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Thématique :
- Endoscopie/Imagerie
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Originalité :
Intermédiaire
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Dans certains cas
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Nom du veilleur :
Docteur Patrice PIENKOWSKI
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Gastroenterology
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2016/04
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2016 Mar;150(3):617-625.e3
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doi: 10.1053/j.gastro.2015.11.042
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A Risk-Scoring System Combined With a Fecal Immunochemical Test Is Effective in Screening High-Risk Subjects for Early Colonoscopy to Detect Advanced Colorectal Neoplasms.
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Chiu HM, Ching JY, Wu KC, Rerknimitr R, Li J, Wu DC, Goh KL, Matsuda T, Kim HS, Leong R, Yeoh KG, Chong VH, Sollano JD, Ahmed F, Menon J, Sung JJ; Asia-Pacific Working Group on Colorectal Cancer.
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http://www.ncbi.nlm.nih.gov/pubmed/?term=A+Risk-Scoring+System+Combined+With+a+Fecal+Immunochemical+Test+Is+Effective+in+Screening+High-Risk+Subjects+for+Early+Colonoscopy+to+Detect+Advanced+Colorectal+Neoplasms.
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BACKGROUND & AIMS:
Age, sex, smoking, and family history are risk factors for colorectal cancer in Asia. The Asia-Pacific Colorectal Screening (APCS) scoring system was developed to identify subjects with a high risk for advanced neoplasm (AN). We tested an algorithm that combined APCS scores with fecal immunochemical test (FIT) in colorectal cancer screening.
METHODS:
We performed a multicenter prospective study, enrolling asymptomatic individuals older than 40 years old in 12 Asia-Pacific regions from December 2011 to December 2013. APCS scores were calculated for each individual (0-1 = low risk [LR], 2-3 = medium risk [MR], and 4-7 = high risk [HR] for AN). LR and MR subjects were offered FIT and referred for early colonoscopies if FIT results were positive. HR subjects were offered colonoscopies. The proportions of subjects with ANs were determined for each group based on colonoscopy findings; odd ratios for LR and MR subjects were calculated compared to LR individuals. We calculated the sensitivity of the APCS-FIT algorithm in identifying subjects with AN.
RESULTS:
A total of 5657 subjects were recruited: 646 subjects (11.4%) were considered LR, 3243 subjects (57.3%) were considered MR, and 1768 subjects (31.3%) were considered HR for AN. The proportions of individuals with an AN in these groups were 1.5%, 5.1%, and 10.9%, respectively. Compared with LR group, MR and HR subjects had a 3.4-fold increase and a 7.8-fold increase in risk for AN, respectively. A total of 70.6% subjects with AN (95% confidence interval: 65.6%-75.1%) and 95.1% subjects with invasive cancers (95% confidence interval: 82.2%-99.2%) were correctly instructed to undergo early colonoscopy examination.
CONCLUSIONS:
The APCS scoring system, which is based on age, sex, family history, and smoking, is a useful tool for determining risk for colorectal cancer and advanced adenoma in asymptomatic subjects. Use of the APCS score-based algorithm in triaging subjects for FIT or colonoscopy can substantially reduce colonoscopy workload.
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Les scores sont-ils pertinents et utiles pour évaluer le risque individuel de CCR et guider la stratégie de dépistage ?
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Etude multicentrique prospective réalisée dans 12 régions d’Asie chez 5657 individus asymptomatiques de plus de 40 ans ; calcul d’un score individuel de 7 critères, prédictif de lésion avancée (age, sexe, histoire familiale, tabac). Les individus classés risque faible ou moyen (score<4) font un FIT puis une coloscopie si positif, les individus à risque élévé (Score entre 4 et 7) sont directement orientés vers une coloscopie. Le taux de lésion avancée augmente avec le score : 1.5% (0-1), 5.1% (2-3) et 10.9% (4-7). 70.6% des individus avec lésion avancée et 95% de ceux avec CCR sont correctement orientés vers une coloscopie première.
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Les scores de risque individuel (incluant pour certains les facteurs familiaux) pourraient permettre de mieux classer les patients et sélectionner les candidats à une coloscopie directe.
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