Screening and Surveillance of Colorectal Cancer Using CT Colonography
- 447 Downloads
Colorectal cancer (CRC) is a common cancer among throughout the world with the highest rates in developed countries such as the USA. There is ample evidence demonstrating the beneficial effects of colorectal cancer screening and, largely thanks to screening initiatives and insurance coverage, epidemiologic analyses show a steady decline in both CRC incidence and mortality rates over the last several decades. However, screening rates for CRC in the US remain low and approximately 1 in 3 adults between the ages of 50 and 75 years has not undergone any form of CRC screening, highlighting the need for additional accurate, minimally invasive, and acceptable screening options. Computed tomography colonography (CTC) has emerged as a viable alternative to existing CRC screening tests and research continues to enhance our knowledge regarding the ability of CTC to play a meaningful role in optimizing CRC screening in areas where it is available. This review highlights recent publications of salient research in the field of CTC. CTC continues to evolve, with lower radiation doses and greater evidence of its ability to identify clinical relevant colonic and extracolonic abnormalities. Recent evidence has bolstered the currently recommended CTC screening interval of 5 years and has reiterated the cost-effectiveness of CTC as a CRC screening examination. Additionally, emerging evidence suggests a role for CTC as a polyp and CRC surveillance modality as well as a preoperative adjunct in patients with established CRC. Data supporting the safety and patient acceptance of CTC also has continued to accumulate and CTC has recently been endorsed as an appropriate test for CRC screening in multiple important guidelines and recommendations. CTC is poised to become an important option in the CRC screening and surveillance arena.
KeywordsColorectal cancer screening CT colonography Virtual colonoscopy Colorectal cancer surveillance Colon polyp detection
Compliance with Ethical Standards
Conflict of Interest
Manoj Kumar and Brooks D. Cash each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance; •• Of major importance
- 2.Balanced Budget Act of 1997, Pub. L. No. 105–33; § 4104 (1997).Google Scholar
- 4.Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN, et al. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116:544–73.CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Bond J, et al. 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. Gastroenterology. 2008;134:1570–95.CrossRefPubMedGoogle Scholar
- 10.Meyerhardt JA, Mangu PB, Flynn PJ, Korde L, Loprinzi CL, Minski BD, et al. 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. 2013;31:4465–70.CrossRefPubMedGoogle Scholar
- 11.Vining DJ, Gelfand DW, Bechtold RE, Scharling ES, Grishaw EK, Shifrin RY. Technical feasibility of colon imaging with helical CT and virtual reality. AJR Am J Roentgenol. 1994;162(Suppl):104.Google Scholar
- 19.Regge D, Laudi C, Galatola G, Della Monica P, Bonelli L, Angelelli Get al. Diagnostic accuracy of computed tomographic colonography for the detection of advanced neoplasia in individuals at increased risk of colorectal cancer. JAMA 2009;301(23):2453-2461.Google Scholar
- 20.Graser A, Stieber P, Nagel D, Schäfer C, Horst D, Becker CR et al. Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population. Gut 2009;58(2):241-248.Google Scholar
- 21.•• Pickhardt PJ, Pooler BD, Mbah I, Weiss JM, Kim DH. Colorectal findings at repeat CT colonography screening after initial CT colonography screening negative for polyps larger than 5 mm. Radiology. 2016;22:160582. First large report of results evaluating serial CTC screening examinationsGoogle Scholar
- 23.American College of Radiology. ACR practice guideline for the performance of computed tomography (CT) colonography in adults. Practice Guidelines and Technical Standards; Reston, VA: 2009.Google Scholar
- 24.• Nagata K, Fujiwara M, Kanazawa H, Mogi T, Iida N, Mitsushima T, et al. Evaluation of dose reduction and image quality in CT colonography: comparison of low-dose CT with iterative reconstruction and routine-dose CT with filtered back projection. Eur Radiol. 2015;25:221–9. Important article showing the feasibility of reduced radiation doses without compromised image quality of CTCCrossRefPubMedGoogle Scholar
- 30.Lambert L, Ourednicek P, Briza J, Giepmans W, Jahoda J, Hruska L, et al. Sub-milliSievert ultralow-dose CT colonography with iterative model reconstruction technique. PeerJ. 4:e1883. doi: 10.7717/peerj.1883.
- 32.•• Pooler BD, Kim DH, Pickhardt PJ. Indeterminate but likely unimportant extracolonic findings at screening CT colonography (C-RADS Category E3): Incidence and outcomes data from a clinical screening program. Am J Roentgenol. 2016;9:1–6. Important real-life experience showing low rates and acuity of extracolonic findings over time with surveillance CTCGoogle Scholar
- 36.•• Tutein Nolthenius CJ, Boellaard TN, de Haan MC, Nio CY, Thomeer MG, Bipat S, et al. Evolution of screen-detected small (6-9 mm) polyps after a 3-year surveillance interval: assessment of growth with CT colonography compared with histopathology. Am J Gastroenterol. 2015;110:1682–90. Landmark article evaluating the natural history of small polyps left in vivoCrossRefPubMedGoogle Scholar
- 46.Tran DQ, Rosen L, Kim R, Riether RD, Stasik JJ, Khubchandani IT. Actual colonoscopy: what are the risks of perforation? Am J Surg. 2001;67:845–7.Google Scholar
- 50.•• Lara LF, Avalos D, Huynh H, Jimenez-Cantisano B, Padron M, Pimentel R, et al. The safety of same-day CT colonography following incomplete colonoscopy with polypectomy. United European Gastroenterol J. 2015;3:358–63. Very nice study demonstrating safety of same day CTC, even after mucosal biopsy during incomplete colonoscopyCrossRefPubMedPubMedCentralGoogle Scholar
- 54.Kriza C, Emmert M, Wahlster P, Niederländer C, Kolominsky-Rabas P. An international review of the main cost-effectiveness drivers of virtual colonography versus conventional colonoscopy for colorectal cancer screening: is the tide changing due to adherence? Eur J Radiol. 2013;82:629–36.CrossRefGoogle Scholar
- 68.Stoop EM, de Haan MC, de Wijkerslooth TR, Bossuyt PM, van Ballegooijen M, Nio CY, et al. Participation and yield of colonoscopy versus non-cathartic CT colonography in population-based screening for colorectal cancer: a randomised controlled trial. Lancet Oncol. 2012;13:55–64.CrossRefPubMedGoogle Scholar
- 72.Jeffery M, Hickey B, Hider P. Follow up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev. 2007;1:CD002200.Google Scholar