlled trial, we found that targeted and random biopsies detect similar proportions of neoplasias. However, a targeted biopsy appears to be a more cost-effective method. Random biopsies from areas without any signs of present or past inflammation were not found to contain neoplastic tissues.

引用

页码：1122 / 1130

页数：9

共 29 条

[1]

BERNSTEIN CN, 1994, LANCET, V343, P71

[2]

Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002) [J].