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Five year colorectal cancer outcomes in a large negative CT colonography screening cohort

  • Gastrointestinal
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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.

Key Points

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.

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  1. 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

    Article  PubMed  CAS  Google Scholar 

  2. 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

    Article  PubMed  CAS  Google Scholar 

  3. 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

    Article  PubMed  CAS  Google Scholar 

  4. 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

    Article  PubMed  CAS  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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

    Article  PubMed  CAS  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  PubMed  CAS  Google Scholar 

  9. 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

    Article  PubMed  Google Scholar 

  10. Zalis ME, Barish MA, Choi JR et al (2005) CT colonography reporting and data system: a consensus proposal. Radiology 236:3–9

    Article  PubMed  Google Scholar 

  11. Ahlbom A (1993) Biostatistics for epidemiologists. CRC, Boca Raton

    Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. Pickhardt PJ, Kim DH (2009) Advanced vs. “High-Risk” adenomas: identifying the relevant target for CT colonography screening. Am J Gastroenterol 104:1599–1600

    Article  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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

    Article  PubMed  CAS  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. 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

    Article  PubMed  CAS  Google Scholar 

  18. Neugut AI, Jacobson JS, Ahsan H et al (1995) Incidence and recurrence rates of colorectal adenomas—a prospective-study. Gastroenterology 108:402–408

    Article  PubMed  CAS  Google Scholar 

  19. Robertson DJ, Greenberg ER, Beach M et al (2005) Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology 129:34–41

    Article  PubMed  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. 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

    Article  PubMed  CAS  Google Scholar 

  22. 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

    Article  PubMed  CAS  Google Scholar 

  23. 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

    Article  PubMed  CAS  Google Scholar 

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This work was supported in part by the research grant 1R01CA144835-01 from the National Cancer Institute. D.H.K is a consultant for Viatronix, co-founder of VirtuoCTC, and a member of the medical advisory board for Digital Artforms. P.J.P is a consultant for Viatronix, Medicsight, Bracco, and Check-cap, and is a co-founder of VirtuoCTC.

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Correspondence to David H. Kim.

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Kim, D.H., Pooler, B.D., Weiss, J.M. et al. Five year colorectal cancer outcomes in a large negative CT colonography screening cohort. Eur Radiol 22, 1488–1494 (2012).

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