Diagnostic Accuracy of Computed Tomographic Colonography for the Detection of Advanced Neoplasia in Individuals at Increased Risk of Colorectal Cancer

被引：150

作者：

Regge, Daniele ^{[2
]}

Laudi, Cristiana ^{[1
]}

Galatola, Giovanni ^{[1
]}

Della Monica, Patrizia ^{[2
]}

Bonelli, Luigina ^{[3
]}

Angelelli, Giuseppe ^{[5
]}

Asnaghi, Roberto ^{[6
]}

Barbaro, Brunella ^{[7
]}

Bartolozzi, Carlo ^{[8
]}

Bielen, Didier ^{[9
]}

Boni, Luca ^{[3
]}

Borghi, Claudia ^{[10
]}

Bruzzi, Paolo ^{[3
]}

Cassinis, Maria Carla ^{[11
]}

Galia, Massimo ^{[12
]}

Gallo, Teresa Maria ^{[2
]}

Grasso, Andrea ^{[4
]}

Hassan, Cesare ^{[13
]}

Laghi, Andrea ^{[14
]}

Martina, Maria Cristina ^{[11
]}

Neri, Emanuele ^{[8
]}

Senore, Carlo ^{[15
]}

Simonetti, Giovanni ^{[16
]}

Venturini, Silvia ^{[17
]}

Gandini, Giovanni ^{[11
]}

机构：

[1] Inst Canc Res & Treatment, Gastroenterol Unit, I-10060 Turin, Italy

[2] Inst Canc Res & Treatment, Radiol Unit, I-10060 Turin, Italy

[3] Natl Inst Canc Res, Epidemiol Unit, Genoa, Italy

[4] Natl Inst Canc Res, Radiol Unit, Genoa, Italy

[5] Univ Bari, Dept Radiol, Policlin Hosp, Bari, Italy

[6] Salvatore Maugeri IRCCS Fdn, Radiol Unit, Novara, Italy

[7] Univ Cattolica Sacro Cuore, Dept Radiol, Policlin Agostino Gemelli, Rome, Italy

[8] Univ Pisa, Dept Radiol, Pisa, Italy

[9] Katholieke Univ Leuven, UZ Gasthuisberg, Dept Radiol, Louvain, Belgium

[10] Valduce Hosp, Radiol Unit, Como, Italy

[11] Univ Turin, Dept Radiol, San Giovanni Battista Hosp, Turin, Italy

[12] Univ Palermo, Dept Radiol, Policlin Paolo Giaccone, Palermo, Italy

[13] Nuovo Regina Margherita Hosp, Gastrointestinal Unit, Rome, Italy

[14] Univ Roma La Sapienza, Dept Radiol, Polo Didatt Pontino ICOT, Rome, Italy

[15] ASO San Giovanni Battista, CPO Piemonte, Turin, Italy

[16] Univ Roma Tor Vergata, Dept Radiol, Rome, Italy

[17] Natl Canc Inst, Radiol Unit, Aviano, Pordenone, Italy

来源：

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2009年 / 301卷 / 23期

关键词：

CONTRAST BARIUM ENEMA; FECAL OCCULT BLOOD; CT COLONOGRAPHY; 1ST-DEGREE RELATIVES; VIRTUAL COLONOSCOPY; ASYMPTOMATIC ADULTS; LARGE ADENOMAS; SURVEILLANCE; SIGMOIDOSCOPY; POPULATION;

D O I：

10.1001/jama.2009.832

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Context Computed tomographic (CT) colonography has been recognized as an alternative for colorectal cancer (CRC) screening in average-risk individuals, but less information is available on its performance in individuals at increased risk of CRC. Objective To assess the accuracy of CT colonography in detecting advanced colorectal neoplasia in asymptomatic individuals at increased risk of CRC using unblinded colonoscopy as the reference standard. Design, Setting, and Participants This was a multicenter, cross-sectional study. Individuals at increased risk of CRC due to either family history of advanced neoplasia in first-degree relatives, personal history of colorectal adenomas, or positive results from fecal occult blood tests (FOBTs) were recruited in 11 Italian centers and 1 Belgian center between December 2004 and May 2007. Each participant underwent CT colonography followed by colonoscopy on the same day. Main Outcome Measures Sensitivity and specificity of CT colonography in detecting individuals with advanced neoplasia (ie, advanced adenoma or CRC) 6 mm or larger. Results Of 1103 participants, 937 were included in the final analysis: 373 cases in the family-history group, 343 in the group with personal history of adenomas, and 221 in the FOBT-positive group. Overall, CT colonography identified 151 of 177 participants with advanced neoplasia 6 mm or larger (sensitivity, 85.3%; 95% confidence interval [CI], 79.0%-90.0%) and correctly classified results as negative for 667 of 760 participants without such lesions (specificity, 87.8%; 95% CI, 85.2%-90.0%). The positive and negative predictive values were 61.9% (95% CI, 55.4%-68.0%) and 96.3% (95% CI, 94.6%-97.5%), respectively; after group stratification, a significantly lower negative predictive value was found for the FOBT-positive group (84.9%; 95% CI, 76.2%-91.3%; P < .001). Conclusions In a group of persons at increased risk for CRC, CT colonography compared with colonoscopy resulted in a negative predictive value of 96.3% overall. When limited to FOBT-positive persons, the negative predictive value was 84.9%. JAMA. 2009; 301(23):2453-2461

引用

页码：2453 / 2461

页数：9