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CT colonography for surveillance of patients with colorectal cancer: Systematic review and meta-analysis of diagnostic efficacy

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To review primary research evidence investigating performance of CT colonography for colorectal cancer surveillance. The financial impact of using CT colonography for surveillance was also estimated.

Methods

We identified primary studies of CT colonography for surveillance of colorectal cancer patients. A summary ROC curve was constructed. Inter-study heterogeneity was explored using the I2 value. Financial impact was estimated for a theoretical cohort of patients, based on Cancer Research UK statistics.

Results

Seven studies provided data on 880 patients. Five of seven studies (765 patients) were included for qualitative analysis. Sensitivity of CT colonography for detection of anastomotic recurrence was 95 % (95 % CI 62 − 100), specificity 100 % (95 % CI 75 − 100) and sensitivity for metachronous cancers was 100 %. No statistical heterogeneity was detected (I2 = 0 %). We estimated that CT colonography as a 'single test' alternative to colonoscopy and standard CT for surveillance would potentially save €20,785,232 (£14,803,404) for an annual cohort of UK patients.

Conclusion

CT colonography compares favourably to colonoscopy for detection of anastomotic recurrence and metachronous colorectal cancer, and appears financially beneficial. These findings should be considered alongside limitations of small patient numbers and high clinical heterogeneity between studies.

Key Points

• CT colonography compares favourably to colonoscopy/standard CT for colorectal cancer surveillance.

• CT colonography offers single-test luminal, serosal and extra-colonic assessment.

• CT colonography is a potentially cost-saving alternative to standard surveillance protocols.

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References

  1. Atkin W, Dadswell E, Wooldrage K et al (2013) Computed tomographic colonography versus colonoscopy for investigation of patients with symptoms suggestive of colorectal cancer (SIGGAR): A multicentre randomised trial. Lancet 381(9873):1194–1202

    Article  PubMed  Google Scholar 

  2. Halligan S, Wooldrage K, Dadswell E et al (2015) Identification of Extra-colonic Pathologies by Computed Tomographic Colonography in Symptomatic Patients. Gastroenterology. doi:10.1053/j.gastro.2015.03.011

    PubMed  Google Scholar 

  3. Meyerhardt JA, Mangu PB, Flynn PJ et al (2013) Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol 31:4465–4470

    Article  PubMed  Google Scholar 

  4. NICE (2011) Nice Clinical Guideline 131. Nice Clin Guidel 131. https://www.nice.org.uk/guidance/cg131

  5. Renehan a G (2002) Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials. BMJ 324:813–813

    Article  PubMed  PubMed Central  Google Scholar 

  6. Jeffery M, Hickey B, Hider P (2007) Follow up strategies for patients treated for non-metastatic colorectal cancer (Review). J Syst Rev (4). http://espace.library.uq.edu.au/view/UQ:137177

  7. Primrose JN, Perera R, Gray A et al (2014) Effect of 3 to 5 years of scheduled CEA and CT follow-up to detect recurrence of colorectal cancer: the FACS randomized clinical trial. JAMA 311(3):263–270

    Article  CAS  PubMed  Google Scholar 

  8. Pineau BC, Paskett ED, Chen GJ et al (2001) Validation of virtual colonoscopy in the detection of colorectal polyps and masses: rationale for proper study design. Int J Gastrointest Cancer 30(3):133–140

  9. Neri E, Halligan S, Hellström M et al (2013) The second ESGAR consensus statement on CT colonography. Eur Radiol 23:720–729

    Article  PubMed  Google Scholar 

  10. Radiologists BS of G and AR (BSGAR) and the RC of. Guidance on the use of CT colonography for suspected colorectal cancer. (Ref No. BFCR(14)9). http://www.rcr.ac.uk/docs/radiology/pdf/BFCR(14)9_COLON.pdf

  11. Whiting PF, Rutjes AWS, Westwood ME et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155(4):529–536

    Article  PubMed  Google Scholar 

  12. Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of Observational Studies in Epidemiology. A Proposal for Reporting. J Am Med Assoc 283(15):2008–2012

  13. Cancer Research UK - Statistics and Outlook for Bowel Cancer. http://www.cancerresearchuk.org/about-cancer/type/bowel-cancer/treatment/statistics-and-outlook-for-bowel-cancer

  14. Cancer Research UK Bowel Cancer Statistics. http://www.cancerresearchuk.org/cancer-info/cancerstats/types/bowel/incidence/

  15. NHS. NHS National tariff Payment System (Annex 5A). https://www.gov.uk/government/publications/national-tariff-payment-system-2014-to-2015

  16. You YT, Chang Chien CR, Wang JY et al (2006) Evaluation of contrast-enhanced computed tomographic colonography in detection of local recurrent colorectal cancer. World J Gastroenterol 12(1):123–126

    Article  PubMed  PubMed Central  Google Scholar 

  17. Fletcher JG, Johnson CD, Krueger WR, et al (2002) Contrast-enhaned CT colonography in Recurrent Colorectal Carcinoma: Feasibility of Simultaneous Evaluation for Metastatic Disease, local recurrence and metachronous neolasia in colorectal carcinoma. AJR Am J Roentgenol 178(2):283–290

  18. Laghi A, Iannaccone R, Bria E et al (2003) Contrast-enhanced computed tomographic colonography in the follow-up of colorectal cancer patients: a feasibility study. Eur Radiol 13:883–889

    PubMed  Google Scholar 

  19. Leonardou P, Striggaris K, Pappas P et al (2006) Screening of patients after colectomy: Virtual colonography. Abdom Imaging 31:521–528

    Article  CAS  PubMed  Google Scholar 

  20. Amitai MM, Fidder H, Avidan B et al (2009) Contrast-enhanced CT colonography with 64-slice MDCT compared to endoscopic colonoscopy in the follow-up of patients after colorectal cancer resection. Clin Imaging 33(6):433–438

    Article  PubMed  Google Scholar 

  21. Neri E, Vagli P, Turini F et al (2010) Post-surgical follow-up of colorectal cancer: Role of contrast-enhanced CT colonography. Abdom Imaging 35:669–675

    Article  PubMed  Google Scholar 

  22. Kim HJ, Park SH, Pickhardt PJ, et al (2010) CT Colonography for Combined Colonic and Extracolonic Resection of Colorectal Cancer. Radiology 57(3). doi:10.1148/radiol.10100385/-/DC1

  23. Bhangu A, Ali SM, Cunningham D, Brown G, Tekkis P (2013) Comparison of long-term survival outcome of operative vs nonoperative management of recurrent rectal cancer. Color Dis 15:156–163

    Article  CAS  Google Scholar 

  24. Bhangu A, Brown G, Akmal M, Tekkis P (2012) Outcome of abdominosacral resection for locally advanced primary and recurrent rectal cancer. Br J Surg 99:1453–1461

    Article  CAS  PubMed  Google Scholar 

  25. Heriot AG, Byrne CM, Lee P et al (2008) Extended radical resection: The choice for locally recurrent rectal cancer. Dis Colon Rectum 51:284–291

    Article  PubMed  Google Scholar 

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Acknowledgments

The scientific guarantor of this publication is David Burling. The authors of this manuscript declare relationships with the following companies: Steve Halligan has a non-renumerated research arrangement with iCAD inc. and has received speaker fees from BRACCO SpA regarding CT colonography. David Burling is the lead for the St Marks CT Colonography service and receives an educational grant from Bracco. The remaining authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. An expert in statistics or biometry was not consulted or required. Thanos Athanasiou kindly provided statistical advice for this manuscript. Mallikarjuna Uppara and George Malietzis have previous statistical experience with meta-analyses. Institutional Review Board approval was not required by our institution for secondary research using existing available literature. The study subjects have been previously reported in existing literature, as referenced in the manuscript and below:

You YT, Chang Chien CR, Wang JY, et al. Evaluation of contrast-enhanced computed tomographic colonography in detection of local recurrent colorectal cancer. World J Gastroenterol. 2006;12(1):123-126.

Fletcher JG, Johnson CD, Krueger WR, et al. Contrast-enhaned CT colonography in recurrent colorectal carcinoma: Feasibility of simultaneous evaluation for metastatic disease, local recurrence and metachronous neolasia in colorectal carcinoma. AJR Am J Roentgenol. 2002;(February):283-290.

Laghi A, Iannaccone R, Bria E, et al. Contrast-enhanced computed tomographic colonography in the follow-up of colorectal cancer patients: a feasibility study. Eur Radiol. 2003;13:883-889. doi:10.1007/s00330-002-1696-4.

Leonardou P, Striggaris K, Pappas P, et al. Screening of patients after colectomy: Virtual colonography. Abdom Imaging. 2006;31(December 2005):521-528. doi:10.1007/s00261-005-0120-3.

Amitai MM, Fidder H, Avidan B, et al. Contrast-enhanced CT colonography with 64-slice MDCT compared to endoscopic colonoscopy in the follow-up of patients after colorectal cancer resection. Clin Imaging. 2009;33(6):433-438. doi:10.1016/j.clinimag.2009.01.002.

Neri E, Vagli P, Turini F, et al. Post-surgical follow-up of colorectal cancer: Role of contrast-enhanced CT colonography. Abdom Imaging. 2010;35(December 2009):669-675. doi:10.1007/s00261-009-9596-6.

Kim HJ, Park SH, Pickhardt PJ, et al. CT Colonography for Combined Colonic and Extracolonic Resection of Colorectal Cancer. Radiology. 2010;257(3). doi:10.1148/radiol.10100385/-/DC1.

Methodology: systematic review and meta-analysis, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Radiology, St Mark’s Hospital, Harrow, UK

    François Porté & David Burling

  2. Surgical Epidemiology, Trials and Outcome Centre (SETOC) St Mark’s Hospital, Harrow, UK

    Mallikarjuna Uppara, George Malietzis & Omar Faiz

  3. Department of Radiology, University College London, London, UK

    Steve Halligan

  4. Department of Surgery and Cancer, Imperial College London, London, UK

    Thanos Athanasiou

Authors
  1. François Porté
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  2. Mallikarjuna Uppara
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  3. George Malietzis
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  4. Omar Faiz
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  5. Steve Halligan
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  6. Thanos Athanasiou
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  7. David Burling
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Corresponding author

Correspondence to David Burling.

Appendix

Appendix

FP is a Gastrointestinal Radiology Fellow at St. Mark’s Hospital, Harrow, UK, and has 6 years of specialty training in clinical radiology.

MU and GM are experienced Clinical Research Fellows in Surgical Epidemiology at the Trials and Outcome Centre (SETOC), St Mark’s Hospital, Harrow, UK, and have previously undertaken several systematic reviews and meta-analyses.

OF is a Consultant Colorectal Surgeon, Surgical Epidemiology, Trials and Outcome Centre (SETOC) St Mark’s Hospital and Honorary Senior Lecturer Imperial college, London, UK.

TA is a Professor in the Department of Surgery at Imperial College London, UK. He has published over 70 systematic reviews and meta-analyses.

SH is a Professor of Gastrointestinal Radiology, University College London, UK, and has a special interest in colorectal cancer imaging with CT colonography.

DB is a Consultant Gastrointestinal Radiologist at St. Mark’s Hospital, Harrow, UK.

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Porté, F., Uppara, M., Malietzis, G. et al. CT colonography for surveillance of patients with colorectal cancer: Systematic review and meta-analysis of diagnostic efficacy. Eur Radiol 27, 51–60 (2017). https://doi.org/10.1007/s00330-016-4319-1

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  • DOI: https://doi.org/10.1007/s00330-016-4319-1

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