Predicting advanced proximal colonic neoplasia with screening sigmoidoscopy.
摘要：
Indications are not well defined for follow-up colonoscopy for all patients with distal colonic tubular adenomas (TAs) found at screening sigmoidoscopy. To determine whether distal adenoma size, number, and villous histology, along with family history and age, are predictors of advanced proximal colonic neoplasia. Cross-sectional analysis conducted between January 1, 1994, and December 31, 1995. Large group-model health maintenance organization in northern California. A total of 2972 asymptomatic subjects aged 50 years or older undergoing colonoscopy as follow-up to a screening sigmoidoscopy. Based on sigmoidoscopy, colonoscopy, and pathology reports, occurrence of advanced proximal neoplasia, defined as adenocarcinoma or TAs 1 cm or larger or with villous features or severe dysplasia located beyond sigmoidoscopic view. The prevalence of advanced proximal neoplasia was similar among patients with no TAs at sigmoidoscopy, those with TAs less than 1 cm in diameter, and those with TAs 1 cm in diameter or larger (prevalence, 5.3%, 5.5%, and 5.6%, respectively). Of patients with a distal tubulovillous or villous adenoma, 12.1% had advanced proximal neoplasia. In multivariate analyses, having a distal tubulovillous adenoma or villous adenoma was the strongest predictor of advanced proximal neoplasia (odds ratio, 2.30; 95% confidence interval, 1.69-3.14). Age of 65 years or older, having more than 1 adenoma, and a positive family history of colorectal cancer were also significant predictors. Distal adenoma size was not a significant predictor in any multivariate analyses. Advanced proximal neoplasia is not uncommon in subjects with or without distal TAs, but subjects with advanced distal histology and those older than 65 years are at increased risk. Age-specific screening using sigmoidoscopy starting at ages 50 to 55 years and colonoscopy after age 65 years may be justified.
展开
DOI：
10.1001/jama.281.17.1611
被引量：
年份：
1999
BMJ
JAMA
(全网免费下载)
JAMA
JAMA
国家科技图书文献中心
(权威机构)
查看更多
EBSCO
万方医学
掌桥科研
万方医学
dx.doi.org
Europe PMC
NCBI
NCBI
Oxford Univ Press
AACR
ResearchGate
ResearchGate
(全网免费下载)
ProQuest
EBSCO
学术范
钛学术
学术范
(全网免费下载)
www.socolar.com
nejm.org
cghjournal.org
钛学术
(全网免费下载)
ejcancer.com
199.171.202.195
mysciencework.com
gastrojournal.org
onAcademic
mendeley.com
通过文献互助平台发起求助，成功后即可免费获取论文全文。
相似文献
参考文献
引证文献
辅助模式
引用
文献可以批量引用啦~
欢迎点我试用！
