Improved screening for colorectal cancer by immunological detection of occult blood

A radial immunodiffusion technique for detecting faecal haemoglobin and the Hemoccult II kit used with and without rehydration of the faecal sample were compared in a screening programme for bowel cancer, in which 1328 subjects took part. A positive result was obtained in 170 (13%) subjects. Nineteen of the 153 subjects investigated were found to have colorectal carcinomas and 52 had polyps (40 with adenomas). Radial immunodiffusion and Hemoccult II with and without rehydration detected bleeding in, respectively, all 19, 15, and 11 subjects with colorectal carcinoma. Hemoccult II with and without rehydration detected only seven and six, respectively, of 11 Duke's stage A carcinomas, whereas all 11 were detected with the immunological test. Hemoccult II with and without rehydration and radial immunodiffusion detected bleeding from adenomas in, respectively, 22, 14, and 34 of the 40 subjects. False positive results occurred in 55 out of 1302 subjects by Hemoccult II with rehydration, in 28 out of 1304 by Hemoccult II without rehydration, and in 50 out of 1304 by the immunological technique; true positive results were defined as bleeding from carcinomas and adenomas. Immunological detection of occult blood in faecal samples seems to show more adenomas and carcinomas (particularly early lesions) than the Hemoccult II kit and has a rate of false positive results that is acceptably low.     

Immunochemical testing for faecal occult blood in patients with colorectal cancer

Eighty-six stool specimens collected from 36 patients with colorectal cancer were tested for occult blood by chemical and immunochemical methods. There was no dietary restriction. Positive results were obtained in 94% of patients by the immunochemical method when the presence of any positive immunochemical test was taken as a positive result. If greater than 1 mg of haemoglobin per gram of faeces was regarded as positive result, then 75% of patients would have been diagnosed as having occult blood in the stool by means of the immunochemical method. Positivity rates for Hemoccult II and rehydrated Hemoccult II were 53% and 81%, respectively.     

Periodic health examination, 1994 update: 2. Screening strategies for colorectal cancer. Canadian Task Force on the Periodic Health Examination.

OBJECTIVE: To make recommendations on the effectiveness of screening for colorectal cancer in asymptomatic patients over 40 years of age. OPTIONS: Multiphase screening that begins with test for fecal occult blood, uniphase screening with sigmoidoscopy and uniphase screening with colonoscopy. Options included screening repeated at different intervals and different procedures for patients with selected risk factors. OUTCOMES: Rates of death, death from cancer and cancer detection; compliance, feasibility and accuracy of each manoeuvre. EVIDENCE: A MEDLINE search for articles published between January 1966 and June 1993 with the use of MeSH terms "screening" and "colorectal neoplasia," a check with the reference sections of review articles published before June 1993 and a survey of content experts. Articles were weighted according to the Canadian Task Force on the Periodic Health Examination levels of evidence. VALUES: The highest value was assigned to manoeuvres that lowered the rate of death from cancer and had a low rate of false-positive results and acceptable cost and compliance. Recommendations were determined by consensus of the authors, members of the task force and colorectal cancer experts. BENEFITS, HARMS AND COSTS: There is evidence that annual fecal occult blood testing with the use of the rehydrated Hemoccult test has a small but significant benefit in lowering the rate of death from cancer after more than 10 years of screening; however, the high rate of false-positive results (9.8%) and the poor sensitivity of annual (49%) and biennial (38%) screening make this a poor method for detecting colorectal cancer. There is fair evidence that screening with sigmoidoscopy may improve survival rates; however, this may be due to volunteer bias. The high cost of and poor compliance with colonoscopic screening make this an unfeasible strategy.     

Double contrast barium enema and colorectal carcinoma: sensitivity and potential role in screening.

To establish the sensitivity of double contrast barium enema (DCBE) for detection of colorectal carcinoma in a tertiary referral centre and consider its possible role as a suitable imaging method in screening for this disease. A total of 160 patients with a histopathologically proven diagnosis of colorectal carcinoma over a two year period were reviewed. Subsequently 112 of the 160 patients were identified as having undergone DCBE, the results of which were analysed to determine its sensitivity for detecting colorectal carcinoma. Colorectal carcinoma was missed in 4 of the 112 barium enemas performed. This corresponds to a sensitivity of 96.5% with a false negative rate of 3.5%. The Dukes Classification in these 4 cases showed that Dukes stage B, C and D were missed, with tumours located in the right and the sigmoid colon. The mean delay to operation in these four cases was 6 weeks. Our study correlates with previous studies showing a false negative rate for DCBE of 3.5%. Colonoscopy also fails to detect small numbers of tumours with false negative rates reported as high as 10%. We suggest that double contrast barium enema should be effective as a screening method in any future colorectal cancer screening program.     

隐血珠在上消化道癌初筛普查中实用价值研究

目的通过对隐血珠初筛人群及癌患者5年、10年随访,进一步证实隐血珠对上消化道癌初筛普查的实用价值。方法空腹时吞入隐血珠,3～5分钟拉出,观察珠内试纸的变化,黄色为阴性(-),浅蓝色为(+),蓝色为(++),深蓝色为(+++),5年、10年后对隐血珠初筛人群及癌患者通过三级防癌网络进行全员随访。结果初筛普查31927人,阳性组3347人做胃镜,经病理确诊为癌患者125人,癌检出率3.74％;阴性组645人做胃镜,确诊癌患者9人,癌检出率1.4％,两组中早期癌患者共78人,占62.4％,性别、年龄、隐血珠反应均是影响癌检出率的因素,经5年及10年两次全员随访资料统计,隐血珠初筛阳性组癌发率均明显高于阴性组,癌患者5年生存率67.2％,10年生存率为55.2％,性别、年龄、隐血珠反应也是影响筛查人群上消化道癌发生率的因素。结论隐血珠在上消化道癌初筛普查中有肯定的实用价值,值得推广。     

Faecal occult blood screening: knowledge, attitudes, and practice in four Hong Kong primary care clinics

OBJECTIVES. To assess primary care patients for their awareness, knowledge, and attitude towards colorectal cancer and screening, to report on the uptake of faecal occult blood test screening and the results of screening, and explore predictors of screening uptake. DESIGN. Cross-sectional study. SETTING. Four primary care clinics in Hong Kong. PATIENTS. A total of 1664 patients aged 50 to 74 years attending the clinics in the period July 2006 to July 2007. MAIN OUTCOME MEASURES. Percentage of subjects who were aware that colorectal cancer is common and curable at an early stage, and who knew that faecal occult blood test or colonoscopy is useful for screening; relevant knowledge score; uptake rate of faecal occult blood testing; rate of testing positive; and factors predicting uptake. RESULTS. A total of 1645 questionnaires were collected. In all, 89% (95% confidence interval, 88-91%) were aware that colorectal cancer is common, 95% (94-96%) believed faecal occult blood test and colonoscopy are useful for screening, and 58% (56-61%) achieved a knowledge score of 50% or above. The uptake rate of the faecal occult blood test was 35%. Uptake was higher among those with a positive family history (odds ratio=1.57; 95% confidence interval, 1.08-2.27; P=0.02), those who were more aware that colorectal cancer is common (1.86; 1.29-2.69; P=0.001), and that colorectal cancer is potentially curable at an early stage (1.76; 1.32-2.36; P=0.0001). Rate of testing positive was 2.1% (95% confidence interval, 0.9-3.3%); no colorectal cancer was detected and the neoplasia detection rate (for cancers and adenomas) was 5.1 per 1000 subjects screened. CONCLUSIONS. Patients were aware that colorectal cancer is common in our community, and faecal occult blood test or colonoscopy is useful for screening. The uptake of screening was low, though relatively higher for those with a positive family history and greater awareness of the high frequency and potential for cure of colorectal cancer. Faecal occult blood test positivity rate was 2.1%, and neoplasia detection rate 5.1 per 1000 screened.     

宫颈癌筛查系统与液基细胞学检测在宫颈病变初筛中的研究

目的:探讨宫颈癌筛查系统(TruScreen)与液基细胞学检测(TCT)在宫颈病变初筛中的应用价值。方法:对1201例患者依次进行TruScreen、TCT及宫颈活检病理学检查,将其病理结果与TruScreen和TCT结果对照分析。结果:TruScreen、TCT阳性结果分别为316例和207例,病理学检查阳性结果为115例。TruScreen、TCT检测的敏感度分别为81.7%、71.3%,特异度分别为79.6%、88.5%、假阴性率分别为18.3%、28.7%,假阳性率分别为20.4%、1 1.5%。TruScreen检查敏感度略高于TCT,差异无统计学意义(P>0.05)。结论:TruScreen的效果评价略优于TCT,具有较低的假阴性率及相对不高的假阳性率,有望成为我国宫颈病变初筛的独立方法。     

宫颈癌筛查系统与液基细胞学检测在宫颈病变初筛中的研究

目的:探讨宫颈癌筛查系统(TruScreen)与液基细胞学检测(TCT)在宫颈病变初筛中的应用价值。方法:对1201例患者依次进行TruScreen、TCT及宫颈活检病理学检查,将其病理结果与Tru-Screen和TCT结果对照分析。结果:TruScreen、TCT阳性结果分别为316例和207例,病理学检查阳性结果为115例。TruScreen、TCT检测的敏感度分别为81.7%、71.3%,特异度分别为79.6%、88.5%,假阴性率分别为18.3%、28.7%,假阳性率分别为20.4%、11.5%。TruScreen检查敏感度略高于TCT,差异无统计学意义(P>0.05)。结论:TruScreen的效果评价略优于TCT,具有较低的假阴性率及相对不高的假阳性率,有望成为我国宫颈病变初筛的独立方法。     

粪便脱落细胞学与粪隐血试验联合检测在结直肠癌诊断的临床意义

目的:通过分析粪便脱落细胞学与粪便隐血在结直肠癌发生、发展中的规律,进而评判粪便脱落细胞学与粪便隐血试验在结直肠癌诊断中的临床意义。方法:对243例患者粪便脱落细胞学与粪便隐血试验与癌胚抗原(CEA)的关系进行分析。结果:243例患者中,粪便隐血试验阳性率为79.5%;粪便脱落细胞学阳性率83.5%;CEA检出率为45.4%或52.9%。结论:粪便脱落细胞学与粪便隐血试验对结直肠癌的诊断有重要的临床意义,是结直肠癌筛检的重要手段,所以在临床应用中,采取两者互补的方法,可大大提高结直肠癌的检出率,且阳性率优于CEA。     

北京市试点社区大肠癌筛查结果及危险因素分析

目的了解北京市试点社区大肠癌筛查的基本情况,探讨影响社区大肠癌发生的危险因素。方法采用问卷调查和大便隐血试验(FOBT)相结合的形式,在北京市的4个社区开展大肠癌筛查项目,所得数据分别采用EPI软件和SPSS软件进行处理。结果实际有效筛查人数为12676人。3472人大便隐血试验为阳性,阳性率为27.39%。阳性人群中,400人进一步接受肠镜检查,检出大肠癌14人,大肠相关疾病293人,无明显异常者93人。单因素分析结果显示,年龄、性别、吸烟、饮酒、不规律饮食、有上腹不适或饱胀感、毒物暴露和受过精神刺激对大肠癌的发生可能有影响(P<0.05)。多因素Logistic回归分析结果显示,性别、不规律饮食和年龄为大肠癌的相关影响因素(P<0.05)。结论北京市试点社区居民大便隐血试验阳性率较高;男性、年龄大是大肠癌发生的危险因素,规律饮食是大肠癌发生的保护因素。     

Influence of non-steroidal anti-inflammatory drugs on the outcome of faecal occult blood tests in screening for colorectal cancer

Non-steroidal anti-inflammatory drugs have been accused of causing false positive results in faecal occult blood tests for colorectal cancer. A study was therefore performed in 10,931 people undergoing faecal occult blood screening tests to assess the effect of these drugs on the predictive value of a positive test result. Those with a positive result were interviewed and a full drug history was taken before they underwent a full colorectal examination. Of the 455 people with a positive result, 50 were taking non-steroidal anti-inflammatory drugs: 10 (20%) had colonic neoplasia. Of the 405 who were not taking non-steroidal anti-inflammatory drugs, 129 (32%) had colonic neoplasia. These detection rates were not significantly different, and the predictive value of a positive result for an adenoma larger than 1 cm was 14% in the group not taking anti-inflammatory drugs and 26% in the group taking them (not significant). These results suggest that a finding of occult faecal blood cannot be attributed to upper gastrointestinal tract bleeding caused by non-steroidal anti-inflammatory drugs and should be followed by a thorough colorectal examination.     

社区糖尿病患者大肠癌筛查结果分析

背景　随着现代生活方式的改变,糖尿病和大肠癌发病率均呈逐渐上升趋势。糖尿病与大肠癌的相关性研究证明,糖尿病是大肠癌的高危因素,该人群应定期进行大肠癌筛查。目的　分析糖尿病患者参与大肠癌筛查的结果,为今后社区糖尿病慢性病管理工作提供更多的技术参考。方法　选取2016-2018年上海市白玉社区卫生服务中心所辖社区中参与大肠癌筛查的糖尿病患者319例,研究初期发放两份调查问卷表,一份是基于体检要求本中心自行设计的健康体检表,主要调查参与筛查的居民有无确诊糖尿病史。另一份为上海市大肠癌筛查项目组统一编制的《上海市社区居民大肠癌筛查危险度评估表》,内容包括基本情况（性别、年龄、婚姻状况、文化程度、职业）、大肠癌危险因素（慢性腹泻史、慢性便秘史、黏液血便史、慢性阑尾炎或阑尾切除史、慢性胆囊炎或胆囊切除史、肠息肉史、血吸虫病史、癌症史、一级亲属肿瘤史、精神创伤史）,记录初筛结果（便隐血试验阳性、危险度评估阳性,任一阳性为初筛阳性）。研究后期针对初筛阳性者发放本中心自行编制的调查问卷表,内容包括是否行肠镜检查、肠镜检查结果、对肠镜检查相关认知（对肠镜检查害怕、认为自己不会有问题、担心检查后出现不适后果、担心查出问题有心理负担、没时间没兴趣、肠镜检查有益处）。结果　319例患者年龄以60~69岁居多（45.8%）,婚姻状况以已婚为主（91.2%）,文化程度以中专/中学为主（57.1%）,职业以国有企业为主（39.8%）。大肠癌危险因素以慢性阑尾炎或阑尾切除史、肠息肉史、慢性胆囊炎或胆囊切除史占比较高,分别为14.7%、13.8%、13.5%。便隐血试验阳性率6.6%（21/319）,危险度评估阳性率18.2%（58/319）,双阳性率6.0%（19/319）。79例初筛阳性患者中,有23例进行了肠镜检查,其中无病变者占39.1%、肠炎者占26.1%、息肉者占21.7%。79例初筛阳性患者中39例认为肠镜检查有益处,22例对肠镜检查害怕。结论　约25%的社区糖尿病患者大肠癌初筛阳性,尤其关注有慢性阑尾炎或阑尾切除史、慢性胆囊炎或胆囊切除史、肠息肉史的患者。     

消化科门诊应用粪便潜血筛检大肠肿瘤的研究

目的探究粪便潜血检查对于大肠肿瘤的筛检意义。方法纳入北京协和医院消化科门诊行粪便潜血和结肠镜检查并有病理学检查结果的512例患者,以结肠镜及病理检查结果为标准,评价粪便潜血结果的诊断价值。结果512例患者中,203例粪便潜血结果阳性,353例结肠镜检查正常,115例有各种息肉,病理检查结果示9例高度不典型增生、21例为大肠癌。粪便潜血检查对于大肠腺瘤性息肉检出的灵敏度、特异度、阳性似然比和阴性似然比分别是42．8％、60．9％、1．09和0．93;对大肠癌及高度不典型增生的灵敏度、特异度、阳性似然比和阴性似然比分别是76．6％、62．5％、2．05和0．37。结论在消化内科就诊的患者中,粪便潜血检查对于大肠癌有一定的诊断和筛查意义,有助于临床医生合理临床决策,但尚需前瞻性研究以建立更可靠的大肠癌筛查模型。     

上海某社区人群大肠癌伺机性筛查结果分析

目的了解社区人群大肠癌危险因素现况,验证分析序贯模式的伺机性筛查效率。方法上海欧阳社区50～85岁常住居民问卷调查和粪便潜血试验（FOBT）初筛,阳性者行肛指、血清肿瘤标记物和结肠镜精筛。结果1206人完成初筛,FOBT总阳性率4％（45／1206）,评估为高危176人,阳性率15％,均接受后续精筛,结肠镜顺应率100％。结肠息肉检出率9％（15／176）,大肠癌检出率5％（8／176）,其中结肠癌5例（63％）,直肠癌3例（37％）。结论社区人群大肠癌高危因素聚焦在遗传背景、腹型肥胖和体力活动缺乏。序贯模式的伺机性筛查顺应性好、效率高、成本低,适合社区人群大肠癌筛查应用。     

直肠粘液T抗原检测在大肠癌临床筛检中的应用

目的　选取结直肠癌及非癌病例作直肠粘液Ｔ抗原检测（Ｓｈａｍ试验）与粪隐血试验的对比分析,评价直肠粘液Ｔ抗原在大肠癌早期初筛中的价值。方法对１９９７～２０００年间５２例结直肠癌及非癌病例进行直肠粘液Ｔ抗原检测及粪隐血试验。结果２９例结直肠癌病例中Ｔ抗原阳性者２６例（８９．７％）、粪隐血阳性者１５例（５１．７％）,２３例非癌病变者Ｔ抗原阳性８例（３４．８％）、粪隐血阳性１１例（４７．８％）。结论直肠粘液Ｔ抗原检测可以取代粪隐血试验成为大肠癌普查的新方法。     

Familial colorectal cancer and the screening of family members

A case-control study was undertaken of the family histories of colorectal cancer in 128 patients with colorectal cancers and those of 61 patients with colorectal adenomas and matched surgical control patients who were attending a regional surgical service in Western Australia. One family with multiple polyposis of the colon was excluded from the study. A history of colorectal cancer in one or more first-degree relatives was associated with a relative risk of colorectal cancer of 2.5 (95% confidence interval, 0.8 to 8.0), of adenoma of 2.0 (95% confidence interval, 0.5 to 8.0) and of any colorectal neoplasm of 2.3 (95% confidence interval, 0.9 to 5.6). Four patients with colorectal cancer and one patient with colorectal adenoma had more than one first-degree relative with colorectal cancer, whereas no control subject gave this history. The five families that were represented by these cases each showed some other features of non-polyposis familial colorectal cancer. It was estimated that familial factors could explain 60% of colorectal cancer in persons with a family history of the disease in a first-degree relative and 5% of colorectal cancer in the population as a whole. Haemoccult II tests were posted to 629 living first-degree relatives of the patients with colorectal cancers and adenomas; 44% of these relatives returned the completed tests. Four relatives with positive results of tests both before and after dietary restriction were investigated; all four subjects had colorectal adenomas. In addition, one subject had a short segment of ulcerative colitis. A further mailing of Haemoccult II tests one year later gave a 39% response rate; no further cases of colorectal neoplasia were found. One relative developed carcinoma of the caecum 10 months after a negative result in the first round of Haemoccult screening. Persons with two or more first-degree relatives with colorectal cancer, with or without other features of non-polyposis familial colorectal cancer, are at a high risk of the development of colorectal cancer. The comparatively-poor response to an offer of Haemoccult II testing and its known insensitivity and lack of specificity suggest that it is not a satisfactory method of screening these high-risk subjects.     

循环肿瘤细胞联合癌胚抗原检测在Ⅰ、Ⅱ期结直肠癌诊断中的应用研究

目的 分析循环肿瘤细胞(circulating tumor cells,CTC)联合癌胚抗原(carcinoembryonic antigen,CEA)检测在Ⅰ、Ⅱ期结直肠癌中的应用价值,为Ⅰ、Ⅱ期结直肠癌患者的临床治疗提供参考。 方法 选取2017年4-9月温州市中心医院收治的结直肠疾病患者121例,根据病理学诊断将其分Ⅰ、Ⅱ期结直肠癌患者和结直肠良性疾病患者,其中Ⅰ、Ⅱ期结直肠癌患者86例作为观察组,结直肠良性疾病患者35例作为对照组,分别检测患者血清中CTC和CEA水平,分析患者CTC计数与其临床资料的关系,并采用一致性检验比较CEA检测、CTC检测、CEA联合CTC检测对Ⅰ、Ⅱ期结直肠癌的诊断价值。 结果 不同CEA水平患者的CTC计数差异有统计学意义(均P<0.05),CEA检测结直肠癌的阳性率为47.67%(41/86),CTC检测结直肠的阳性率为72.09%(62/86),CTC联合CEA检测结直肠癌的阳性率为90.70%(78/86),一致性检验结果显示,CTC联合CEA检测的灵敏度、特异度、准确度及一致性均高于CEA及CTC单独检测。 结论 CTC联合CEA检测在Ⅰ、Ⅱ期结直肠癌诊断中有较高应用价值。      

上海市金山区某社区大肠癌筛查效果评估

目的 评估社区大肠癌筛查工作现况,为完善大肠癌社区筛查工作提供理论参考。 方法 选取2013年5月—2015年1月期间在上海市金山区朱泾社区卫生服务中心进行大肠癌筛查的40岁以上社区居民的筛查资料,采用SPSS 19.0统计软件对这些居民的大便潜血检查结果、危险度评估结果与肠镜检查和活检的最终结果进行一致性分析。 结果 2013年5月—2015年1月期间共计7 787例辖区居民进行大肠癌社区初筛,筛出1 727例阳性,检出率22.4%;其中,大便潜血阳性1 447例,检出率为18.8%,问卷危险度评估阳性438例,阳性率为5.7%,2种方法检出的阳性重复病例为158例,重复率为9.15%。转诊818例(47.37%),确诊病例303例(37.04%),大便潜血和危险度评估确诊率分别为36.24%、39.90%。经检验,2种办法与诊断结果一致性也并不显著(P＞0.05)。 结论 我国社区目前在大肠癌初筛过程中所使用的危险度评估和大便潜血检验方法,筛查效能相当且重复率较低,这就保障了卫生资源的充分利用。多种低重复、高效度筛查指标协同配合可有效提高社区人群大肠癌筛查的早发现、早诊断,但人群转诊依从性有明显限效作用需进一步提高。      

尿膀胱肿瘤抗原在膀胱癌中的表达及意义

摘要：目的  探讨膀胱肿瘤抗原（BTA）的临床应用价值。方法  收集46例膀胱癌、35例泌尿系良性疾病、10例健康者尿液,同时做尿脱落细胞学及BTA检测。结果  ①BTA检测的敏感性为86.9%,特异性为82.2%,假阳性率为17.8%（95%CI：0.759,0.924）;尿脱落细胞学检测的敏感性为34.7%,特异性为97.8%,假阳性率为2.2%（95%CI：0.550,0.775）;②BTA表达水平和敏感性与肿瘤分级分期、有无肉眼血尿有关（P <0.05）,与复发或初发无关（P >0.05）;BTA对各级、各期的膀胱癌的敏感性均高于尿脱落细胞学检测（P <0.05）;③BTA在早期膀胱癌（Ta～T1期）中表达水平高于良性疾病组、健康组（P <0.05）。结论  BTA对膀胱癌的诊断、早期筛查及跟踪随访有较高的临床应用价值,但应注意血尿影响BTA检测结果。

     

前哨淋巴结定位在结直肠癌中的研究

目的探讨结直肠癌前哨淋巴结的检测厦其对淋巴结转移的预测，用于指导手术范围。方法术中注射异硫蓝方法对43例结肠癌患者进行手术中前哨淋巴结的临床研究，手术中取前哨淋巴结作快速冰冻病理并与术后常规蜡块病理相对照，观察冰冻病理前哨淋巴结转移与常规病理肠系膜淋巴转移的相关性，厦其对肠系膜淋巴结转移的预测价值。结果43例结直肠癌病人中，42例确定了前哨淋巴结，前哨淋巴结活检成功率97．7％。42例病人共检出淋巴结142个。检出前哨淋巴结35个。将前哨淋巴结冰冻病理与常规病理结果对照，42例结肠癌病人中15例患者证实淋巴结有转移，13例有前哨淋巴结转移，其中9例有非前哨淋巴结转移，4例无非前哨淋巴结转移；29例无前哨淋巴结转移，其中27例无非前哨淋巴结转移，2例有非前哨淋巴结转移。检出特异性为100％（27／27），敏感性为86．7％（13／15），前哨淋巴结假阴性率为13．3％（2／15）。结论前哨淋巴结检测结肠癌对淋巴结转移有重要价值。可以用于指导临床手术。