Rate of detection of advanced neoplasms in proximal colon by simulated sigmoidoscopy vs fecal immunochemical tests.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Castells Antoni, Quintero Enrique, Álvarez Cristina, Bujanda Luis, Cubiella Joaquín, Salas Dolores, Lanas Angel, Carballo Fernando, Morillas Juan Diego, Hernández Cristina, Jover Rodrigo, Hijona Elizabeth, Portillo Isabel, Enríquez-Navascués José M, Hernández Vicent, Martínez-Turnes Alfonso, Menéndez-Villalva Carlos, González-Mao Carmen, Sala Teresa, Ponce Marta, Andrés Mercedes, Teruel Gloria, Peris Antonio, Sopeña Federico, González-Rubio Francisca, Seoane-Urgorri Agustín, Grau Jaume, Serradesanferm Anna, Pozo Àngels, Pellisé Maria, Balaguer Francesc, Ono Akiko, Cruzado José, Pérez-Riquelme Francisco, Alonso-Abreu Inmaculada, Carrillo-Palau Marta, de la Vega-Prieto Mariola, Iglesias Rosario, Amador Javier, Blanco José Manuel, Sastre Rocio, Ferrándiz Juan, González-Hernández Ma José, Andreu Montserrat, Bessa Xavier, COLONPREV Study Investigators
Аннотация
METHODS: We identified asymptomatic men and women, 50-69 years old, through community health registries and randomly assigned them to groups that received a single colonoscopy examination or biennial FIT. Sigmoidoscopy yield was simulated from results obtained from the colonoscopy group, according to the criteria proposed in the UK Flexible Sigmoidoscopy Trial for colonoscopy referral. Patients who underwent FIT and were found to have ≥75 ng hemoglobin/mL were referred for colonoscopy. Data were analyzed from 5059 subjects in the colonoscopy group and 10,507 in the FIT group. The main outcome was rate of detection of any advanced neoplasm proximal to the splenic flexure.
RESULTS: Advanced neoplasms were detected in 317 subjects (6.3%) in the sigmoidoscopy simulation group compared with 288 (2.7%) in the FIT group (odds ratio for sigmoidoscopy, 2.29; 95% confidence interval, 1.93-2.70; P = .0001). Sigmoidoscopy also detected advanced distal neoplasia in a higher percentage of patients than FIT (odds ratio, 2.61; 95% confidence interval, 2.20-3.10; P = .0001). The methods did not differ significantly in identifying patients with advanced proximal neoplasms (odds ratio, 1.17; 95% confidence interval, 0.78-1.76; P = .44). This was probably due to the lower performance of both strategies in detecting patients with proximal lesions (sigmoidoscopy detected these in 19.1% of patients and FIT in 14.9% of patients) vs distal ones (sigmoidoscopy detected these in 86.8% of patients and FIT in 33.5% of patients). Sigmoidoscopy, but not FIT, detected proximal lesions in lower percentages of women (especially those 50-59 years old) than men.
CONCLUSIONS: Sigmoidoscopy and FIT have similar limitations in detecting advanced proximal neoplasms, which depend on patients' characteristics; sigmoidoscopy underperforms for women 50-59 years old. Screening strategies should be designed on the basis of target population to increase effectiveness and cost-effectiveness. ClinicalTrials.gov number: NCT00906997.