Abdominal Imaging

, Volume 31, Issue 3, pp 297–301 | Cite as

CT colonography: screening in individuals at high risk for colorectal cancer

PERSPECTIVE

Abstract

The use of computed tomographic colonography (CTC) as a screening test for colorectal cancer is being advocated with growing enthusiasm by physicians and the public as stronger evidence of its validity and limited invasiveness emerges from the literature. Because the approach to surveillance of colorectal cancer depends on an individual’s degree of risk category, which depends on familial and personal histories, it seems logical that the diagnostic performance and cost efficacy of screening CTC may differ according to the characteristics of the target population. Although CTC seems a valid option in low- to average-risk populations, pending a careful assessment of its cost and estimates of its cost efficacy, there are some important issues that should be addressed when it comes to considering its use in high-risk patients. The expected larger number of induced colonoscopies and higher false-positive rates are likely to have a great influence on CTC costs, but if its implementation causes a dramatic increase in the number of patients willing to undergo screening, thanks to its acceptability, then the cost efficacy ratio may ultimately become competitive with all other screening strategies for colorectal cancer. We strongly feel that large and well-conducted trials are needed to clarify the role of CTC in screening patients at increased risk of developing colorectal cancer.

Keywords

Computed tomographic colonography Conventionalcolonoscopy Colorectal cancer Screening 

References

  1. 1.
    Bray F, Sankila R, Ferlay J, Parkin DM (2002) Estimates of cancer incidence and mortality in Europe in 1995. Eur J Cancer 38:99–166CrossRefPubMedGoogle Scholar
  2. 2.
    Smith RA, Cokkinides V, von Eschenbach AC, et al. (2002) American Cancer Society guidelines for the early detection of cancer. CA Cancer J Clin 52:8–22PubMedCrossRefGoogle Scholar
  3. 3.
    Winawer SJ, Fletcher RH, Rex D, et al. (2003) Colorectal screening and surveillance: clinical guidelines rationale—update based on new evidence. Gastroenterology 124:544–560CrossRefPubMedGoogle Scholar
  4. 4.
    Wagner JL, Tunis S, Brown M, et al. (1996) The cost-effectiveness of colorectal cancer screening in average-risk adults. In: Young G, Levin B, Rozen A, eds. Prevention and early detection of colorectal cancer. London: WB Saunders, 321–256Google Scholar
  5. 5.
    Lynch HT, de la Chapelle A (2003) Hereditary colorectal cancer. N Engl J Med 348:919–932CrossRefPubMedGoogle Scholar
  6. 6.
    Fuchs CS, Giovannucci EL, Colditz GA, et al. (1994) A prospective study of family history and the risk of colorectal cancer. N Engl J Med 331:1669–1674CrossRefPubMedGoogle Scholar
  7. 7.
    Winawer SJ, Zauber AG, Gerdes H, et al. (1996) Risk of colorectal cancer in the families of patients with adenomatous polyps National Polyp Study Workgroup. N Eng J Med 334:82–87CrossRefGoogle Scholar
  8. 8.
    Henry LG, Condon RE, Schulte WJ, et al. (1975) Risk of recurrence of colon polyps. Ann Surg 182:511–515PubMedGoogle Scholar
  9. 9.
    Kirsner JB, Rider JA, Moeller HC, et al. (1960) Polyps of the colon and rectum: statistical analysis of a long-term follow-up study. Gastroenterology 39:178–182PubMedGoogle Scholar
  10. 10.
    Waye JD, Braunfeld SF (1982) Surveillance intervals after colonoscopic polypectomy. Endoscopy 14:79–81PubMedGoogle Scholar
  11. 11.
    Fowler DL, Hedberg SE (1980) Follow-up colonoscopy after polypectomy [abstract]. Gastrointest Endosc 26:67Google Scholar
  12. 12.
    Matek W, Guggenmoos-Holzman I, Demling L (1985) Follow-up of patients with colorectal adenomas. Endoscopy 17:175–181PubMedCrossRefGoogle Scholar
  13. 13.
    Atkin WS, Morson BC, Cuzick J (1992) Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med 326:658–662PubMedCrossRefGoogle Scholar
  14. 14.
    Gillespie PE, Chambers RJ, Chan KW, et al. (1979) Colonic adenomas: a colonoscopy survey. Gut 20:240–245PubMedGoogle Scholar
  15. 15.
    Winawer S, Zauber AG, O’Brien MJ, et al. (1993) Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. N Engl J Med 328:901–906CrossRefPubMedGoogle Scholar
  16. 16.
    Van Stolk RU, Beck GJ, Baron JA, et al. (1998) Adenoma characteristics at first colonoscopy as predictors of adenoma recurrence and characteristics at follow-up. Gastroenterology 115:13–18CrossRefPubMedGoogle Scholar
  17. 17.
    Zauber AG, Winawer SJ (1997) Initial management and follow-up surveillance of patients with colorectal adenomas. Gastroenterol Clin North Am 26:85–101CrossRefPubMedGoogle Scholar
  18. 18.
    Choi PM, Nugent FW, Schoetz DJJ, et al. (1993) Colonoscopic surveillance reduces mortality from colorectal cancer in ulcerative colitis. Gastroenterology 105:418–424PubMedGoogle Scholar
  19. 19.
    Citarda F, Tomaselli G, Capocaccia R, et al. (2001) The Italian Multicentre Study Group. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut 48:812–815CrossRefPubMedGoogle Scholar
  20. 20.
    Gatto NM, Frucht H, Sundararajan V, et al. (2003) Risk of perforation after colonoscopy and sigmoidoscopy: a population-based study. J Natl Cancer Inst 95:230–236PubMedCrossRefGoogle Scholar
  21. 21.
    Vining DJ, Gelfand DW, Bechtold RE, et al. (1994) Technical feasibility of colon imaging with helical CT and virtual reality [abstract]. AJR 62(suppl 104):104aGoogle Scholar
  22. 22.
    Halligan S, Fenlon HM (1999) Virtual colonoscopy. BMJ 319(7219):1249–1252PubMedGoogle Scholar
  23. 23.
    Summers RM, Jerebko AK, Franaszek M, et al. (2002) Colonic polyps: complementary role of computer-aided detection in CT colonography. Radiology 225:391–399PubMedGoogle Scholar
  24. 24.
    Yoshida H, Nappi J, MacEneaney P, et al. (2002) Computer-aided diagnosis scheme for detection of polyps at CT colonography. Radiographics 22:963–979PubMedGoogle Scholar
  25. 25.
    Kiss G, Van Cleynenbreugel J, Thomeer M, et al. (2002) Computer-aided diagnosis in virtual colonography via combination of surface normal and sphere fitting methods. Eur Radiol 12:77–81CrossRefPubMedGoogle Scholar
  26. 26.
    Johnson CD, Ahlquist DA (1999) Computed tomography colonography (virtual colonoscopy): a new method for colorectal screening. Gut 44:301–305PubMedCrossRefGoogle Scholar
  27. 27.
    Morrin MM, LaMont JT (2003) Screening virtual colonoscopy—ready for prime time? N Engl J Med 349:2261–2264CrossRefPubMedGoogle Scholar
  28. 28.
    Johnson CD, Harmsen WS, Wilson LA, et al. (2003) Prospective blinded evaluation of computed tomographic colonography for screen detection of colorectal polyps. Gastroenterology 125:311–319CrossRefPubMedGoogle Scholar
  29. 29.
    Yee J, Akerkar GA, Hung RK, et al. (2001) Colorectal neoplasia: performance characteristics of CT colonography for detection in 300 patients. Radiology 219:685–692PubMedGoogle Scholar
  30. 30.
    Spinzi G, Belloni G, Martegani A, et al. (2001) Computed tomographic colonography and conventional colonoscopy for colon diseases: a prospective, blinded study. Am J Gastroenterol 96:394–400CrossRefPubMedGoogle Scholar
  31. 31.
    Gallo TM, Galatola G, Fracchia M, et al. (2003) Computed tomography colonography in routine clinical practice. Eur J Gastroenterol Hepatol 15:1323–1331CrossRefPubMedGoogle Scholar
  32. 32.
    Sosna J, Morrin MM, Kruskal JB, et al. (2003) CT colonography of colorectal polyps: a metaanalysis. AJR 181:1593–1598PubMedGoogle Scholar
  33. 33.
    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 349:2191–2200CrossRefPubMedGoogle Scholar
  34. 34.
    Johnson CD, Harmsen WS, Wilson LA, et al. (2003) Prospective blinded evaluation of computed tomographic colonography for screen detection of colorectal polyps. Gastroenterology 125:311–319CrossRefPubMedGoogle Scholar
  35. 35.
    Macari M, Bini EJ, Jacobs SL, et al. (2004) Colorectal polyps and cancers in asymptomatic average-risk patients: evaluation with CT colonography. Radiology 230:629–636PubMedGoogle Scholar
  36. 36.
    Cotton PB, Durkalski VL, Pineau BC, et al. (2004) Computed tomographic colonography (virtual colonoscopy): a multicenter comparison with standard colonoscopy for detection of colorectal neoplasia. JAMA 291:1772–1774CrossRefGoogle Scholar
  37. 37.
    Van Gelder RE, Nio CY, Florie J, et al. (2004) Computed tomographic colonography compared with colonoscopy in patients at increased risk for colorectal cancer. Gastroenterology 127:41–48CrossRefPubMedGoogle Scholar
  38. 38.
    Fenlon HM, Nunes DP, Schroy PC III, et al. (1999) A comparison of virtual and conventional colonoscopy for the detection of colorectal polyps. N Engl J Med 341:1496–1503CrossRefPubMedGoogle Scholar
  39. 39.
    Hurlstone DP, Cross SS, Adam I, et al. (2003) A prospective clinicopathological and endoscopic evaluation of flat and depressed colorectal lesions in the United Kingdom. Am J Gastroenterol 98:2543–2549CrossRefPubMedGoogle Scholar
  40. 40.
    Hurlstone DP, Cross SS, Adam I, et al. (2004) Efficacy of high magnification chromoscopic colonoscopy for the diagnosis of neoplasia in flat and depressed lesions of the colorectum: a prospective analysis. Gut 53:284–290CrossRefPubMedGoogle Scholar
  41. 41.
    Pickhardt PJ (2005) CT colonography (virtual colonoscopy) for primary colorectal screening: challenges facing clinical implementation. Abdom Imaging 30:1–4CrossRefPubMedGoogle Scholar
  42. 42.
    van Gelder RE, Florie J, Stoker J (2005) Colorectal cancer screening and surveillance with CT colonography: current controversies and obstacles. Abdom Imaging 30:5–12CrossRefPubMedGoogle Scholar
  43. 43.
    1990 Recommendations of the International Commission on Radiological Protection. In: Smith H, (ed). Annals of the ICRP 21 (nos. 1–3). International Commission on Radiological Protection publication 60. Oxford: Pergamon Press, 1991Google Scholar
  44. 44.
    van Gelder RE, Venema HW, Serlie IW, et al. (2002) CT colonography at different radiation dose levels: feasibility of dose reduction. Radiology 224:25–33PubMedGoogle Scholar
  45. 45.
    Iannaccone R, Laghi A, Catalano C, et al. (2003) Feasibility of ultra-low-dose multislice CT colonography for the detection of colorectal lesions: preliminary experience. Eur Radiol 13:1297–1302PubMedGoogle Scholar
  46. 46.
    van Gelder RE, Venema HW, Florie J, et al. (2004) CT colonography: feasibility of substantial dose reduction—comparison of medium to very low doses in identical patients. Radiology 232:611–620PubMedGoogle Scholar
  47. 47.
    Sonnenberg A, Delco F, Bauerfeind P (1999) Is virtual colonoscopy a cost-effective option to screen for colorectal cancer? Am J Gastroenterol 94:2268–2274CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  1. 1.Radiology UnitInstitute for Cancer Research and TreatmentCandioloItaly
  2. 2.Gastroenterology UnitInstitute for Cancer Research and TreatmentCandioloItaly

Personalised recommendations