Coloscopie virtuelle méta-analyse des performances diagnostiques, indications et conditions de réalisation. - Abstract Virtual colonoscopy meta-analysis of diagnostic accuracy, indications and conditions of use - Version anglaise

Has

Description

Posted on Oct 22 2010 En 2004, l'Agence Nationale d'Accréditation et d'Evaluation en Santé (ANAES) avait considéré que la seule indication validée de la coloscopie virtuelle correspondait à la situation de vidéo-coloscopie incomplète. Depuis, la coloscopie virtuelle a fait l'objet de progrès techniques et de nouvelles études cliniques et a parfois été présentée en date de cette évaluation comme l'alternative à la vidéo-coloscopie la plus aboutie. Dans ce contexte, ce rapport a pour objectif d'actualiser l'estimation des performances diagnostiques de la coloscopie virtuelle afin d'en préciser la place dans la stratégie d'exploration colique des patients soumis à un dépistage de lésions colorectales ou à un diagnostic de symptômes coliques. Posted on Oct 22 2010

Sujets

• Imagerie médicale

Informations

• Publié par: haute-autorite-sante-techniques-et-procedures-de-diagnostic
• Publié le: 01 janvier 2010
• Nombre de lectures: 9
• Licence : En savoir +
  Paternité, pas d'utilisation commerciale, partage des conditions initiales à l'identique
• Langue: English

Extrait

  Virtual colonoscopy: meta-analysis of diagnostic accuracy, indications and conditions of use.    Agency HAS, Haute Autorité de Santé  2, Avenue du Stade de France – F 93218 La Plaine CEDEX  Tel : + 33 (0) 1 55 93 71 12 – Fax : + 33 (0) 1 55 93 74 35,ws.-whwantsafre.    Reference ptthw//:optria/lcjsmc/9_ww.has-sante.fr/leutriv--atem-elco4/7523ieopscloyse-anal des-performances-diagnostiques-indications-et-conditions-de-realisation    Aim   The diagnostic accuracy of virtual colonoscopy (VC) compared to optical colonoscopy (OC) remains questionable for two main reasons. Firstly, conflicting results have repeatedly been reported in original and large studies. Secondly, meta-analyses (MA) published at the time of our assessment could not be used for health technology assessment (HTA) as they included studies in which the mode of use of VC did not correspond to international current standards. Considering these facts, the French National Authority for Health (HAS) performed a new MA of the diagnostic accuracy of VC in the detection of polyps and colorectal cancer in order to advise National Health Insurance Funds making a decision on VC reimbursement.   Conclusions and results   24 studies involving 7202 patients were included. MA showed highly heterogeneous results, requiring the use of a mixed model (Markov chain Monte Carlo method). Whatever the lesion size, OC had significantly high er sensitivity and specificity than VC. Complications were infrequent for both. Subgroup analyses helped to define optimal technical characteristics of VC: complete colonic cleansing with faecal tagging, high spatial resolution imaging and expert reading combining 2D and 3D methods. HAS guidance concluded that VC cannot replace OC, e xcept in the case of incomplete optical colonoscopy, serious comorbidities or patient refusal.    Methods   All studies (Medline, Embase, Pascal, 2001-2009) comparing the diagnostic accuracy of VC in the detection of colorectal polyps and cancer ag ainst OC as the gold standard were identified. Unlike previous MA, only studies that used a VC with systematic prone and supine acquisitions and with slice collimation not greater than 2.5 mm were included. Methodological quality of included studies was asse ssed using the “Quality Assessment of Diagnostic Accuracy Studies”. Additionally, 14 experts representing 5 medical spe cialties (radiologist, gastroenterologist, oncologist, pathologist and public health) were consulted. Conclusions were appraised by a specialised committee of the HAS (“Commission d’Eva luation des Actes Professionnels”).   Further research   Further assessment should specify the attitude to be taken on discovery of polyps smaller than 6 mm. A medico-economic evaluation should also spec ify the place of VC in the event of OC refusal by a patient with a positive faecal test.   Written byDominique Tessier-Vetzel, HAS, France,[e-mail]