结直肠镜漏诊结直肠癌情况一致性的评价研究

Evaluation of the colorectal cancer missing rate by colonscopy

目的利用美国前列腺、肺、结直肠及卵巢癌筛查数据库(prostate,lung,colorectal,and ovarian,PLCO),评价结直肠镜漏诊结直肠癌的比例及漏诊病人的特征,为提高结直肠癌的筛查效果提供循证依据。方法选择PLCO研究干预人群中进行了基线检查或者3年或5年结直肠镜复查的结直肠癌病人为研究对象。以基线或者随访结直肠镜检查没发现的结直肠癌患者为分子,以基线或者随访结直肠镜检查一年内发现的所有结直肠癌患者(结直肠镜发现的结直肠癌患者+肿瘤登记系统发现的结直肠癌患者+年度自我报告问卷发现的结直肠癌患者)为分母,计算结直肠镜漏诊结直肠癌的比例。结果共有338名结直肠癌患者纳入分析,其中经结直肠镜检查漏诊59名,漏诊比例为17.5%。65~69岁的漏诊率相对较高(24.2%)、低分化和近端结肠癌漏诊比例较高(32.4%和47.4%)。结论结直肠镜检查漏诊结直肠癌的比例相对较高,漏诊主要集中在近端结肠,提高粪便DNA等检测技术的准确性,可能是克服结直肠镜漏诊问题的有效途径。

Objective To evaluate the colonscopy missed colorectal cancer rate using the data collected from Prostate,Lung,Colorectal,and Ovarian(PLCO)study.Methods The colorectal cancer patients who were enrolled in the screening arm of PLCO study and completed the baseline or 3 or 5 years endoscopy screenings were selected as participants.The missing rate was defined as the number of colorectal cancer patients missed by colonscopy divided by the number of colorectal cancer patients confirmed by colonscopy,annual questionnaire,or cancer registry system.Results 59 out of 338 colorectal cancer patients were missed by colonscopy,which accounted for 17.5%of the total patients.The patients aged 65-69 years old(24.2%),with moderately differentiated histological type(32.4%),and with lesion s at proximal colon sites(47.4%)had high missing rates.Conclusions Colonscopy missed a relatively high proportion of colorectal cancer patients especially for those occurring at proximal colon.To improve the diagnostic accuracy of noninvasive screening method might overcome the limitation of high missing rate of endoscopy.