Abstract
Objectives
CT Colonography (CTC) is being increasingly used for the radiological evaluation of colorectal symptoms. Aim of this study was to assess the role of CTC in excluding a colorectal cancer (CRC) in older symptomatic patients.
Methods
1,359 CTC studies performed between March 2002 and December 2007 were analysed retrospectively. Gold standard was an endoscopic examination within 1 year and/or clinical, endoscopic and/or radiological follow-up until the time of data analysis. Patients not diagnosed as having a CRC on CTC were assumed as true-negatives if the gold standard was negative and did not feature on the regional cancer registry (at least 18 months post-CTC). Sensitivity, specificity, positive and negative predictive values were calculated for detection of colorectal cancer.
Results
After exclusions, 1,177 CTC studies were included. These were undertaken in 463 men and 714 women. Median age of patients undergoing CTC was 71 (range, 27–96) years. 59 invasive CRC were detected. Median follow-up was 34.5 (range 18–84) months. Three small colorectal cancers were missed. Sensitivity and negative predictive value for CRC were 94.9% (95% CI:84.9%–98.7%) and 99.7% (95% CI:99.1%–99.9%) respectively.
Conclusions
CTC has a high sensitivity and negative predictive value in excluding a CRC in patients with colorectal symptoms.
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References
Terhaar Sive Droste JS, Craanen ME, van der Hulst RW et al (2009) Colonoscopic yield of colorectal neoplasia in daily clinical practice. World J Gastroenterol 15:1085–1092
Loffeld RJ, van der Putten AB (2009) The completion rate of colonoscopy in normal daily practice: factors associated with failure. Digestion 80:267–270
Bowles CJ, Leicester R, Romaya C, Swarbrick E, Williams CB, Epstein O (2004) A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow? Gut 53:277–283
Pickhardt PJ, Taylor AJ, Gopal DV (2006) Surface visualization at 3D endoluminal CT colonography: degree of coverage and implications for polyp detection. Gastroenterology 130:1582–1587
East JE, Saunders BP, Burling D, Boone D, Halligan S, Taylor SA (2007) Surface visualization at CT colonography simulated colonoscopy: effect of varying field of view and retrograde view. Am J Gastroenterol 102:2529–2535
Berrington de Gonzalez A, Kim KP, Yee J (2010) CT colonography: perforation rates and potential radiation risks. Gastrointest Endosc Clin N Am 20:279–291
Khan JS, Moran BJ (2009) Iatrogenic perforation at colonic imaging. Colorectal Dis
Yee J, Sadda S, Aslam R, Yeh B Extracolonic findings at CT colonography. Gastrointest Endosc Clin N Am 20:305–322
Tolan DJ, Armstrong EM, Chapman AH (2007) Replacing barium enema with CT colonography in patients older than 70 years: the importance of detecting extracolonic abnormalities. AJR Am J Roentgenol 189:1104–1111
Almond M, Bowley D, Hendrickse C, Roy-Choudhury S, Karandikar SS (2010) Trends in whole colonic imaging. Acta Radiol 51:708
Fisichella VA, Hellstrom M (2010) Survey update on implementation, indications, and technical performance of computed tomography colonography in Sweden. Acta Radiol 51:4–8
Svensson MH, Svensson E, Lasson A, Hellstrom M (2002) Patient acceptance of CT colonography and conventional colonoscopy: prospective comparative study in patients with or suspected of having colorectal disease. Radiology 222:337–345
Taylor SA, Halligan S, Saunders BP, Bassett P, Vance M, Bartram CI (2003) Acceptance by patients of multidetector CT colonography compared with barium enema examinations, flexible sigmoidoscopy, and colonoscopy. AJR Am J Roentgenol 181:913–921
Jensch S, de Vries AH, Peringa J et al (2008) CT colonography with limited bowel preparation: performance characteristics in an increased-risk population. Radiology 247:122–132
Kim DH, Pickhardt PJ, Taylor AJ et al (2007) CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 357:1403–1412
Pickhardt PJ, Choi JR, Hwang I et al (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349:2191–2200
Johnson CD, Chen MH, Toledano AY et al (2008) Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 359:1207–1217
Pickhardt PJ, Wise SM, Kim DH (2010) Positive predictive value for polyps detected at screening CT colonography. Eur Radiol 20:1651–1656
Ozsunar Y, Coskun G, Delibas N, Uz B, Yukselen V (2009) Diagnostic accuracy and tolerability of contrast enhanced CT colonoscopy in symptomatic patients with increased risk for colorectal cancer. Eur J Radiol 71:513–518
White TJ, Avery GR, Kennan N, Syed AM, Hartley JE, Monson JR (2009) Virtual colonoscopy vs conventional colonoscopy in patients at high risk of colorectal cancer—a prospective trial of 150 patients. Colorectal Dis 11:138–145
McArthur DR, Mehrzad H, Patel R et al (2010) CT colonography for synchronous colorectal lesions in patients with colorectal cancer: initial experience. Eur Radiol 20:621–629
Zalis ME, Barish MA, Choi JR et al (2005) CT colonography reporting and data system: a consensus proposal. Radiology 236:3–9
Thomas S, Atchley J, Higginson A (2009) Audit of the introduction of CT colonography for detection of colorectal carcinoma in a non-academic environment and its implications for the national bowel cancer screening programme. Clin Radiol 64:142–147
Connolly DJ, Traill ZC, Reid HS, Copley SJ, Nolan DJ (2002) The double contrast barium enema: a retrospective single centre audit of the detection of colorectal carcinomas. Clin Radiol 57:29–32
Smith GA, O’Dwyer PJ (2001) Sensitivity of double contrast barium enema and colonoscopy for the detection of colorectal neoplasms. Surg Endosc 15:649–652
Halligan S, Altman DG, Taylor SA et al (2005) CT colonography in the detection of colorectal polyps and cancer: systematic review, meta-analysis, and proposed minimum data set for study level reporting. Radiology 237:893–904
Neri E, Giusti P, Battolla L et al (2002) Colorectal cancer: role of CT colonography in preoperative evaluation after incomplete colonoscopy. Radiology 223:615–619
Sabanli M, Balasingam A, Bailey W, Eglinton T, Hider P, Frizelle FA (2010) Computed tomographic colonography in the diagnosis of colorectal cancer. Br J Surg 97:1291–1294
Leaper M, Johnston MJ, Barclay M, Dobbs BR, Frizelle FA (2004) Reasons for failure to diagnose colorectal carcinoma at colonoscopy. Endoscopy 36:499–503
McDonald S, Lyall P, Israel L, Coates R, Frizelle F (2001) Why barium enemas fail to identify colorectal cancers. ANZ J Surg 71:631–633
Singh H, Nugent Z, Demers AA, Bernstein CN (2010) Rate and predictors of early/missed colorectal cancers after colonoscopy in manitoba: a population-based study. Am J Gastroenterol 105:2588–2596
Bressler B, Paszat LF, Vinden C, Li C, He J, Rabeneck L (2004) Colonoscopic miss rates for right-sided colon cancer: a population-based analysis. Gastroenterology 127:452–456
Aunt Minnie. SIGGAR trial results a win-win for virtual colonoscopy (2010). Available via http://www.auntminnie.com/index.asp?sec=ser&sub=def&pag=dis&ItemID=92515. Access date 23 Feb 2011
Pickhardt PJ, Choi JH (2003) Electronic cleansing and stool tagging in CT colonography: advantages and pitfalls with primary three-dimensional evaluation. AJR Am J Roentgenol 181:799–805
Pickhardt PJ, Lee AD, Taylor AJ et al (2007) Primary 2D versus primary 3D polyp detection at screening CT colonography. AJR Am J Roentgenol 189:1451–1456
Taylor SA, Halligan S, Burling D et al (2004) CT colonography: effect of experience and training on reader performance. Eur Radiol 14:1025–1033
Pickhardt PJ, Kim DH, Meiners RJ et al (2010) Colorectal and extracolonic cancers detected at screening CT colonography in 10,286 asymptomatic adults. Radiology 255:83–88
Liedenbaum MH, de Vries AH, van Rijn AF et al (2010) CT colonography with limited bowel preparation for the detection of colorectal neoplasia in an FOBT positive screening population. Abdom Imaging 35:661–668
Kim HJ, Park SH, Pickhardt PJ et al (2010) CT colonography for combined colonic and extracolonic surveillance after curative resection of colorectal cancer. Radiology 257:697–704
Laghi A, Iannaccone R, Carbone I et al (2002) Computed tomographic colonography (virtual colonoscopy): blinded prospective comparison with conventional colonoscopy for the detection of colorectal neoplasia. Endoscopy 34:441–446
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Badiani, S., Hernandez, S.T., Karandikar, S. et al. CT Colonography to exclude colorectal cancer in symptomatic patients. Eur Radiol 21, 2029–2038 (2011). https://doi.org/10.1007/s00330-011-2151-1
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DOI: https://doi.org/10.1007/s00330-011-2151-1