INTRODUCTION The colorectal cancer (CRC) is one of the most common cancers in industrialized countries. It is the second leading cause of cancer death worldwide in both sexes. The global incidence of one million new cases / year. In Italy the incidence CRC is approximately 30-53 new cases / year / 100,000. Since the cancer develops from an adenomatous polyp degenereted in 70% of cases , the American Cancer Society has estimated that 90% of colorectal cancers would be preventable with the correct screening protocols. Among the imaging techinque CT-Colonography (CTC) is currently the best tool for screening and early detection of colorectal cancer as widely recognized in the scientific literature due to its non-invasiveness and high diagnostic accuracy. CT colonography is a radiological technique based on a low-dose ionizing radiation CT in two acquisition, prone and supine,after adequate bowel preparation and gaseous distension of the colon Images are analyzed on a dedicated workstation and so It's possible to reconstruct the colon in 3D or to make a virtual endoscopy. METHODS From January 2014 to December 2016 at "Centro Radiological Potito" we performed 807 of CT colonography In particular, we studied 443 females (54.9%) and 364 males (45.1%). The average age was of 59.7 years. We collected the main reasons that led the patients under our observation. Most of the tests were performed for abdominal pain (260), screening (155) and Usual bowel habits (112) Other reasons were the presence of blood in the stool, a suspended previous traditional colonoscopy, constipation and rectal bleeding RESULTS All of our patients conducted CT colonography in the absence of adverse reactions or significant discomfort Among neoplastic diseases, we identified 12 carcinomas, 58 polypoid lesions, 2 other tumors (1 GIST and 1 waiting for histology tests) Among the patients with neoplastic disease, the average age was 65.7 years In our experience we found extra colonic findings in 106/807 patients In particular 34/807 of these patients had E4 findings with an important potential clinical impact (aortic aneurysms, solid parenchymal lesions...) DISCUSSION The current screening programs are not effective: in fact there was a very low adhesion (not more than 25-40%). The reason for this low compliance of patients is probably to be found in the discomfort that characterizes techinque, such as optical colonoscopy in relation to its invasiveness a wellas in relation to the preparation prior cathartic which is needed The difficulty of identifying effective preliminary tests lies in the extreme variability of the symptoms and signs that brought the patients positive for malignancy to undergo CTC Very interesting is also the lack of interest towards FOBT the most advantageous preliminary test from the cost /benefit point of view: 41 / 72 patients didn’t run the test. The goal of CTC is to increase the adhesion of asymptomatic or nonspecific symptoms patients to prevention paths. CONCLUSION In general, the CTC is now considered the radiological best tool in the study of polypoid lesions replacing totally the double contrast barium enema as an alternative to optical colonoscopy when this examination is contraindicated or impractical or has not been completely conducted.
INTRODUZIONE Il carcinoma colon-rettale è una delle neoplasie maggiormente diffuse nei Paesi industrializzati . Rappresenta la seconda causa di morte per tumore nel mondo nei due sessi. L’incidenza mondiale è di un milione di nuovi casi/anno. In Italia l’incidenza di questa neoplasia è di circa 30-53 nuovi casi/anno/100.000 Tenendo conto che nel 70% dei casi il carcinoma si sviluppa da un polipo adenomatoso degenerato, secondo i dati dell’American Cancer Society il 90% dei carcinomi del colon retto sarebbe prevenibile con un adeguato screening. Tra le metodiche di diagnostica per immagini la colografia-TC (CTC) è attualmente l’indagine di riferimento nello screening e nella diagnosi precoce del carcinoma del colon retto come ampiamente riconosciuto alla letteratura scientifica in ragione della sua non invasività e dell’elevata accuratezza diagnostica. La colonscopia virtuale è una tecnica di studio radiologica realizzata con una TC a bassa dose di radiazioni ionizzanti in duplice acquisizione prono e supino previo adeguata preparazione intestinale e distensione gassosa del colon .Mediante l’analisi delle immagini su una su una workstation dedicata è possibile di ricostruire il colon in 3D ed eseguirne una endoscopia virtuale. MATERIALI E METODI Da Gennaio 2014 a Dicembre 2016 presso il “Centro Radiologico Potito” abbiamo eseguito 807 indagini di colografia TC. In particolare abbiamo studiato 443 femmine (54.9%) e 364 maschi (45.1%). L’età media è risultata di 59.7 anni. Abbiamo raccolto le principali motivazioni che hanno condotto i pazienti alla nostra osservazione. La maggior parte degli esami sono stati eseguiti per dolore addominale (260), screening (155) e alterazioni dell’alvo (112). Tra le rimanenti motivazioni la presenza di sangue vivo nelle feci, una precedente colonscopia tradizionale non condotta a termine, stipsi e rettorragia. RISULTATI Tutti gli 807 pazienti hanno condotto l’indagine a termine in assenza di reazioni avverse o episodi di discomfort significativi. Nell’ambito delle patologie neoplastiche abbiamo identificato: 12 carcinomi,58 lesioni polipoidi,2 neoplasie di diversa natura (GIST e altro in attesa di istologico). Tra i pazienti portatori di patologia neoplastica l’età media è risultata 65.7 anni. Nel nostro lavoro sono emersi inoltre reperti extra colici in 106/807 pazienti. In particolare 34/807 avevano reperti E4 ovvero reperti che hanno potenziale impatto clinico importante ( aneurismi aortici, masse solide parenchimali…) DISCUSSIONE Gli attuali programmi di screening non risultano efficaci dato che è stata riscontrata una bassissima adesione (non superiore al 25-40%). Il motivo di questa bassa compliance dei pazienti è da ricercare probabilmente nel discomfort che caratterizza metodiche come la colonscopia ottica sia in rapporto alla sua invasività sia in relazione alla preparazione catartica preventiva di cui essa necessita. La difficoltà nell’identificare test preliminari efficaci si riscontra nella variabilità estrema dei sintomi che hanno condotto i pazienti positivi per patologia neoplastica all’ indagine. Molto interessante risulta inoltre lo scarso interesse verso l’indagine preliminare più vantaggiosa dal punto di vista costo beneficio ovvero il SOF test :41/72pazienti non hanno eseguito il test. La CTC si inserisce quindi nella problematica dello screening nel tentativo di incrementare l’adesione dei soggetti asintomatici o con sintomi aspecifici ai percorsi di prevenzione. CONCLUSIONE In generale la CTC è ormai ritenuta l’esame radiologico di prima scelta nello studio delle lesioni polipoidi coliche sostituendo completamente il clisma opaco a doppio contrasto come alternativa alla colonscopia a fibre ottiche nei casi in cui questa indagine sia controindicata o impraticabile o non sia stata condotta a termine.
Colografia-TC (CTC) nel percorso diagnostico del carcinoma del colon retto (CCR): esperienza di un singolo centro
Maggialetti , Nicola
2017-05-18
Abstract
INTRODUCTION The colorectal cancer (CRC) is one of the most common cancers in industrialized countries. It is the second leading cause of cancer death worldwide in both sexes. The global incidence of one million new cases / year. In Italy the incidence CRC is approximately 30-53 new cases / year / 100,000. Since the cancer develops from an adenomatous polyp degenereted in 70% of cases , the American Cancer Society has estimated that 90% of colorectal cancers would be preventable with the correct screening protocols. Among the imaging techinque CT-Colonography (CTC) is currently the best tool for screening and early detection of colorectal cancer as widely recognized in the scientific literature due to its non-invasiveness and high diagnostic accuracy. CT colonography is a radiological technique based on a low-dose ionizing radiation CT in two acquisition, prone and supine,after adequate bowel preparation and gaseous distension of the colon Images are analyzed on a dedicated workstation and so It's possible to reconstruct the colon in 3D or to make a virtual endoscopy. METHODS From January 2014 to December 2016 at "Centro Radiological Potito" we performed 807 of CT colonography In particular, we studied 443 females (54.9%) and 364 males (45.1%). The average age was of 59.7 years. We collected the main reasons that led the patients under our observation. Most of the tests were performed for abdominal pain (260), screening (155) and Usual bowel habits (112) Other reasons were the presence of blood in the stool, a suspended previous traditional colonoscopy, constipation and rectal bleeding RESULTS All of our patients conducted CT colonography in the absence of adverse reactions or significant discomfort Among neoplastic diseases, we identified 12 carcinomas, 58 polypoid lesions, 2 other tumors (1 GIST and 1 waiting for histology tests) Among the patients with neoplastic disease, the average age was 65.7 years In our experience we found extra colonic findings in 106/807 patients In particular 34/807 of these patients had E4 findings with an important potential clinical impact (aortic aneurysms, solid parenchymal lesions...) DISCUSSION The current screening programs are not effective: in fact there was a very low adhesion (not more than 25-40%). The reason for this low compliance of patients is probably to be found in the discomfort that characterizes techinque, such as optical colonoscopy in relation to its invasiveness a wellas in relation to the preparation prior cathartic which is needed The difficulty of identifying effective preliminary tests lies in the extreme variability of the symptoms and signs that brought the patients positive for malignancy to undergo CTC Very interesting is also the lack of interest towards FOBT the most advantageous preliminary test from the cost /benefit point of view: 41 / 72 patients didn’t run the test. The goal of CTC is to increase the adhesion of asymptomatic or nonspecific symptoms patients to prevention paths. CONCLUSION In general, the CTC is now considered the radiological best tool in the study of polypoid lesions replacing totally the double contrast barium enema as an alternative to optical colonoscopy when this examination is contraindicated or impractical or has not been completely conducted.File | Dimensione | Formato | |
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