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目的对于排除有症状的结直肠癌(CRC)病人,CT结肠成像(CTC)较结肠镜是一种更易为病人所接受的检查。我们评估接受CTC检查而被漏诊的CRC病人的比率。方法 2007年1月1日—2011年1月1日期间做过CTC检查的病人与2007年1月1日—2011年7月1日期间肿瘤登记处记录的所有CRC病人进行合并,以便确定所有病人在被诊断为CRC之前2年内接受了CTC检查。结果在1855例经CTC检查的病人中有53例被诊断为CRC。其中,40例为疑似CRC,5例在CTC上可见较大息肉。5例有不确定肿块的病人被进一步确诊为恶性。1例盲肠癌由于舒张太差被漏诊。2例病人在远端直肠和升结肠的癌被漏诊。CTC诊断CRC的敏感度为94.3%(95%CI:88%～100%)。在排除舒张不充分的病例后,真正的漏诊率为2/53(3.8%)。结论本研究表明CTC检查的漏诊率较低,这意味着CTC能够低风险、准确地排除有症状的CRC病人。要点①CTC对结肠癌的漏诊率低。②CTC能正确地排除有症状病人的CRC。③CTC是有症状病人排除CRC可以选择的方法。
Purpose CT colonography (CTC) is a more patient-friendly test than colonoscopy in patients with symptomatic colorectal cancer (CRC). We evaluated the percentage of CRC patients who missed the CTC examination. Methods Patients with CTC examinations between January 1, 2007 and January 1, 2011 were pooled with all CRC patients recorded by the Tumor Registry from January 1, 2007 to July 1, 2011 to determine all The patient underwent CTC examination within 2 years before being diagnosed with CRC. Results Of the 1855 CTC-reviewed patients, 53 were diagnosed with CRC. Among them, 40 cases were suspected CRC, 5 cases showed larger polyps in CTC. Five patients with an indeterminate mass were further diagnosed as malignant. One case of cecal cancer was missed because of poor diastole. Two patients had missed diagnosis of distal rectal and ascending colon cancers. The sensitivity of CTC in the diagnosis of CRC was 94.3% (95% CI: 88% -100%). After excluding cases of inadequate diastole, the true missed diagnosis rate was 2/53 (3.8%). Conclusions This study shows that there is a low rate of misdiagnosis in CTCs, which means that CTCs can exclude symptomatic CRC patients with low risk and accuracy. Key points ①CTC low rate of missed diagnosis of colon cancer. CTC can correctly exclude symptomatic patients CRC. ③ CTC is symptomatic patients excluded CRC can choose the method.