Gut:基于FIT的CRC筛查中无柄锯齿状息肉的检出率和预测因素

2016-03-05 Mechront 译 MedSci原创

背景:评估基于粪便免疫化学测试(FIT)的结直肠癌(CRC)筛查项目中,无柄锯齿状息肉(SSPs)的检出率和预测因素。方法:数据来自FIT阳性个体结肠镜检查的案例系列,获取历史资料、内镜和组织学检查结果,并在内镜中心和内镜医师处收集附加信息,包括每位内镜医师年龄标准化和性别标准化的腺瘤检出率(ADR)。评估研究人群的SSP检出率(SSP-DR),对患者/内镜中心/内镜医师进行多层次分析,识别SSP

背景:评估基于粪便免疫化学测试(FIT)的结直肠癌(CRC)筛查项目中,无柄锯齿状息肉(SSPs)的检出率和预测因素。

方法:数据来自FIT阳性个体结肠镜检查的案例系列,获取历史资料、内镜和组织学检查结果,并在内镜中心和内镜医师处收集附加信息,包括每位内镜医师年龄标准化和性别标准化的腺瘤检出率(ADR)。评估研究人群的SSP检出率(SSP-DR),对患者/内镜中心/内镜医师进行多层次分析,识别SSP的预测因素。

结果:共分析了72 021例结肠镜检查,1295例有至少一个SSP(SSP-DR 1.8%; 95% CI 1.7% to 1.9%)。从每个患者的角度来看,SSP-DR与男性(OR 1.35; 95% CI 1.17 to 1.54)和盲肠插管(OR 3.75; 95% CI 2.22 to 6.34)有关,与FIT次数无关。有SSPs的患者至少一个高危腺瘤的发生率更高(OR 2.08; 95% CI 1.86 to 2.33)。从内镜医师层面分析,SSP-DR与ADR有关(第三与第一ADR四分位数区间相比:OR 1.55; 95% CI 1.03 to 2.35;第四与第一ADR四分位数区间相比:OR 1.89; 95% CI 1.24 to 2.90)。

结论:低SSPs患病率和缺乏与FIT次数的关联,因此SSP似乎不是基于FIT的项目中的合适目标。SSP-DR与结肠镜检查质量密切相关,基于FIT的项目中,盲肠插管率和高的ADR需要SSP特异性质量指标。

原始出处:

Zorzi M, Senore C,et al.Detection rate and predictive factors of sessile serrated polyps in an organised colorectal cancer screening programme with immunochemical faecal occult blood test: the EQuIPE study (Evaluating Quality Indicators of the Performance of Endoscopy).Gut. 2016 Feb 19. pii: gutjnl-2015-310587. doi: 10.1136/gutjnl-2015-310587. 


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    2016-04-08 yxch36
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