重视粪便血红蛋白免疫学检测在结直肠癌筛查中的应用及质量控制

结直肠癌(CRC)的发病率高且呈上升趋势，多数患者在就诊时已出现血便及局部浸润或转移。粪便血红蛋白免疫学检测(FIT)可筛查出一般风险人群中一定比例的结直肠进展期腺瘤(AA)和CRC,降低CRC的发病率和死亡率。FIT被广泛用于CRC的筛查。该文对FIT用于CRC筛查的风险和获益、一般风险人群的筛查策略、现实与理想筛查模型及其质量控制进行概述。     

结直肠癌筛查的研究进展

结直肠癌是常见恶性肿瘤之一,早期诊断对提高治疗效果及患者生存率有重要作用,但我国多数结直肠癌患者就诊时已处于肿瘤进展期,接受手术、放疗及化疗等综合治疗后预后较差。结直肠癌筛查有助于肿瘤早期诊断,为积极治疗争取时间。目前,粪便筛查和内镜筛查技术用于结直肠癌筛查已被较多国家认可和采用。本文就粪便筛查、内镜筛查及二者用于大规模筛查中的可行性作一综述。     

结直肠癌筛查的研究进展

结直肠癌是常见恶性肿瘤之一,早期诊断对提高治疗效果及患者生存率有重要作用,但我国多数结直肠癌患者就诊时已处于肿瘤进展期,接受手术、放疗及化疗等综合治疗后预后较差。结直肠癌筛查有助于肿瘤早期诊断,为积极治疗争取时间。目前,粪便筛查和内镜筛查技术用于结直肠癌筛查已被较多国家认可和采用。本文就粪便筛查、内镜筛查及二者用于大规模筛查中的可行性作一综述。     

结直肠癌筛查的研究进展

结直肠癌是常见恶性肿瘤之一,早期诊断对提高治疗效果及患者生存率有重要作用,但我国多数结直肠癌患者就诊时已处于肿瘤进展期,接受手术、放疗及化疗等综合治疗后预后较差.结直肠癌筛查有助于肿瘤早期诊断,为积极治疗争取时间.目前,粪便筛查和内镜筛查技术用于结直肠癌筛查已被较多国家认可和采用.本文就粪便筛查、内镜筛查及二者用于大规模筛查中的可行性作一综述.     

腹腔镜结直肠癌根治术的临床应用

目的探讨腹腔镜行结直肠癌根治术的可行性。方法总结31例经腹腔镜结直肠癌根治术手术时间,出血量,术后肠功能恢复时间,住院时间,淋巴结清扫,术后复发转移及并发症发生的情况。结果31例患者恢复良好,手术时间150～320min,平均222min;术中出血80～300ml;术后平均33h恢复胃肠道功能,平均住院10.5d,淋巴结清扫11个。结论腹腔镜技术在结直肠恶性肿瘤根治术中有广阔的应用前景。     

由381例结直肠癌患者资料探讨伺机性筛查方法

[目的]分析本院收治的381例确诊结直肠癌患者的临床资料,以探讨结直肠癌伺机性筛查的策略.[方法]回顾性分析2014年1月至2019年12月本院收治381例确诊为结直肠癌患者的临床资料,对患者人口学特征、生化资料、组织学类型等进行分析,比较不同性别结直肠癌患者年龄分布、患病位置及组织学类型情况,并分析结直肠癌患者高危因...     

遗传性非息肉病性结直肠癌的诊治

遗传性非息肉病性结直肠癌 (ＨＮＰＣＣ)是一种常染色体显性遗传性疾病。Ｌｙｎｃｈ和他的同事们仔细的描述了这种疾病的遗传学和临床特征 ,由此 ,ＨＮＰＣＣ又被称作Ｌｙｎｃｈ综合征。本病的特点 :肿瘤发生早 ,好发于近侧结肠 ,同时或异时大肠癌多见 ,常见肠外恶性肿瘤。本病的诊治、随访与一般散发大肠癌有所不同。材料与方法本病按１９９１年国际ＨＮＰＣＣ协作组制定的Ａｍｓｔｅｒｄａｍ诊断标准,同时具备以下三点 :１、家系中至少有３例经组织病理学确诊的大肠癌患者 ,其中１例必须是另外２例的直系亲属 ;２、大肠癌必须累及连续两…     

FOBT阳性人群结肠镜二次筛查结直肠癌的效果分析

目的观察连续粪便隐血试验(FOBT)阳性人群应用结肠镜二次筛查结直肠癌的效果。方法选取FOBT阳性2 192例为目标人群,应用结肠镜进行二次筛查结直肠癌。发现息肉样病变即取活检或摘除,病理确诊。分析筛查数据,计算初筛阳性人群中不同年龄段和不同性别人群的结直肠肿瘤检出率。结果 2 048例完成结肠镜检查,检出结直肠肿瘤307例,检出率为14.99%(95%CI:12.89%~17.01%)。其中结直肠癌33例,检出率为1.61%(95%CI:0.91%~2.03%);进展期腺瘤92例,检出率为4.49%(95%CI:3.88%~5.12%);非进展期腺瘤182例,检出率为8.89%(95%CI:7.81%~10.01%)。结直肠癌发病率男性高于女性(P=0.013),年龄段越大结直肠癌发病率越高(P0.05)。结论 FOBT阳性人群应用结肠镜二次筛查结直肠癌效果显著,值得推广。     

早发型结直肠癌的临床病理及分子病理学特征

目的 通过分析早发型结直肠癌(CRC)的临床及分子病理学特征,探讨其潜在发病机制及生物学行为。方法 回顾江苏省人民医院/南京医科大学第一附属医院病理学部2018—2020年CRC手术样本,整理相关的临床,分子病理学及随访资料。结果 在1243例手术样本中,早发型CRC(≤50岁)共计180例(14%):女性73例,男性107例;右半结肠42例,左半结肠136例;57例肿瘤为低分化,122例为中高分化;肿瘤平均大小为(4.37±2.01)cm;组织学腺癌143例,黏液腺癌或含黏液成分38例;微卫星高度不稳定(MSI-H)22例,微卫星稳定或低度不稳定(Non-MSI-H)158例。检测到KRAS突变型79例;NRAS突变型4例;BRAF突变型6例。相对于非早发型CRC,早发型肿瘤的分化更差,MSI-H比例更高(P<0.05)。Kaplan-Meier曲线显示早发型与非早发型CRC 3年总生存率无显著差异(P>0.05)。COX比例风险模型显示发病年龄(≤50岁)对CRC患者生存无显著影响(P>0.05)。结论 早发型CRC具有特殊的临床病理及分子病理学特征,提示这部分肿...     

A novel multitarget stool DNA test for colorectal cancer screening

Review of: Imperiale TF, Ransohoff DF, Itzkowitz SH, Levin TR, Lavin P, Lidgard GP, Ahlquist DA, Berger BM. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med 2014;370(14):1287–97.

This Practice Pearl reviews the results of a prospective, multicenter, cross-sectional clinical study that evaluated the performance of a new multitarget stool DNA (or mt-sDNA) screening test for colorectal cancer (CRC) and compared it with a fecal immunochemical test (FIT) in individuals at average risk for CRC. The potential impact of this test on the future of CRC screening is also discussed in a brief commentary. mt-sDNA testing is a noninvasive screening test designed to detect DNA biomarkers associated with colorectal neoplasia and occult hemoglobin in the stool. The sensitivity of mt-sDNA testing for detection of CRC was 92.3%, compared with 73.8% for FIT (p = 0.002). Sensitivity for detecting advanced precancerous lesions was 42.4% for mt-sDNA testing and 23.8% for FIT (p < 0.001). The specificities of mt-sDNA testing and FIT were 86.6% and 94.9%, respectively (p < 0.001). mt-sDNA testing thus may be a first-line screening option for asymptomatic individuals at average risk for CRC who do not want to have a colonoscopy.     

Adaptation and validation of the health belief model scale for colorectal cancer screening

Korea has the second highest incidence of colorectal cancer in the world. Instruments that are culturally and contextually sensitive, as well as valid and reliable, for determining health beliefs regarding colorectal cancer screening are essential for obtaining accurate information. The purpose of this study was to adapt and validate the health belief model scale for Koreans regarding colorectal cancer and fecal occult blood test utilization. Individual and cognitive interviews (also known as cognitive debriefing) with 33 Koreans, expert reviews with seven nursing practitioners and professors, and a pilot test with 18 Koreans were conducted to make the existing health belief model scale culturally and contextually sensitive. Subsequently, a cross‐sectional survey with 728 Koreans aged > 50 years was conducted. Exploratory and confirmatory factor analyses of the construct validity and internal consistency reliability supported the adapted health belief model scale. The adapted and validated health belief model scale in this study could contribute to the assessment of health beliefs regarding the fecal occult blood test among Koreans with a greater degree of accuracy with respect to Korean culture and context.     

Ultrasonographic diagnosis of advanced colorectal cancer

We investigated the efficacy of transabdominal ultrasonography for the diagnosis of advanced colorectal cancer. Colonic examination by colonoscopy, barium study, or surgery was carried out in our institution on 1579 patients during the past 5 years. This study focused on 1564 of these patients, 15 who has been diagnosed with colorectal cancer before ultrasound examination having been excluded. The results included 51 ultrasound-positive cases, 9 ultrasound-false-positive cases, 1476 ultrasound-negative cases, and 28 ultrasound-false-negative cases. Sensitivity was 64.6 percent and specificity was 99.6 percent. Of the 28 ultrasound-false-negative cases, the lesion was detected in the ascending colon in 2, in the transverse colon in 6, in the descending colon in 1, in the sigmoid colon in 3, and in the rectum in 16. Obstruction and dilatation suggested colorectal cancer in 3 cases, which were thus classified as ultrasound-negative when no tumors were detected. Sensitivity was investigated by site. Sensitivity was lowest at 30.4 percent in rectal cancer, but was 78.6 percent in colon cancer, exclusive of rectal cancer. Laboratory findings and clinical symptoms which were suggestive of colorectal cancer were used as information before ultrasound examination was performed. Sensitivity of examinations carried out on examinees on whom prior information was available and on those on whom there was no information did not differ significantly. Furthermore, ultrasound was thought to detect approximately 65 percent of advanced colorectal cancers when it was used aggressively to investigate the large intestine. Ultrasound was thus considered effective for detecting advanced colorectal cancer.     

北京大学首钢医院社区大肠癌筛查调查分析

目的总结本院社区大肠癌筛查及结肠镜检查结果,探讨进一步提高癌前病变和早期大肠癌检出率、减少大肠癌发病率的方法。方法2016年3月至2018年9月对本院所属四个社区卫生服务中心消化科就诊患者进行问卷调查及粪便潜血试验,针对高危人群进行结肠镜检查,对结肠镜检查结果进行分析。结果参与筛查及完成结肠镜检查的女性患者均多于男性;息肉总检出率为35.6%,男性检出率(42.6%)高于女性(31.7%)(P<0.05);腺瘤总检出率为29.3%,男性检出率(35.5%)高于女性(25.8%)(P<0.05)。结论对无明显症状的社区居民进行大肠癌筛查,尤其是男性居民,可提早发现并处理癌前病变和早期大肠癌,有效降低大肠癌的发病率。     

An intervention study to increase colorectal cancer knowledge and screening among community elders

This study evaluates the effectiveness of a culturally relevant intervention, delivered over 12 months on knowledge of colorectal cancer and participation in fecal occult blood testing. An experimental, repeated measures design was used. Free fecal occult blood testing was offered to the participants. Fifteen senior centers were randomly selected and assigned to the Cultural and Self-Empowerment Group, the Modified Cultural Group, or the Traditional Group. Their mean age was 73.83 years, and their average educational level was 8.8 years. The majority was African American, female, and reported annual incomes < or = 10,000 dollars. Data were collected at baseline, at 6 months, and at 12 months. Participants in the Cultural and Self-Empowerment Group had a significantly greater increase in their knowledge of colorectal cancer over time. Group membership and knowledge of colorectal cancer were significant predictors of participation in colorectal cancer screening. Participants in the Cultural and Self-Empowerment Group and those with greater knowledge of colorectal cancer were more likely to participate in fecal occult blood testing at the end of the 12-month period. Similar strategies may be implemented in community settings and health care agencies to inform elders about colorectal cancer.     

新型超细鼻胃镜联合色素染色门诊机会性筛查早期胃癌及癌前病变的临床应用价值

目的 探讨新型超细鼻胃镜联合色素染色门诊机会性筛查早期胃癌及癌前病变的临床应用价值.方法 2016年1月至2018年5月在我院内镜室应用日本Fujifilm最新型EG-530 NW超细电子胃镜经鼻腔插入对7421例门诊患者进行上消化道检查.统计患者的活检病理结果,分析癌前病变、早期胃癌、进展期胃癌患者的临床及病理特征、...     

Using iron deficiency tests for colorectal cancer screening: a feasibility study in one UK general practice

Iron deficiency is common at presentation in colorectal cancer. Testing for it may complement other screening tests such as faecal occult blood testing and sigmoidoscopy. We therefore examined the feasibility of offering iron deficiency testing to patients in a primary care setting in the UK, offering testing to all 1240 patients aged 55-74 years in one general practice in South Wales, UK. Patients with abnormal results were assessed and offered further investigations. Five hundred and fifty-one people (44.4%) attended for iron deficiency blood tests, of whom 26 patients (4.7%) were iron deficient and offered endoscopic assessment. This identified two cases of benign neoplasia amenable to treatment and no cases of cancer. Iron deficiency testing in a screening context appeared feasible although uptake may be low.     

New molecular diagnosis and screening methods for colorectal cancer using fecal protein,DNA and RNA

Several screening methods for reducing the mortality rate of colorectal cancer (CRC) have been reported in recent decades. Fecal occult blood tests (FOBTs) are widely used for CRC screening and immunochemical FOBTs perform better than guaiac FOBTs; however, the sensitivity and specificity of immunochemical FOBTs remain unsatisfactory. To resolve this problem, novel fecal molecular methods based on fecal protein, DNA and RNA analyses have been developed. Regarding fecal proteins, several marker proteins indicating intestinal bleeding and cancer cell-specific proteins have been investigated. Regarding fecal DNA, numerous gene mutation and gene methylation analyses have been reported. Consequently, fecal DNA analysis was recommended as a CRC screening method in 2008. In addition, gene expression analyses of CRC-specific genes and miRNAs in fecal RNA have been investigated over the last decade. This review article summarizes molecular methods using fecal samples for CRC screening, focusing on reports within the last 5 years.     

Potential biases in colorectal cancer screening using faecal occult blood test

Background Colorectal cancer (CRC) is one of the most common types of cancer in European countries and associated with a high mortality rate. A 16% relative risk reduction (RRR) of mortality was found in a meta‐analysis based on four randomized controlled trials (RCT) on CRC screening. The aim of this paper was to scrutinize these trials for potential biases and assess their influence on the screening trials. Methods The four RCTs were reviewed based on the principles of ‘Critical Appraisal of the Medical Literature’. Principal investigators of the four RCTs were contacted to clarify uncertainties in their study. Data were collected from The Danish Data Archives. Authors of the Cochrane review were contacted. Results Six biases were identified, of which five favour screening. Three of the biases identified were specific to CRC screening: type of diagnostic method, place of surgery and diagnostic delay. Conclusion The 16% RRR in CRC mortality found in the updated Cochrane review's meta‐analysis is overestimated.