粪潜白蛋白试验在大肠癌普查中的筛选意义

本文对比粪便潜血试验(ＦＯＢＴ)和粪便潜白蛋白试验(ＦＯＡＴ)两种方法对大肠癌和癌前病变的检出情况,以评价ＦＯＡＴ作为一种新的检测方法在人群普查大肠癌筛选中的作用。1　材料和方法1.1　标本来源　146名实验对象为在本院内镜室作纤维结肠镜检查的门诊及住院病人。其中经纤维结肠镜检查和病理证实的良、恶性大肠肿瘤及慢性结、直肠炎患者100例,自回盲部以下大肠未见病变的正常人46例,分为4个组。大肠癌组35例,男性20例,女性15例,平均年龄为52.5岁;大肠腺瘤性息肉组24例,男性20例,女性4例,平均年龄为51.9岁;大肠炎症组(包括炎性息肉)41…     

多层螺旋CT仿真结肠镜诊断直、结肠病变

目的: 研究多层螺旋CT(MSCT)仿真结肠镜诊断结肠病变的临床价值.材料和方法: 应用MSCT对63例患者行一次屏气全结肠容积扫描,包括直结肠癌39例,息肉19例,多憩室2例,慢性结肠炎2例,纤维脂肪瘤1例.除憩室、慢性结肠炎2例外,均经手术和常规结肠镜活检病理证实.用工作站软件获取仿真结肠镜CTVC、多平面重建MPR、表面遮盖显示SSD和透明显示Raysum等图像进行分析比较.结果: MSCTVC能够显示结肠癌的大体分型、大于5.0mm的癌结节和溃疡;有利于显示大于3.0mm的息肉检出,与常规结肠镜比较直结肠癌肿检出率为100%;直结肠息肉检出率为92.3%.MPR能直观反映息肉和癌肿处肠壁及肠周受侵状况,对癌肿肠周受侵判断正确率达100%.结合SSD更有助于对假阳性的鉴别.Raysum在显示癌肿的长度上占优势,判断正确率达100%,结论: MSCTVC、MPR、SSD、Raysum检查结肠占位性病变的临床应用价值各有不同,4种后处理技术的结合,更有助于病变的检出与病变的定位、定性.MSCT仿真结肠镜将为直结肠病变的检查开创新的临床途径.     

下消化道息肉电凝电切后继发出血急症处理7例

1988～1998年行纤维结肠镜检查2040例,发现结肠息肉296例,经纤维结肠镜下圈套电凝电切292例(348颗),术后24ｈ内继发出血7例(3ｈ内出血4例,5ｈ内出血3例),出血量120～300ｍｌ,分别于出血后给于处理,病人转归正常,无1例经外科处置,现将资料报告如下。1　临床资料7例出血病例中,男5例,女2例,年龄24～56岁,平均年龄42岁。7例患者均有明确诊断,息肉位于直肠2例,乙状结肠4例,横结肠1例,息肉形态:葡萄状广基息肉2例,亚蒂状息肉伴基底部出血1例,息肉大小15～20ｃｍ2例,20～24ｃｍ4例,大于25ｃｍ1例。出血病例中均有不同程度的腹胀、腹痛、鲜血便,4例…     

CT仿真结肠镜与三维重建相结合对结肠病变的诊断价值

目的探讨多排螺旋CT仿真结肠镜与三维重建相结合在结肠病变中的临床应用价值。方法分析26例CT仿真结肠镜的病例并经纤维结肠镜及临床手术病理证实的病例：结果结肠癌7例(其中1例伴有息肉)、结肠炎5例、结肠息肉6例、结肠憩室1例、结肠镜未见异常4例、结肠镜显示不满意3例：其中，纤维结肠镜所见的息肉均被仿真结肠镜所显示.纤维结肠镜所不能到达的肠腔被仿真结肠镜发现肿瘤1例：结肠炎症可表现为黏膜展平，管腔狭窄，呈渐进性改变，对点状出血不能显示、结论cT仿真结肠镜结合三维重建作为一种非侵入性的新检查方法，弥补了纤维结肠镜和结肠造影的不足。     

纤维结肠镜高频电凝切大肠息肉66例

息肉为大肠疾病中的常见病之一,常见的临床症状是便血,其危险性是可恶变,因此,应及早发现,予以摘除.经纤维结肠镜高频电凝切除大肠息肉,可以避免外科手术,并可提供病理组织学的分类研究.我院自1982年以来在纤维结肠镜下高频电凝切大肠息肉66例,共摘除109个息肉,现报告如下.一般资料66例中单发息肉47例,多发息肉19例.男性51例,女性15例,男:女=3.4:1.年龄6～70岁,以20～30岁组最多,共20例(30.3%),41～50岁和51～60岁组分别为15例(22.7%)和14例(21.2%),居2、3位.病程1个月～5     

直肠乙状结肠息肉内镜高频电凝切除后保留灌肠的临床疗效观察

我科2003年7月-2005年12月采用olympus．CF-201结肠镜共检出乙状结肠、直肠炎性息肉及腺瘤样息肉共76例（炎性息肉40例，腺瘤样息肉36例），经高频电凝切除后保留灌肠进行治疗。常规6个月一次结肠镜复查，随访2年，临床效果满意，总结如下。     

内窥镜检查结肠癌45例分析

我院自1976年1月至1987年2月,共行纤维结肠镜检查882例(977例次),其中共检出结肠癌45例(均经病理或手术证实),现分析如下:一般资料 性别,年龄与病程 45例中男性32例,26—71岁,平均52.03     

纤维结肠镜检查高原地区结肠疾病278例分析

纤维结肠镜在平原地区医院早已广泛用于结肠疾病检查,而有关高原地区纤维结肠镜检查资料尚未见报道。现对我院(拉萨,海拔3658m)1990年1月～1996年4月纤维结肠镜检查的278例资料进行综合分析,旨在探讨高原地区人群中结肠疾病的发病情况。1 临床资料1.1 一般资料 278例中,男215例,女63例,男女之比为3.41:1。年龄范围7～62岁,平均31.7岁。汉族193例(69.42％),为移居高原1个月至30年不等。藏族85例(30.58％),为世居高原者。病程<6个月68例(24.46％),<1年73例(26.26％),<3年53例(19.06％),<10年28例(10.07),≤30年10例(3.60％)。     

点电灼电切治疗小儿大肠息肉33例临床分析

本组33例经纤维结肠镜确诊为小儿大肠息肉,经内镜点电灼电切息肉24例,共切治36枚大肠息肉。 一般资料:男24例,女9例。年龄3～12岁,其中5～8岁20例。病程1个月～6年。血便28例,单纯性     

一组空肠疾病的内镜检出率和临床分析

我院自1985年以来应用日本OIympus SIF-B型小肠镜检查病人143例,现报告如下: 本组受检查均有不同程度的消化道症状、体征,怀疑有小肠疾患而经其它手段未能确诊的病人。其中男121例,女22例,年龄16～65岁。按纤维小肠镜检查常规手法进行操作,达空肠上段50～60Cm,大部分采取单人法,平均插入时间6分钟。到达空肠者140例,成功率98.5％,高于有关报告的95.2％(中华消化杂志1984;2:46)。检出正常者42例(占29.6％),浅表性空肠炎70例(占50％),萎缩性空肠炎10例(占7.15％),灶型糜烂6例(占4.75％),息肉4例(占2.84％),空肠溃疡3例(占2.13％),憩室2例(占1.42％),原发性淋巴瘤1例,肠套叠不全梗阻1例,Crohns病1例。选择性取材128例(256块)与病理相符的     

Colorectal neoplasia screening with CT colonography in average-risk asymptomatic subjects: community-based study

PURPOSE: To evaluate computed tomographic (CT) colonography as a screening tool for average-risk asymptomatic subjects with regard to participation, acceptability, and safety. MATERIALS AND METHODS: CT colonography for colorectal neoplasia screening was offered to 2,000 subjects aged 50-54 and 65-69 years. Only asymptomatic subjects at average risk of colorectal neoplasia were enrolled. Participants underwent CT colonography followed by colonoscopy if CT colonography findings showed any polyps. Acceptability was measured with a 100-point (0, most favorable; 100, least favorable) visual analogue scale (VAS). Chi2 statistic was used to compare participation rates among subgroups. Safety of CT colonography was evaluated by recording all important adverse events. RESULTS: A total of 1,452 subjects were eligible for screening. The adjusted participation rate was 28.4%. Participation was higher in younger subjects and in those from a high socioeconomic region. Major reasons for nonparticipation were insufficient time and perceived good health. Median VAS scores for pain, general satisfaction, embarrassment, and willingness to repeat screening were 13, 6, 8, and 5, respectively. Most subjects found CT colonography better than (60%) or same as (32%) expected. Ninety-three (27.4%) of 340 subjects were referred for colonoscopy, with polyps found in 67 (positive predictive value, 0.73). By adopting criteria that a positive finding at CT colonography is that of a single polyp larger than 5 mm or multiple polyps larger than 2 mm, 14% of CT examinations would have led to colonoscopy; 5.7% of CT findings were false-positive, with no significant impairment in large polyp detection. There were no important adverse events related to CT colonography, although four subjects had syncope or presyncope related to bowel preparation. CONCLUSION: Community-based colorectal neoplasia screening with CT colonography was accompanied by a participation rate that compares favorably with that of similar screening programs. CT colonography was highly acceptable to participants.     

CT colonography before colonoscopy in subjects with positive faecal occult blood test. Preliminary experience

Purpose

We report a preliminary evaluation of the performance of computed tomography colonography (CTC) systematically obtained before optical colonoscopy (OC) in subjects with positive faecal occult blood test (FOBT) within a population-based screening programme for colorectal cancer (CRC).

Materials and methods

Seventy-nine subjects with positive FOBT from a regional screening programme were invited to perform same day CTC and OC. CTC was performed with standard bowel preparation. OC with segmental unblinding was the reference standard. A perpatient per-adenoma analysis was performed.

Results

Forty-nine of 79 subjects (62%) with positive FOBT adhered to the study and completed both examinations. Twenty-two (44.9%) of the 49 had a cancer or an adenoma ≥6 mm. Per-patient sensitivity, specificity, negative predictive value and positive predictive value for cancer or adenoma ≥6 mm were 95.5% (95%CI:77.2%–99.9%), 51.9% (95%CI:32.0%–71.3%), 93.3% (95%CI:68.1%–99.8%) and 61.8% (95%CI:43.6%–77.8%).

Conclusions

In the setting of a FOBT-based screening programme for CRC, CTC showed a high sensitivity, but relatively low specificity and positive predictive value, for cancer and adenoma ≥6 mm. Probably performing CTC without faecal tagging as second line test after a positive FOBT is not a cost-effective strategy.     

Reassessing the role of radiology in Hemoccult screening

During a recent regional screening program, 98 patients with a positive Hemoccult test were evaluated radiographically. Double-contrast barium enema (DCBE) detected all six carcinomas and 92% of 37 polyps. DCBE was also the most cost-effective procedure. Colonoscopy dramatically increased screening costs without providing evidence to support its use in all Hemoccult-positive patients. It is recommended that DCBE be the initial diagnostic test in Hemoccult-positive patients, to be supplemented in selected patients by flexible sigmoidoscopy or colonoscopy depending on the pathology evident on DCBE and on clinical circumstances.     

Detection of colorectal cancer and adenomas by FDG-PET cancer screening program: results based on a nationwide Japanese survey

Purpose

The aim of this study was to analyze the detection rate for CRC and adenomas for asymptomatic subjects in Japan by FDG-PET cancer screening program carried out between 2006 and 2009.

Methods

The “FDG-PET cancer screening program” included both PET and positron emission tomography with computed tomography (PET/CT) with or without other screening tests. A total of 154,783 asymptomatic subjects underwent FDG-PET cancer screening program; we analyzed the 1,808 cases with findings from any detection method that indicated suspected CRC.

Results

Among the 1,808 cases, the number of cases verified as CRC and adenoma was 394 and 679, respectively. The sensitivity and positive predictive value (PPV) of FDG-PET were 86.0 and 31.7 % for CRC, and 63.6 and 63.8 % for CRC and adenoma. The sensitivity and PPV of fecal occult blood test (FOBT) for CRC were lower than those of FDG-PET, but higher for adenoma. Therefore, FDG-PET and FOBT were complementary for screening for CRC, and CRC and adenoma. The majority of CRC detected by the FDG-PET imaging was UICC stage 0 or I, however, detection of smaller or less invasive cancer was limited.

Conclusion

The FDG-PET screening program in Japan has detected CRC at an early stage and adenomas as premalignant lesions. A combination of FDG-PET and FOBT yields the best results if the intent is to detect either CRC or adenoma. However, it is absolutely clear that an FDG-PET cancer screening program cannot detect all colon lesions.     

Diagnostic accuracy of CT colonography in patients with positive faecal occult blood test: results of the Italian project Legatumori 2003–2006

Purpose

In the framework of the 3-year project of the Italian Legatumori (2003–2006), we evaluated the diagnostic accuracy of computed tomography (CT) colonography in detecting colorectal lesions in a screening population with positive faecal occult blood test (FOBT).

Materials and methods

Two hundred and thirty asymptomatic subjects (age range 45–80 years) were enrolled in the study. CT colonography was performed with standard patient preparation (no faecal tagging) and a 4-detector-row CT scanner. Image analysis was carried out with primary 2D analysis and the use of 3D endoluminal views to solve difficult cases. Patients were referred for conventional colonoscopy in the following situations: detection of three or more suspected lesions with maximum diameter ≤6 mm; evidence of one or more lesions with maximum diameter >6 mm; presence of colonic masses (maximum diameter >3 cm).

Results

CT colonography detected colonic masses in 12 out of 135 subjects (8%). It generated 93 false positives and 19 false negatives in the identification of diminutive lesions (≤6 mm), and 70 false positives and six false negatives in lesions >6 mm. Sensitivity was 83% in smaller lesions and 93% in lesions >6 mm; specificity was 45% and 59%, respectively.

Conclusions

In a screening population with positive FOBT, CT colonography without faecal tagging and no definite size threshold for the reporting of polyps showed very low specificity but high sensitivity in the detection of all colorectal lesions.     

Nd∶YAG激光对喉部良性病变的治疗作用

目的总结纤维喉镜下激光治疗喉部良性病变的方法与疗效。方法Ｎｄ∶ＹＡＧ激光经纤维喉镜导入治疗喉部良性病变３７例,其中声带息肉与声带息肉样变２１例,声带小结４例,喉囊肿８例,喉乳头状瘤４例。结果所有息肉、囊肿及小结均治疗１次后痊愈;乳头状瘤经１次治疗彻底切除１例,经２次治疗根治２例,１例经４次手术方切净。术后患者发音有明显改善,无出血及呼吸困难。术后随访３～５年,仅经４次激光治疗的乳头状瘤患者复发。结论纤维喉镜下Ｎｄ∶ＹＡＧ激光术用于喉部良性病变的治疗疗效肯定,并具有无须全麻、术中痛苦小、术后反应轻、恢复快、经济省时等优点,值得推广应用。     

Colorectal cancer: screening double-contrast barium enema examination in average-risk adults older than 50 years

PURPOSE: To retrospectively determine the diagnostic yield of double-contrast barium enema examinations performed for colorectal cancer screening of neoplasms 1 cm or larger or advanced neoplastic lesions of any size in average-risk adults older than 50 years. MATERIALS AND METHODS: The Institutional Review Board at the affiliated Veterans Affairs Medical Center approved this HIPAA-compliant study protocol and did not require informed consent from patients. Computerized databases revealed 276 double-contrast barium enema examinations performed for colorectal cancer screening in average-risk adults older than 50 years. Radiographic and pathologic reports were reviewed to determine the number of patients who had polypoid lesions 1 cm or larger, polyps smaller than 1 cm, or advanced neoplastic lesions of any size. Forty-five (16.3%) of the 276 patients underwent follow-up sigmoidoscopy or colonoscopy. Medical, endoscopic, and pathologic records were reviewed and compared with radiographic findings. RESULTS: The results of double-contrast barium enema examination revealed 74 (26.8%) of 276 patients with 104 polypoid lesions in the colon, including 32 patients (11.6%) with 41 polypoid lesions 1 cm or larger, 15 patients (5.4%) with 19 polyps 6-9 mm, and 27 patients (9.8%) with 44 polyps 5 mm or smaller. Endoscopy was performed in 24 (75%) of 32 patients, the results of which confirmed 23 (72%) of 32 radiographically diagnosed lesions 1 cm or larger in 16 (67%) of 24 patients. In two of these individuals, the polyps were hyperplastic. The remaining 14 patients had a total of 21 neoplastic lesions 1 cm or larger, including 11 tubular adenomas, seven tubulovillous adenomas, one villous adenoma with marked dysplasia, and two cancers. The diagnostic yield of screening double-contrast barium enema examination was 5.1% (14 of 276 patients) for neoplastic lesions 1 cm or larger and 6.2% (17 of 276 patients) for advanced neoplastic lesions of any size. CONCLUSION: Double-contrast barium enema examinations performed in average-risk adults older than 50 years have a diagnostic yield of 5.1% for neoplastic lesions 1 cm or larger and 6.2% for advanced neoplastic lesions, regardless of size.     

Limitations of combined flexible sigmoidoscopy and double contrast barium enema in patients with rectal bleeding

Eighty-seven outpatients with non-massive rectal bleeding or asymptomatic positive fecal occult blood were evaluated with 35 cm flexible sigmoidoscopy, double contrast barium enema (DBCE) and colonoscopy. 82% had hemorrhoids and 35% harbored colorectal neoplasia. The combination of flexible sigmoidoscopy and DCBE missed none of 7 malignant lesions. However, 36% of benign polyps greater than or equal to 1 cm and 60.25% of those less than 1 cm were not detected by this combination. The presence of hemorrhoids should not prevent a search for colon neoplasia and colonoscopy is the preferred method.     

Colonic polyp patterns in familial polyposis

The diagnosis of familial polyposis depends on there being more than 100 adenomatous polyps in the large bowel. The polyps are the result of intramucosal microadenomatous growth. The age at which this occurs varies, and in the early stages of polyp development relatively few larger polyps may be seen. The numbers and size of the polyps as seen on double-contrast barium enema were compared with the macroscopic findings on the resected specimens in 27 patients with proven polyposis. Of these patients, 23 (83%) were diagnosed when polyps were first found at sigmoidoscopy. Radiologically the predominant polyp size was more than 5 mm in only four cases, 2-5 mm in 22 (81%), and less than 2 mm in one. Of the 22 with predominately 2-5 mm polyps, eight had significant numbers of nodules smaller than 2 mm and three had considerable numbers of polyps larger than 5 mm. Eleven (41%) were thought to have fewer than 70 polyps. Pathologically the nodular pattern (less than 2 mm) predominated in 11 (41%) and 14 had polyps of 2-5 mm. More than 100 polyps were present in each case, with fewer than 500 polyps in eight. In the 11 patients thought radiologically to have fewer than 70 polyps, the nodular pattern predominated in nine. In the initial stages of polyp growth, the larger polyps are less numerous, and the background nodular pattern is a useful diagnostic feature of familial polyposis.     

Cost-effectiveness modeling of colorectal cancer: computed tomography colonography vs colonoscopy or fecal occult blood tests

Objectives

To assess the cost-effectiveness of three colorectal-cancer (CRC) screening strategies in France: fecal-occult-blood tests (FOBT), computed-tomography-colonography (CTC) and optical-colonoscopy (OC).

Methods

Ten-year simulation modeling was used to assess a virtual asymptomatic, average-risk population 50–74 years old. Negative OC was repeated 10 years later, and OC positive for advanced or non-advanced adenoma 3 or 5 years later, respectively. FOBT was repeated biennially. Negative CTC was repeated 5 years later. Positive CTC and FOBT led to triennial OC. Total cost and CRC rate after 10 years for each screening strategy and 0–100% adherence rates with 10% increments were computed. Transition probabilities were programmed using distribution ranges to account for uncertainty parameters. Direct medical costs were estimated using the French national health insurance prices. Probabilistic sensitivity analyses used 5000 Monte Carlo simulations generating model outcomes and standard deviations.

Results

For a given adherence rate, CTC screening was always the most effective but not the most cost-effective. FOBT was the least effective but most cost-effective strategy. OC was of intermediate efficacy and the least cost-effective strategy. Without screening, treatment of 123 CRC per 10,000 individuals would cost €3,444,000. For 60% adherence, the respective costs of preventing and treating, respectively 49 and 74 FOBT-detected, 73 and 50 CTC-detected and 63 and 60 OC-detected CRC would be €2,810,000, €6,450,000 and €9,340,000.

Conclusion

Simulation modeling helped to identify what would be the most effective (CTC) and cost-effective screening (FOBT) strategy in the setting of mass CRC screening in France.