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Computerised tomography colonography as a screening test for colorectal cancer
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Abstracts
were 96,9%, 100%, 100%, 93,3%, and 97% respectively (only 2 false negative). In 37 HCC >3 em sens, spes, VPP, VPN, ODA were 86,4%, 62,5%, 91,4%,50%,and 74% respectively (5 false negatives, 3 false positives Conclusions: Our study confirm the suggestions of EFSUMB guidelines. CEUS has a good diagnostic accuracy in the diagnosis of HCC in cirrhosis; the hypervascularity pattern during arterial phase has a good VPP and VPN for the diagnosis of HCC (particularly in the early < 3cm HCC). Therefore CEUS could be reliably used in the assessment of hypervascularity of a focal liver lesion in cirrhosis as suggested also by the recent EASL guidelines. References [1] Tranquart L et al Ultrashall Med 2004; 25: 249
PA.2S9 TRANSIENT LIVER ELASTOGRAPHY (FIBROSCAN) IN HEALTHY BLOOD DONORS
R. Bottelli *, D. Sala, M. Balzarini, C. Calcara, G. Grasso Ospedale C. Ondali, Angera Background and aim: The evaluation of liver fibrosis has relevant prognostic implication and is one of the most important parameters to be considered in the treatment flow chart. Recent data suggest a close relation between Fibroscan results and histologically proven liver fibrosis in patients with chronic HCV related hepatitis. There are no data reported concerning Fibroscan values in healthy people Aim of this study is to determine Fibroscan results in a series of non selected healthy blood donors and to analize the power of discrimination with mild-moderate chronic hepatitis. Material and methods: We considered 40 healty blood donors (22 male, 18 female, age 24-63) and 20 patients (12 male, 8 female, age 29-69) with histologically proven chronic hepatitis (15 HCV, 2 HBV, 3 Alcool) with Metavir stage Fl and F2. Healthy blood donors underwent evaluations for anti-HCV, HBsAg, anti-HIV, GOT, GPT, HCV RNA and blood cells count, before every donation, in the two years before Fibroscan evaluation. Ten validated Fibroscan measurements were performed in each patient. The results were expressed in Kilopascals (kPa). The median value was considered representative of the elastic modulus of the liver. Results: The mean value of Fibroscan was 4,85 ± 1,17 in the group of healthy blood donors and 7,54 ± 3,67 in patients with chronic hepatitis. This difference was statistically significant (p=0,025). Among healthy blood donors there was no difference between males and females and there was no correlation between age and Fibroscan values. To evalueted the diagnostic performance of Fibroscan elastometry in identification of healthy people and patients having a fibrosis score 1 or 2 by Metavir, we performed R.O.C. analysis. We choose a cut-off of 5,7 KPa that permitted to identify patients having a fibrosis score 1 or 2 with a sensibility of 60% and a specificity of 75%. By using this cut off we identify 30 of the 40 healthy blood donors (VPP 81%, VPN 57%). Conclusions: Fibroscan values in healthy people showed a very little variance. Fibroscan in our experience was a simple, fast and non invasive method to differenziate chronic hepatitis patients from normal blood donors. A quite good specificity and sensibility was shown in our population in identify healthy people and patients with chronic hepatitis and therefore Fibroscan results could help in clinical management of patients with hepatic diseases
PA.290 COMPUTERISED TOMOGRAPHY COLONOGRAPHY AS A SCREENING TEST FOR COLORECTAL CANCER G. Galatola *,1, C. Laudi 1, T. Gallo 1, F Coppola 1, P. Dellamonica 1 , D. Regge 1 , G. Corrao 2 1 fRCe,
Candiala-Turin Bicocca, Milan
2 University
Background and aim: Computerized tomography (CTC) is increasingly proposed as a screening test for colorectal cancer (CRC). We designed a randomised prospective controlled study to compare efficacy of CTC vs. colonoscopy (CS) in a screening situation using faecal occult blood (FOB) as a control test. Material and methods: Eligible subjects are first degree relative aged 40-65 years of patients with CRC or high risk adenoma before 60 years. Subjects are randomised to once only CTC followed by CS on the same day (group C); or yearly 3-day FOBT (group F), sent to CS if FOBT+. An operator blind to CTC results performs CS; accuracy is checked by an assistant aware of CTC results. Subjects tolerance assessed by visual scale. Results: We identified 281 index cases who generated 707 relatives: 386 were eligible, 248 accepted randomisation (35%: 148F, 95C). FOBT was positive in 18 subjects. 68 colonoscopies have been assessed at the present time. 28 polyps were found during CS in 21 subjects: 4 had multiple pOlyps. At per-patient analysis, there were 17 adenomas (25% prevalence), 10 advanced (15% prevalence). 6 polyps were 2:10 mm (all adenomas); five 6-9 mm (all adenomas, 2 advanced) and ten < 5 mm (4 hyperplastic, 6 adenomas, 2 advanced). Overall CTC sensitivity (SS) for polyp detection was 33%. CTC identified polyps 2:10 mm in 4/6 cases (SS=67%) and polyps >5 mm in 6/11 cases (SS=55%); only 1/10 polyps < 5 mm was identified by CTC. In 39 subjects CS was negative: in 6 of them CTC identified polyps <5 mm which were excluded by CS. Thus, overall specificity was 85%, but it was 100% if polyps <5 mm were not considered. Subjects tolerance was 4.1 ± 2.2 (SD) for CTC and 5.0 ± 2.8 forCS (p=NS). Subjects preferred CTC in 50% and CS in 25% of cases Conclusions: CTC is a valid screening test if a threshold of >5 mm is set for defining positive results, providing 100% specificity. Tolerability of CTC was less than expected. Overall sensitivity may not be optimal due to the high false positive rate for small polyps, and specificity for this kind of lesions is low. CTC may be reasonably acceptable as a screening test if small polyps are not considered. The higher compliance to CTC may make it a competitive test by comparison with colonoscopy despite its relatively poorer accuracy.
PA.291 IMAGING IN DIAGNOSIS OF CYSTIC DYSTROPHY OF DUODENAL WALL: EUS IS BETTER
F Ievoli, G. Biscaglia *, FR. De Filippo, F Terracciano, G. Forte A.O.R.N. San Sebastiana, Caserta Background and aim: Cystic dystrophy of the duodenal wall (CDDW) is a rare condition characterized by the presence of cystic formations in the duodenal wall, reported as sporadic cause of acute or chronic pancreatitis. A recent multicentric Italian study indicates CDDW as cause of 7% of chronic pancreatitis. Diagnosis is usually made by endoscopic ultrasound (EUS), magnetic resonance (MR) or computed tomography (CT), however, which is the best imaging technique to identify CDDW is not established. Material and methods: Sixty patients (M1F=33127, median age 43, range 19-73) were consecutively undergone to EUS (Olympus GFUM20) under suspicion of a bilio-pancreatic disease. Meanwhile these patients were undergone to CT and MR. EUS evaluation of pancreas was performed according to Lees-Wiersema criteria and patients with
Abstracts
were 96,9%, 100%, 100%, 93,3%, and 97% respectively (only 2 false negative). In 37 HCC >3 em sens, spes, VPP, VPN, ODA were 86,4%, 62,5%, 91,4%,50%,and 74% respectively (5 false negatives, 3 false positives Conclusions: Our study confirm the suggestions of EFSUMB guidelines. CEUS has a good diagnostic accuracy in the diagnosis of HCC in cirrhosis; the hypervascularity pattern during arterial phase has a good VPP and VPN for the diagnosis of HCC (particularly in the early < 3cm HCC). Therefore CEUS could be reliably used in the assessment of hypervascularity of a focal liver lesion in cirrhosis as suggested also by the recent EASL guidelines. References [1] Tranquart L et al Ultrashall Med 2004; 25: 249
PA.2S9 TRANSIENT LIVER ELASTOGRAPHY (FIBROSCAN) IN HEALTHY BLOOD DONORS
R. Bottelli *, D. Sala, M. Balzarini, C. Calcara, G. Grasso Ospedale C. Ondali, Angera Background and aim: The evaluation of liver fibrosis has relevant prognostic implication and is one of the most important parameters to be considered in the treatment flow chart. Recent data suggest a close relation between Fibroscan results and histologically proven liver fibrosis in patients with chronic HCV related hepatitis. There are no data reported concerning Fibroscan values in healthy people Aim of this study is to determine Fibroscan results in a series of non selected healthy blood donors and to analize the power of discrimination with mild-moderate chronic hepatitis. Material and methods: We considered 40 healty blood donors (22 male, 18 female, age 24-63) and 20 patients (12 male, 8 female, age 29-69) with histologically proven chronic hepatitis (15 HCV, 2 HBV, 3 Alcool) with Metavir stage Fl and F2. Healthy blood donors underwent evaluations for anti-HCV, HBsAg, anti-HIV, GOT, GPT, HCV RNA and blood cells count, before every donation, in the two years before Fibroscan evaluation. Ten validated Fibroscan measurements were performed in each patient. The results were expressed in Kilopascals (kPa). The median value was considered representative of the elastic modulus of the liver. Results: The mean value of Fibroscan was 4,85 ± 1,17 in the group of healthy blood donors and 7,54 ± 3,67 in patients with chronic hepatitis. This difference was statistically significant (p=0,025). Among healthy blood donors there was no difference between males and females and there was no correlation between age and Fibroscan values. To evalueted the diagnostic performance of Fibroscan elastometry in identification of healthy people and patients having a fibrosis score 1 or 2 by Metavir, we performed R.O.C. analysis. We choose a cut-off of 5,7 KPa that permitted to identify patients having a fibrosis score 1 or 2 with a sensibility of 60% and a specificity of 75%. By using this cut off we identify 30 of the 40 healthy blood donors (VPP 81%, VPN 57%). Conclusions: Fibroscan values in healthy people showed a very little variance. Fibroscan in our experience was a simple, fast and non invasive method to differenziate chronic hepatitis patients from normal blood donors. A quite good specificity and sensibility was shown in our population in identify healthy people and patients with chronic hepatitis and therefore Fibroscan results could help in clinical management of patients with hepatic diseases
PA.290 COMPUTERISED TOMOGRAPHY COLONOGRAPHY AS A SCREENING TEST FOR COLORECTAL CANCER G. Galatola *,1, C. Laudi 1, T. Gallo 1, F Coppola 1, P. Dellamonica 1 , D. Regge 1 , G. Corrao 2 1 fRCe,
Candiala-Turin Bicocca, Milan
2 University
Background and aim: Computerized tomography (CTC) is increasingly proposed as a screening test for colorectal cancer (CRC). We designed a randomised prospective controlled study to compare efficacy of CTC vs. colonoscopy (CS) in a screening situation using faecal occult blood (FOB) as a control test. Material and methods: Eligible subjects are first degree relative aged 40-65 years of patients with CRC or high risk adenoma before 60 years. Subjects are randomised to once only CTC followed by CS on the same day (group C); or yearly 3-day FOBT (group F), sent to CS if FOBT+. An operator blind to CTC results performs CS; accuracy is checked by an assistant aware of CTC results. Subjects tolerance assessed by visual scale. Results: We identified 281 index cases who generated 707 relatives: 386 were eligible, 248 accepted randomisation (35%: 148F, 95C). FOBT was positive in 18 subjects. 68 colonoscopies have been assessed at the present time. 28 polyps were found during CS in 21 subjects: 4 had multiple pOlyps. At per-patient analysis, there were 17 adenomas (25% prevalence), 10 advanced (15% prevalence). 6 polyps were 2:10 mm (all adenomas); five 6-9 mm (all adenomas, 2 advanced) and ten < 5 mm (4 hyperplastic, 6 adenomas, 2 advanced). Overall CTC sensitivity (SS) for polyp detection was 33%. CTC identified polyps 2:10 mm in 4/6 cases (SS=67%) and polyps >5 mm in 6/11 cases (SS=55%); only 1/10 polyps < 5 mm was identified by CTC. In 39 subjects CS was negative: in 6 of them CTC identified polyps <5 mm which were excluded by CS. Thus, overall specificity was 85%, but it was 100% if polyps <5 mm were not considered. Subjects tolerance was 4.1 ± 2.2 (SD) for CTC and 5.0 ± 2.8 forCS (p=NS). Subjects preferred CTC in 50% and CS in 25% of cases Conclusions: CTC is a valid screening test if a threshold of >5 mm is set for defining positive results, providing 100% specificity. Tolerability of CTC was less than expected. Overall sensitivity may not be optimal due to the high false positive rate for small polyps, and specificity for this kind of lesions is low. CTC may be reasonably acceptable as a screening test if small polyps are not considered. The higher compliance to CTC may make it a competitive test by comparison with colonoscopy despite its relatively poorer accuracy.
PA.291 IMAGING IN DIAGNOSIS OF CYSTIC DYSTROPHY OF DUODENAL WALL: EUS IS BETTER
F Ievoli, G. Biscaglia *, FR. De Filippo, F Terracciano, G. Forte A.O.R.N. San Sebastiana, Caserta Background and aim: Cystic dystrophy of the duodenal wall (CDDW) is a rare condition characterized by the presence of cystic formations in the duodenal wall, reported as sporadic cause of acute or chronic pancreatitis. A recent multicentric Italian study indicates CDDW as cause of 7% of chronic pancreatitis. Diagnosis is usually made by endoscopic ultrasound (EUS), magnetic resonance (MR) or computed tomography (CT), however, which is the best imaging technique to identify CDDW is not established. Material and methods: Sixty patients (M1F=33127, median age 43, range 19-73) were consecutively undergone to EUS (Olympus GFUM20) under suspicion of a bilio-pancreatic disease. Meanwhile these patients were undergone to CT and MR. EUS evaluation of pancreas was performed according to Lees-Wiersema criteria and patients with