结肠镜筛查女性人群结肠直肠瘤  

Colonoscopic screening of average-risk women for colorectal neoplasia

作　　者：Schoenfeld P. Cash B. Flood A. 刘丽娜 

机构地区：[1]VAMC 111-D, 2215 Fuller Rd., Ann Arbor, MI 48105, United States Dr.

出　　处：《世界核心医学期刊文摘（胃肠病学分册）》2005年第9期4-5,共2页Core Journals in Gastroenterology

摘　　要：BACKGROUND: Veterans Affairs (VA) Cooperative Study 380 showed that some advan ced colorectal neoplasias (i.e., adenomas at least 1 cm in diameter, villous ade nomas, adenomas with highgrade dysplasia, or cancer) in men would be missed wi th the use of flexible sigmoidoscopy but detected by colonoscopy. In a tandem st udy, we examined the yield of screening colonoscopy in women. METHODS: To determ ine the prevalence and location of advanced neoplasia, we offered colonoscopy to consecutive asymptomatic women referred for coloncancer screening. The diagno stic yield of flexible sigmoidoscopy was calculated by estimating the proportion of patients with advanced neoplasia whose lesions would have been identified if they had undergone flexible sigmoidoscopy alone. Lesions were considered detect able by flexible sigmoidoscopy if they were in the distal colon or if they were in the proximal colon in patients who had concurrent small adenomas in the dista l colon, a finding that would have led to colonoscopy. The results were compared with the results from VA Cooperative Study 380 for agematched men and women wit h negative fecal occultblood tests and no family history of colon cancer. RESU LTS: Colonoscopy was complete in 1463 women, 230 of whom (15.7 percent) had a fa mily history of colon cancer. Colonoscopy revealed advanced neoplasia in 72 wome n (4.9 percent). If flexible sigmoidoscopy alone had been performed, advanced ne oplasia would have been detected in 1.7 percent of these women (25 of 1463) and missed in 3.2 percent (47 of 1463). Only 35.2 percent ofwomen with advanced neop lasia would have had their lesions identified if they had undergone flexible sig moidoscopy alone, as compared with 66.3 percent of matched men from VA Cooperati ve Study 380 (P< 0.001). CON CLUSIONS: Colonoscopy may be the preferred method of screening for colorectal cancer in women.BACKGROUND: Veterans Affairs (VA) Cooperative Study 380 showed that some advan ced colorectal neoplasias (i.e., adenomas at least 1 cm in diameter, villous ade nomas, adenomas with highgrade dysplasia, or cancer) in men would be missed wi th the use of flexible sigmoidoscopy but detected by colonoscopy. In a tandem st udy, we examined the yield of screening colonoscopy in women. METHODS: To determ ine the prevalence and location of advanced neoplasia, we offered colonoscopy to consecutive asymptomatic women referred for coloncancer screening. The diagno stic yield of flexible sigmoidoscopy was calculated by estimating the proportion of patients with advanced neoplasia whose lesions would have been identified if they had undergone flexible sigmoidoscopy alone. Lesions were considered detect able by flexible sigmoidoscopy if they were in the distal colon or if they were in the proximal colon in patients who had concurrent small adenomas in the dista l colon, a finding that would have led to colonoscopy. The results were compared with the results from VA Cooperative Study 380 for agematched men and women wit h negative fecal occultblood tests and no family history of colon cancer. RESU LTS: Colonoscopy was complete in 1463 women, 230 of whom (15.7 percent) had a fa mily history of colon cancer. Colonoscopy revealed advanced neoplasia in 72 wome n (4.9 percent). If flexible sigmoidoscopy alone had been performed, advanced ne oplasia would have been detected in 1.7 percent of these women (25 of 1463) and missed in 3.2 percent (47 of 1463). Only 35.2 percent ofwomen with advanced neop lasia would have had their lesions identified if they had undergone flexible sig moidoscopy alone, as compared with 66.3 percent of matched men from VA Cooperati ve Study 380 (P< 0.001). CON CLUSIONS: Colonoscopy may be the preferred method of screening for colorectal cancer in women.

关 键 词：结肠直肠 结肠镜筛查 女性人群 乙状结肠镜 早期肿瘤 结肠癌筛查 远端结肠 漏诊率 大便隐血试验 诊断率 

分 类 号：R735.3[医药卫生—肿瘤]