单次软性乙状结肠镜筛查对后续粪便隐血试验筛查结果的影响。
Effect of once-only flexible sigmoidoscopy screening on the outcomes of subsequent faecal occult blood test screening.
机构信息
1 Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.
2 NHS Cancer Screening Programmes, Sheffield, UK.
出版信息
J Med Screen. 2019 Mar;26(1):11-18. doi: 10.1177/0969141318785654. Epub 2018 Oct 3.
OBJECTIVE
To investigate the outcomes of biennial guaiac faecal occult blood test (gFOBT) screening after once-only flexible sigmoidoscopy (FS) screening.
METHODS
Between 1994 and 1999, as part of the UK FS Screening Trial (UKFSST), adults aged 55-64 were randomly allocated to an intervention group (offered FS screening) or a control group (not contacted). From 2006, a subset of UKFSST participants (20,895/44,041 intervention group; 41,497/87,149 control group) were invited to biennial gFOBT screening by the English Bowel Cancer Screening Programme. We analysed gFOBT uptake, test positivity, yield of colorectal cancer (CRC), and positive predictive value (PPV) for CRC, advanced adenomas (AAs), and advanced colorectal neoplasia (ACN: AA/CRC).
RESULTS
Uptake of gFOBT at first invitation was 1.9% lower (65.7% vs. 67.6%, p < 0.01) among intervention versus control group participants. Positivity was 0.4% lower (2.0% vs. 2.4%, p < 0.01) and CRC yield was 0.08% lower (0.19% vs. 0.27%, p = 0.14). PPVs were also lower in the intervention versus control group, at 10.3% vs. 12.3% ( p = 0.44) for CRC, 22.7% vs. 31.4% ( p < 0.01) for AA, and 33.0% vs. 43.7% ( p < 0.01) for ACN. Among those who refused FS ( n = 5532), gFOBT uptake at first invitation was 47.7%, CRC yield was 0.25%, and PPV for ACN was 46.2%. Among FS attenders ( n = 15,363), uptake was 72.2%, CRC yield was 0.18%, and PPV for ACN was 27.9%.
CONCLUSIONS
Uptake, positivity and PPV of gFOBT screening were reduced following prior offer of FS screening. However, a quarter of FS screened participants receiving a diagnostic examination after positive gFOBT were diagnosed with ACN.
目的
研究单次乙状结肠镜筛查后进行两年一次粪便潜血免疫化学试验（gFOBT）筛查的结果。
方法
1994 年至 1999 年，作为英国乙状结肠镜筛查试验（UKFSST）的一部分，55-64 岁的成年人被随机分配到干预组（接受乙状结肠镜筛查）或对照组（不联系）。从 2006 年开始，英国 FSST 参与者的一个亚组（干预组 20895/44041 人；对照组 41497/87149 人）受邀参加英国肠癌筛查计划的两年一次 gFOBT 筛查。我们分析了 gFOBT 的检出率、检测阳性率、结直肠癌（CRC）检出率、阳性预测值（PPV），以及 CRC、高级腺瘤（AA）和高级结直肠肿瘤（ACN：AA/CRC）的检出率。
结果
与对照组相比，干预组首次受邀时 gFOBT 的检出率低 1.9%（65.7%比 67.6%，p<0.01）。阳性率低 0.4%（2.0%比 2.4%，p<0.01），CRC 检出率低 0.08%（0.19%比 0.27%，p=0.14）。干预组的 PPV 也低于对照组，CRC 的 PPV 为 10.3%比 12.3%（p=0.44），AA 的 PPV 为 22.7%比 31.4%（p<0.01），ACN 的 PPV 为 33.0%比 43.7%（p<0.01）。在拒绝接受 FS 检查的 5532 人中（ n=5532），首次受邀时 gFOBT 的检出率为 47.7%，CRC 检出率为 0.25%，ACN 的 PPV 为 46.2%。在接受 FS 检查的 15363 人中（ n=15363），gFOBT 的检出率为 72.2%，CRC 检出率为 0.18%，ACN 的 PPV 为 27.9%。
结论
在提供 FS 筛查后，gFOBT 筛查的检出率、阳性率和 PPV 均有所降低。然而，在接受阳性 gFOBT 筛查后接受诊断性检查的 FS 筛查参与者中，有四分之一被诊断为 ACN。
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