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Investigating Symptoms Suggestive of Colorectal Cancer: Computed Tomographic Colonography or Colonoscopy?

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Timely Diagnosis of Colorectal Cancer

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Abstract

Clinicians have many options when choosing how best to investigate patients with colorectal symptoms. Colonoscopy and computed tomographic colonography (CTC) are employed frequently, since they can examine the entire colon. In this chapter, we will summarize the evolution and development of CTC, early work suggesting high diagnostic accuracy, more recent studies confirming this excellent performance can be generalized across a variety of healthcare settings, and consider extracolonic evaluation, patient acceptability, safety, and cost-effectiveness.

Meta-analysis shows that CTC has high sensitivity for established colorectal cancer (CRC), similar to that of colonoscopy (CTC: 96%, colonoscopy: 95%), and that it is approximately 90% sensitive for colorectal neoplasia measuring 1 cm or more. More recent randomized data from a symptomatic population, representative of those referred for prompt exclusion of CRC (the SIGGAR trials), showed no significant difference in detection rates of CRC or 1 cm + polyps between CTC and colonoscopy. CTC also makes important extracolonic diagnoses in around 2% of symptomatic patients. However, the benefits of this are uncertain, partly because of false-positives and partly because patients having colonoscopy may often have subsequent abdominopelvic CT if no cause for their symptoms is found at colonoscopy. The two tests are finely balanced in terms of cost-effectiveness and patient preference, and both are very safe.

Widespread deployment of CTC as a test for symptomatic patients is already in progress, since CTC and colonoscopy are often complementary rather than competitive. Close collaboration between clinicians, service managers and commissioners will optimize appropriate use of both tests, for the ultimate benefit of patients.

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Authors and Affiliations

  1. UCL Centre for Medical Imaging, Podium Level 2, 235 Euston Rd, London, NW1 2HE, UK

    A. A. Plumb BM BCh, PhD, MRCP, FRCR & S. Halligan PhD, FRCP, FRCR, FMedSci

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  1. A. A. Plumb BM BCh, PhD, MRCP, FRCR
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  2. S. Halligan PhD, FRCP, FRCR, FMedSci
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Correspondence to A. A. Plumb BM BCh, PhD, MRCP, FRCR .

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  1. Karolinska Institutet, Stockholm, Sweden

    Louise Olsson

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Plumb, A.A., Halligan, S. (2018). Investigating Symptoms Suggestive of Colorectal Cancer: Computed Tomographic Colonography or Colonoscopy?. In: Olsson, L. (eds) Timely Diagnosis of Colorectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-65286-3_5

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  • DOI: https://doi.org/10.1007/978-3-319-65286-3_5

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