Postopratif kolan kanserli olgularda bilgisayarlı tomografi kolonografi / Computed tomography colonography in the follow up of postoperative colon cancer cases
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Tarih
2011
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Maltepe Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
AMAÇ: Kolorektal kanserler ciddi morbidite ve mortaliteyle seyreden önemli sağlık problemlerinden biridir. Bu nedenle postoperatif hastalar düzenli aralıklarla çeşitli invazif ve non-invazif yöntemlerle tekrar değerlendirilmektedir. Bilgisayarlı tomografi (BT) kolonografi tanı rehberlerinde önerilen bir tarama yöntemidir. Ancak henüz nüks tarama rehberlerinde önerilen bir yöntem değildir. Bu çalışmanın amacı kolon kanseri olgularının postoperatif takibinde kontrastlı BT kolonografinin etkinliğinin değerlendirilmesidir. GEREÇ ve YÖNTEM: Çalışmaya kolorektal kanser nedeniyle opere olmuş toplam 22 hasta katıldı. Tüm olgulara, BT kolonografi tetkikini takiben dört hafta içerisinde standart konvansiyonel kolonoskopi yapıldı. Barsak temizliği yetersiz olan 1 hasta ile striktüre bağlı konvansiyonel kolonoskopi işlemi tamamlanamayan 1 hasta çalışma dışında tutuldu. Yirmi hastadan elde edilen BT kolonografi ve standart konvansiyonel kolonoskopi sonuçları karşılaştırıldı. BULGULAR: Çalışmaya katılan toplam 20 hastanın (9 erkek, 11 kadın) yaş ortalaması 63,75 ± 10,24 yıldı. BT kolonografi operasyon tarihinden ortalama 17,7 ± 16,7 ay (medyan: 14,45 ay) sonra çekildi. Barsak distansiyonu optimal düzeydeydi. BT kolonografi işlemi sonucunda 5 hastada farklı lokalizasyonlarda ve değişik boyutlarda toplam 15 polipoid oluşum saptandı. Konvansiyonel kolonoskopi işlemi sonucunda ise 4 hastada toplam 17 tane polipoid oluşum saptandı. Saptanan poliplerin boyutları açısından anlamlı bir fark gözlenmedi (5,3 ± 3,2 mm vs. 4,5 ± 3,5 mm, p=0,25). Ayrıca ? 5 mm olan lezyonların değerlendirmesinde de istatistiksel iii olarak anlamlı bir fark saptanmamakla birlikte BT kolonografinin sensitivitesi % 42,8, spesifitesi % 57,1, pozitif prediktif değeri % 75 ve negatif prediktif değeri % 7,6 olarak saptandı (?2=0,4). Tüm polipler değerlendirildiğinde, BT kolonografinin sensitivitesi % 83,3, spesifitesi % 88,2, pozitif prediktif değeri %46,8, negatif prediktif değeri %25 olarak saptandı (?2=0,28). SONUÇ: BT kolonografinin postoperatif kolorektal kanser olgularında metakron lezyonların saptanmasında yüksek sensitivite ve spesifite değerlerine sahip olduğunu saptadık. BT kolonografinin metakron lezyon tespitinde etkin bir yöntem olduğunu ve tarama rehberlerinde gelecek yıllarda daha ağırlıklı olarak yer alacağını düşünüyoruz.
OBJECTIVE: Colorectal cancer is an important healthcare problem with significant morbidity and mortality. Hence, postoperative patients are reevaluated by various invasive and non-invasive procedures in regular intervals. Computed tomography (CT) colonography is a proposed screening method in diagnostic guidelines, but it is not suggested in recurrence screening guidelines, yet. The aim of this study was to evaluate the efficacy of CT colonography in the follow up of postoperative colon cancer cases. MATERIAL & METHODS: Twenty two patients who underwent surgery for colorectal cancer were included in the study. Following the CT colonography procedure standard conventional colonoscopy was carried out in 4 weeks for all cases. One patient with inadequate bowel cleaning and 1 patient with inconclusive conventional colonoscopy evaluation, because of a stricture, were excluded. Results of 20 patients were evaluated. RESULTS: Mean age of 20 patients (9 male, 11 female) included in the study was 63.75 ± 10.24 years. CT colonography was performed at 17.7 ± 16.7 months (median: 14.45 months) after surgery. Bowel distention was optimal. Fifteen polypoid lesions with different size and location were suspected in 5 patients by CT colonography. Conventional colonoscopy detected 17 polypoid structures in 4 patients. A significant size difference was not observed (5.3 ± 3.2 mm vs. 4.5 ± 3.5 mm, p=0.25) between the polyps. While there was no statistically significant difference for suspicious lesions ? 5 mm, CT colonoscopy had 42.8% sensitivity, 57.1% specificity, 75% positive predictive value and 7.6% negative predictive value in such lesions (?2=0,4). In the assessment of all polyps, BT colonoscopy had 83.3% sensitivity, 88.2% specificity, 46.8% positive predictive value and 25% negative predictive value (?2=0,28). CONCLUSION: We found that CT colonography had a high specificity and sensitivity in the detection of metachronous lesions in postoperative colorectal cancer cases. We believe that CT colonography is an efficient method for detecting the metachronous lesions postoperatively and that it will be widely included in follow up screening guidelines in the future.
OBJECTIVE: Colorectal cancer is an important healthcare problem with significant morbidity and mortality. Hence, postoperative patients are reevaluated by various invasive and non-invasive procedures in regular intervals. Computed tomography (CT) colonography is a proposed screening method in diagnostic guidelines, but it is not suggested in recurrence screening guidelines, yet. The aim of this study was to evaluate the efficacy of CT colonography in the follow up of postoperative colon cancer cases. MATERIAL & METHODS: Twenty two patients who underwent surgery for colorectal cancer were included in the study. Following the CT colonography procedure standard conventional colonoscopy was carried out in 4 weeks for all cases. One patient with inadequate bowel cleaning and 1 patient with inconclusive conventional colonoscopy evaluation, because of a stricture, were excluded. Results of 20 patients were evaluated. RESULTS: Mean age of 20 patients (9 male, 11 female) included in the study was 63.75 ± 10.24 years. CT colonography was performed at 17.7 ± 16.7 months (median: 14.45 months) after surgery. Bowel distention was optimal. Fifteen polypoid lesions with different size and location were suspected in 5 patients by CT colonography. Conventional colonoscopy detected 17 polypoid structures in 4 patients. A significant size difference was not observed (5.3 ± 3.2 mm vs. 4.5 ± 3.5 mm, p=0.25) between the polyps. While there was no statistically significant difference for suspicious lesions ? 5 mm, CT colonoscopy had 42.8% sensitivity, 57.1% specificity, 75% positive predictive value and 7.6% negative predictive value in such lesions (?2=0,4). In the assessment of all polyps, BT colonoscopy had 83.3% sensitivity, 88.2% specificity, 46.8% positive predictive value and 25% negative predictive value (?2=0,28). CONCLUSION: We found that CT colonography had a high specificity and sensitivity in the detection of metachronous lesions in postoperative colorectal cancer cases. We believe that CT colonography is an efficient method for detecting the metachronous lesions postoperatively and that it will be widely included in follow up screening guidelines in the future.
Açıklama
Anahtar Kelimeler
BT kolonografi, Postoperatif, Kolorektal kanser, Rekürren kolorektal kanser, Kolorektal kanser takibi, CT colonography, Postoperative, Colorectal cancer, Recurrent colorectal cancer,, Colorectal cancer follow up
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Sayı
Künye
Tozan Bayrak, E. (2011). Postopratif kolan kanserli olgularda bilgisayarlı tomografi kolonografi / Computed tomography colonography in the follow up of postoperative colon cancer cases (Yayımlanmamış Uzmanlık Tezi). Maltepe Üniversitesi, Tıp Fakültesi, İstanbul.
