- 期刊
Is Single Stool Occult Blood Test or Serum CEA Level Valuable in Health Check Up?
單次糞便潛血檢查及血清CEA值用於健康檢查中檢測大腸直腸疾病之成效探討
摘要
目的 糞便潛血試驗及血清CEA值，目前已成為一般健檢中常見的篩檢項目之一。本文主要探討在一般健檢中，這兩種篩檢方式的成效。 方法 自2004年4月至2005年5月止，共收集了1404位接受一般體檢的病人。所有 的病患在體檢期間均接受了糞便潛血試驗，血清CEA值，及完整大腸鏡檢查。 結果 在1404位病患中，有9人被篩檢出大腸直腸癌：268位為大腸息肉症，86位為大腸憩室症。糞便潛血試驗陽性的病例佔6.9%。糞便潛血試驗用於篩檢大腸直腸疾病之敏感性，特異性，偽陽性，偽陰性分別為14.4%，93.1%，6.9%及85.6%。血清CEA值大於6ng/mL之病例佔2.8%。血清CEA 值用於篩檢大腸直腸疾病之敏感性，特異性，偽陽性，偽陰性分別為15.4%，92.8%，7.2%及84.6%。被篩檢出大腸直腸疾病的病竈中，73.5%位於降結腸之更遠端處。被篩檢出罹患大腸直腸癌之病患中，只有一位病患在接受健檢前，毫無任何症狀。 結論 糞便潛血試驗及血清CEA值，由於敏感性過低及偽陰性過高之因素，使其無法成為一有效之篩檢工具。目前常用之乙狀結腸鏡檢，因約四分之一之大腸直腸病竈，其位置已超過其鏡檢長度，而無法成為有效之工具。至目前為止，最為有效之大腸直腸疾病篩檢方式，仍然是病患對其症狀之早期警覺，以及在一般健檢病患要求之下，所進行之完整大腸鏡檢。
並列摘要
Purpose. Stool occult blood tests and serum CEA level examinations are widely used at health check-up of detecting colorectal lesions. The aim of this study is to evaluate the effectiveness of using single stool occult blood tests or serum CEA levels in routine health check up. Methods. We examined 1404 patients who came for health check up at Veterans General Hospital, Taipei, Taiwan from April 2004 to May 2005. They were all underwent single stool occult blood test, serum CEA level and complete colonoscopy during the check up. Results. There were patients with colorectal cancers in 9 (0.6%), polyps in 268 (19.1%) (Significant polyps in 95), diverticulum in 86 (6.1%) and other lesions in 9 (0.6%). Positive stool occult blood tests were noted in 97 patients (6.9%). The sensitivity, specificity, false positive rate and false negative rate of stool occult blood test to detect significant colorectal neoplasm were 14.4%, 93.1%, 6.9% and 85.6% respectively. There were 39 (2.8%) patients showed elevated serum CEA level with the cut-off value of 6.0 ng/mL. The sensitivity, specificity, false positive rate and false negative rate of elevated CEA level to detect colorectal tumor was 15.4%, 92.8%, 7.2% and 84.6% respectively. The distributions of colorectal cancers and polyps were 26.5% proximal and 73.5% distal to the descending colon. Among the patients with colorectal cancers, only one who came for health check-up was completely free of gastrointestinal symptoms. Conclusions. Single stool occult blood test and serum CEA level were failed to effectiveness in health check up due to very low sensitivity and unacceptable high false-negative rates, the routine fibro-sigmoidoscopic examination of 60cm in check up was not enough for complete detection of colorectal cancer and polyp because there were still one fourth lesions distributed proximal to the upper limit of flexible sigmoidoscopic examinations. The most effective ways to detect colorectal lesions were complete colonoscopy and the awareness of the early symptoms of the cancer. Complete colonoscopy should be recommended in patients asking for health checkup.