KOLOREKTAL POLİP VE KANSERLERİN SAPTANMASINDA BİLGİSAYARLI TOMOGRAFİK KOLONOGRAFİ İLE VİDEO KOLONOSKOPİNİN KARŞILAŞTIRILMASI

Öz

Amaç: Çok kesitli bilgisayarlı tomografi kolonografinin kolorektal patolojileri saptamadaki tanısal duyarlılığını video kolonoskopi ile karşılaştırarak belirlemektir.

Gereç ve Yöntemler: Çalışmamızda 18 aylık period içerisinde çok kesitli bilgisayarlı tomografi kolonografi ve video kolonoskopi yapılan 70 hasta retrospektif olarak incelendi ve çok kesitli bilgisayarlı tomografi kolonografi bulguları video kolonoskopi bulguları ile karşılaştırıldı.

Bulgular: Hastaların %57.1’i erkek (n=40) ve %42.9’u kadın (n=30) olup ortalama yaşları 52.8 /yıl idi. Video kolonoskopi ile toplam 39 polip, 15 kolon tümörü, 5 ülseratif kolit, 4 divertikülozis koli, 1 anjiodisplazi ve 1 nonspesifik proktosigmoidit olmak üzere 38 hastada 65 patoloji saptandı. Saptanan 39 polipten 31’i ≤5 mm, 4’ü 6-9 mm ve 4’ü ≥10 mm idi. Çok kesitli bilgisayarlı tomografi kolonografinin boyut farkı gözetmeksizin tüm poliplerde duyarlılığı %64.1, ≥10 mm poliplerde %100, 6-9 mm arası poliplerde %75, ≤5 mm poliplerde %58.1 idi. Duyarlılık kolon tümörlerinde %100, divertikülozisde %75 ve ülseratif kolitte %80 bulundu.

Sonuç: Çok kesitli bilgisayarlı tomografi kolonografinin kolon patolojilerinin tanısında yüksek duyarlılık ve özgüllüğe sahip olması, tarama yöntemi olarak veya kolon patolojilerinin değerlendirilmesinde, video kolonoskopiye ciddi alternatif ve tamamlayıcı bir yöntem olacağını göstermektedir.

Anahtar Kelimeler

• kolon
• kanser
• polip
• video kolonoskopi
• Bilgisayarlı tomografi kolonografi

Comparison of Computed Tomographic Colonography and Video Colonoscopy in the Detection of Colorectal Polyps and Cancers

Öz

Objective: To determine the diagnostic efficiency of multislice computed tomography colonography in detection of colorectal pathologies compared with video colonoscopy.

Material and Methods: In our study, 70 patients who underwent multislice computed tomography colonography and video colonoscopy within an 18-month period were analyzed retrospectively, and multislice computed tomography colonography findings were compared with video colonoscopy findings.

Results: Of the patients, 57.1% were male (n=40) and 42.9% were female (n=30), with a mean age of 52.8 years. A total of 65 pathologies including 39 polyps, 15 colon tumors, 5 ulcerative colitis, 1 angiodysplasia and 1 nonspecific proctosigmoiditis, were detected in 38 patients by video colonoscopy. Of the 39 polyps detected, 31 were ≤5 mm, 4 were 6-9 mm and 4 were ≥10 mm. The sensitivity of multislice computed tomography colonography for detection of all polyps regardless their size was 64.1%, 100% for polyps ≥10 mm, 75% for polyps that are between 6-9 mm and 58.1% for polyps ≤5 mm. The sensitivity was 100% for colon cancers, 75% for diverticulosis and 80% for ulcerative colitis.

Conclusion: The high sensitivity and specificity of multislice computed tomography colonography in the diagnosis of colon pathologies will make it the screening modality and a serious alternative and complementary method for video colonoscopy in the evaluation of colon pathologies.

Anahtar Kelimeler

• Cancer
• colon
• polyp
• video colonoscopy
• computed tomography colonography

Kaynakça

1. 1. Cronin KA, Lake AJ, Scott S, Sherman RL, Noone AM, Howlader N et al. Annual report to the nation on the status of cancer, part I: National cancer statistics. Cancer. 2018;124(13):2785-800.
2. 2. T.C. Sağlık Bakanlığı. Türkiye Halk Sağlığı Kurumu. 2017 Yılı Türkiye Kanser İstatistikleri. Erişim tarihi: 2017: https://hsgm.saglik.gov.tr/tr/kanser-istatistikleri/yillar/2017-turkiye-kanser-i-statistikleri.html
3. 3. Geenen RW, Hussain SM, Cademartiri F, Poley JW, Siersema PD, Krestin GP. CT and MR colonography: scanning techniques, postprocessing, and emphasis on polyp detection. Radiographics. 2004;24(1):e18.
4. 4. Tuncel E. Klinik Radyoloji. 2. baskı. Bursa. Nobel & Güneş Tıp Kitabevleri, 2008.
5. 5. Zauber AG, Winawer SJ, O'Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366(8):687-96.
6. 6. Rex DK, Johnson DA, Lieberman DA, Burt RW, Sonnenberg A. Colorectal cancer prevention 2000: screening recommendations of the American College of Gastroenterology. Am J Gastroenterol. 2000;95(4):868-77.
7. 7. Wolf AMD, Fontham ETH, Church TR, Flowers CR, Guerra CE, LaMonte SJ et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250-81.
8. 8. T.C. Sağlık Bakanlığı. Türkiye Halk Sağlığı Kurumu. Kanser Daire Başkanlığı. Türkiye Kanser Kontrol Programı. Erişim tarihi: 2016: https://hsgm.saglik.gov.tr/depo/birimler/kanser-db/yayinlar/Kitaplar/turkiye_kanser_kontrol_programi_2016.pdf

9. 9. Sali L, Ventura L, Grazzini G, Borgheresi A, Delsanto S, Falchini M et al. Patients' experience of screening CT colonography with reduced and full bowel preparation in a randomised trial. Eur Radiol. 2019;29(5):2457-64.
10. 10. Hara AK, Johnson CD, Reed JE, Ahlquist DA, Nelson H, Ehman RL et al. Detection of colorectal polyps by computed tomographic colography: feasibility of a novel technique. Gastroenterology. 1996;110(1):284-90.
11. 11. Hara AK, Johnson CD, Reed JE, Ehman RL, Ilstrup DM. Colorectal polyp detection with CT colography: two- versus three-dimensional techniques. Radiology. 1996;200(1):49-54.
12. 12. Fenlon HM, Nunes DP, Schroy PC, Barish MA, Clarke PD, Ferrucci JT. A comparison of virtual and conventional colonoscopy for the detection of colorectal polyps. N Engl J Med. 1999;341(20):1496-503.
13. 13. Wessling J, Fischbach R, Domagk D, Lugering N, Neumann E, Heindel W. Colorectal polyps: Detection with multi-slice CT colonography. Rofo. 2001;173(12):1069-71.
14. 14. Rogalla P, Meiri N, Ruckert JC, Hamm B. Colonography using multislice CT. Eur J Radiol. 2000;36(2):81-5.
15. 15. Doshi T, Rusinak D, Halvorsen RA, Rockey DC, Suzuki K, Dachman AH. CT colonography: false-negative interpretations. Radiology. 2007;244(1):165-73.
16. 16. Halligan S, Park SH, Ha HK. Causes of false-negative findings at CT colonography. Radiology. 2006;238(3):1075-6; author reply 1076-7.
17. 17. Park SH, Ha HK, Kim AY, Kim KW, Lee MG, Kim PN et al. Flat polyps of the colon: detection with 16-MDCT colonography--preliminary results. AJR. 2006;186(6):1611-7.
18. 18. Hara AK, Johnson CD, MacCarty RL, Welch TJ, McCollough CH, Harmsen WS. CT colonography: single- versus multi-detector row imaging. Radiology. 2001;219(2):461-5.
19. 19. Royster AP, Fenlon HM, Clarke PD, Nunes DP, Ferrucci JT. CT colonoscopy of colorectal neoplasms: two-dimensional and three-dimensional virtual-reality techniques with colonoscopic correlation. Am J Roentgenol. 1997;169(5):1237-42.
20. 20. Harvey CJ, Amin Z, Hare CM, Gillams AR, Novelli MR, Boulos PB et al. Helical CT pneumocolon to assess colonic tumors: radiologic-pathologic correlation. AJR.1998;170(6):1439-43.