Five year colorectal cancer outcomes in a large negative CT colonography screening cohort
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To assess the 5-year incidence of clinically presenting colorectal cancers following a negative CT colonography (CTC) screening examination, as few patient outcome data regarding a negative CTC screening result exist.
Negative CTC screening patients (n = 1,050) in the University of Wisconsin Health system over a 14-month period were included. An electronic medical record (EMR) review was undertaken, encompassing provider, colonoscopy, imaging and histopathology reports. Incident colorectal cancers and other important GI tumours were recorded.
Of the 1,050 cohort (mean [±SD] age 56.9 ± 7.4 years), 39 (3.7%) patients were excluded owing to lack of follow-up within our system beyond the initial screening CTC. The remaining 1,011 patients were followed for an average of 4.73 ± 1.15 years. One incident colorectal adenocarcinoma represented a crude cancer incidence of 0.2 cancers per 1,000 patient years. EMR revealed 14 additional patients with clinically important GI tumours including: advanced adenomas (n = 11), appendiceal goblet cell carcinoid (n = 1), appendiceal mucinous adenoma (n = 1) and metastatic ileocolonic carcinoid (n = 1). All positive patients including the incident carcinoma are alive at the time of review.
Clinically presenting colorectal adenocarcinoma is rare in the 5 years following negative screening CTC, suggesting that current strategies, including non-reporting of diminutive lesions, are appropriate.
• CT colonography (CTC) screening is increasingly used to identify potential colorectal cancer.
• Clinically presenting cancers are rare for 5 years following negative CTC screening.
• The practice of setting a 6 mm polyp size threshold seems safe.
• An interval of 5 years for routine CTC screening is appropriate.
- 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 CrossRef
- 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 CrossRef
- Graser A, Stieber P, Nagel D et al (2009) Comparison of CT colonography, colonoscopy, sigmoidoscopy, and fecal occult blood tests for the detection of advanced adenoma in an average risk population. Gut 58:241–248 CrossRef
- Regge D, Laudi C, Galatola G et al (2009) Diagnostic accuracy of computed tomographic colonography for the detection of advanced neoplasia in individuals at increased risk of colorectal cancer. JAMA 301:2453–2461 CrossRef
- Levin B, Lieberman DA, McFarland B et al (2008) Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 58:130–160 CrossRef
- 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 CrossRef
- Rex DK, Overhiser AJ, Chen SC, Cummings OW, Ulbright TM (2009) Estimation of impact of american college of radiology recommendations on CT colonography reporting for resection of high-risk adenoma findings. Am J Gastroenterol 104:149–153 CrossRef
- Soetikno RM, Kaltenbach T, Rouse RV et al (2008) Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA 299:1027–1035 CrossRef
- Pickhardt PJ, Taylor AJ, Kim DH, Reichelderfer M, Gopal DV, Pfau PR (2006) Screening for colorectal neoplasia with CT colonography: initial experience from the 1st year of coverage by third-party payers. Radiology 241:417–425 CrossRef
- Zalis ME, Barish MA, Choi JR et al (2005) CT colonography reporting and data system: a consensus proposal. Radiology 236:3–9 CrossRef
- Ahlbom A (1993) Biostatistics for epidemiologists. CRC, Boca Raton
- Lieberman D, Moravec M, Holub J, Michaels L, Eisen G (2008) Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography. Gastroenterology 135:1100–1105 CrossRef
- Pickhardt PJ, Kim DH (2009) Advanced vs. “High-Risk” adenomas: identifying the relevant target for CT colonography screening. Am J Gastroenterol 104:1599–1600 CrossRef
- Pickhardt PJ, Kim DH, Robbins JB (2010) Flat (Nonpolypoid) colorectal lesions identified at CT colonography in a US screening population. Acad Radiol 17:784–790 CrossRef
- Imperiale TF, Glowinski EA, Lin-Cooper C, Larkin GN, Rogge JD, Ransohoff DF (2008) Five-year risk of colorectal neoplasia after negative screening colonoscopy. N Engl J Med 359:1218–1224 CrossRef
- Leung WK, Lau JYW, Suen BY et al (2009) Repeat-screening colonoscopy 5 years after normal baseline-screening colonoscopy in average-risk Chinese: a prospective study. Am J Gastroenterol 104:2028–2034 CrossRef
- Rex DK, Cummings OW, Helper DJ et al (1996) 5-year incidence of adenomas after negative colonoscopy in asymptomatic average-risk persons. Gastroenterology 111:1178–1181 CrossRef
- Neugut AI, Jacobson JS, Ahsan H et al (1995) Incidence and recurrence rates of colorectal adenomas—a prospective-study. Gastroenterology 108:402–408 CrossRef
- Robertson DJ, Greenberg ER, Beach M et al (2005) Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology 129:34–41 CrossRef
- Pabby A, Schoen RE, Weissfeld JL et al (2005) Analysis of colorectal cancer occurrence during surveillance colonoscopy in the dietary polyp prevention trial. Gastrointest Endosc 61:385–391 CrossRef
- Alberts DS, Martinez ME, Roe DJ et al (2000) Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. N Engl J Med 342:1156–1162 CrossRef
- Arminski TC, McLean DW (1964) Incidence and distribution of adenomatous polyps of the colon and rectum based on 1,000 autopsy examinations. Dis Colon Rectum 7:249–261 CrossRef
- Gaglia P, Atkin WS, Whitelaw S et al (1995) Variables associated with the risk of colorectal adenomas in asymptomatic patients with a family history of colorectal-cancer. Gut 36:385–390 CrossRef
- Five year colorectal cancer outcomes in a large negative CT colonography screening cohort
Volume 22, Issue 7 , pp 1488-1494
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- CT colonography
- Advanced adenoma
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- Author Affiliations
- 1. Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA
- 2. Section of Gastroenterology, Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA