Colonografia por TC no diagnóstico de lesões colo-rectais: estudo prospectivo

CT colonography for colorectal lesions: prospective trial

 

S. Leite ¹, S. Barroso ¹, M. J. Moreira ¹, S. C. Lima ¹, J.M. Ribeiro ¹, J. A. Pinho ², F. Macedo ²,A. S. Dias ² , J. Cotter¹

 

Resumo

INTRODUÇÃO: A colonografia por TC (CTC) tem um papel diagnóstico controverso. Objectivos: Determinação da eficácia e da experiência dos pacientes com a CTC comparando com a colonoscopia óptica (CO). Métodos: Estudo prospectivo, cego para os avaliadores, com recrutamento de 100 pacientes com indicação para CO, que foram submetidos a CTC prévia. Resultados: Excluídos 6 pacientes por impossibilidade de realização da CTC ou da CO. A sensibilidade (S) e a especificidade (E) da CTC na detecção de pacientes com pólipos ≥10 mm foi 57% (intervalo de confiança [CI] de 95%, 12-86%) e 96% (IC95%, 43-63%); pólipos no global S = 49% (IC95%, 12-86%) e E = 67% (IC95%; 57-77%); entre 6-9 mm S = 31% (IC95%, 6-56%) e E = 80% (IC95%, 71-89%) e ≤ 5 mm S = 18% (IC95%, 7-31%) e E = 88% (IC95%, 71-89%). A CTC não detectou 3 lesões planas e 1 dos 2 tumores observados na CO; 56% dos pacientes preferiram a CTC. Conclusões: Neste estudo, a CTC mostrou sensibilidade insatisfatória para pólipos, apesar de melhor quando de dimensões significativas. A especificidade para pólipos foi elevada. Salientam-se as falhas para cancro e lesões planas. Os pacientes manifestaram preferência pela CTC.

 

Abstract

BACKGROUND: CT colonography (CTC) has a controversial diagnostic role in the diagnosis of colorectal lesions. aims: In this study we prospectively assess the accuracy and patient experience with CTC compared with optical colonoscopy (OC) in a evaluator-blinded study of 100 patients referred for colonoscopy who previously performed CTC. results: Six patients were excluded due to impossibility to perform CTC or OC. Sensitivity (S) and specificity (E) of CTC for detecting polyps ≥10 mm was 57% (95% confidence interval [IC], 12-86%) and 96% (95%CI, 43-63%); overall polyps S = 49% (95%CI, 12-86%) and E = 67% (95%CI; 57-77%); between 6-9 mm S = 31% (95%CI, 6-56%) and E = 80% (IC95%, 71-89%); ≤ 5 mm S = 18% (95%CI, 7-31%) and E = 88% (95%CI, 71-89%). CTC missed 3 flat lesions and 1of the 2 cancers detected on OC. 56% patients expressed preference for CTC. Conclusions: In this study, overall estimated sensitivity of CTC was inadequate to detect polyps for polyps, although it was better in the detection of polyps with significant dimensions. Estimated specificity of CTC was high for polyps. CTC had a relevant number of missed flat lesion and cancer. Patients preferred CTC over OC.

 

 

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¹Serviço de Gastrenterologia, Centro Hospitalar do Alto Ave, EPE (Unidade de Guimarães);

²Serviço de Imagiologia, Centro Hospitalar do Alto Ave, EPE (Unidade de Guimarães); Patrocínio: Núcleo de Gastrenterologia dos Hospitais Distritais (NGHD)

Correspondência:

Sílvia Leite

Rua da Póvoa, nº 379, R/C; 4000-400 Porto

Email: slv.leite@gmail.com

Recebido: 10/02/2009 e Aceite para Publicação: 16/11/2009