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Layer G, Wessling J. [Colorectal cancer screening with virtual colonography]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:471-478. [PMID: 38739177 DOI: 10.1007/s00117-024-01321-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Since 2003, a decline in the age-standardized incidence rates of colorectal cancer (CRC) has been observed in Germany. Nonetheless, one in eight cancer cases still affects the colon or rectum. The prognosis has improved, with the relative 5‑year survival rate for CRC being approximately 65%. METHODS This positive trend is probably a result of preventive measures introduced over the last 20 years. This could be further improved, however, as CRC can not only be detected early but in almost all cases also prevented through the identification of benign precursors. Less than half of all eligible individuals participate in screening via colonoscopy. This implies that further, possibly even imaging, screening test methods should be explored and offered. Studies have reported that virtual colonography techniques have a comparable accuracy to endoscopy of about 90% for polyp sizes larger than 5 mm. The data for computed tomography (CT) is more extensive than for magnetic resonance imaging (MRI). CONCLUSION Significant challenges are posed however by the fact that in Germany CT colonography (CTC) is not considered a viable screening option due to radiation protection concerns, and MRI screening is not an established screening method. Radiologists should be familiar with classification using the CT Colonography Reporting and Data System (C-RADS), which uses criteria such as CT density, morphology, size, and location for classification. C‑RADS classification follows the categories: C0 (inadequate study), C1 (normal), C2a (indeterminate), C2b (benign), C3 (suspicious), and C4 (malignant), as well as extracolonic categories E1/2 (no clinically significant findings), E3 (likely insignificant findings), and E4 (likely significant findings).
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Affiliation(s)
- Günter Layer
- Zentralinstitut für Diagnostische und Interventionelle Radiologie, Klinikum der Stadt Ludwigshafen gGmbH, Akademisches Lehrkrankenhaus der Johannes Gutenberg Universität Mainz und der Medizinischen Fakultät Mannheim der Universität Heidelberg, Ludwigshafen, Deutschland.
| | - Johannes Wessling
- Zentrum für Radiologie, Neuroradiologie und Nuklearmedizin, Clemenshospital und Raphaelsklinik, Münster, Deutschland
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Berg EP, Mohammed A, Shipp ZJ, Tenegra JC. Colorectal Cancer Screening and Iron Deficiency Anemia. Prim Care 2023; 50:481-491. [PMID: 37516515 DOI: 10.1016/j.pop.2023.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
In the United States, colorectal cancer has the fourth highest amount of annual new cancer cases per year between 2014 and 2018. In this article, the authors review the data and guidelines supporting effective direct visualization and stool-based testing methods of colon cancer screening along with work-up and management of Iron Deficiency Anemia.
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Affiliation(s)
- Ethan P Berg
- SIU Decatur Family Medicine Residency, 102 West Kenwood Avenue, Ste 100, Decatur, IL 62526, USA; Department of Family & Community Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Asiya Mohammed
- Department of Family & Community Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA; SIU Springfield Family Medicine Residency, 520 N. 4th Street, Springfield, IL 62702, USA
| | - Zachary J Shipp
- SIU Decatur Family Medicine Residency, 102 West Kenwood Avenue, Ste 100, Decatur, IL 62526, USA; Department of Family & Community Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Johnny C Tenegra
- SIU Decatur Family Medicine Residency, 102 West Kenwood Avenue, Ste 100, Decatur, IL 62526, USA; Department of Family & Community Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA; Department of Family & Community Medicine, Southern Illinois University School of Medicine Decatur Family Medicine Residency, Decatur, IL, USA.
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Mang T, Lampichler K, Scharitzer M. [CT colonography : Technique and indications]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:418-428. [PMID: 37249607 PMCID: PMC10234944 DOI: 10.1007/s00117-023-01153-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Dedicated radiological expertise and a high-quality examination, performed according to current technical standards and for accepted indications, are prerequisite to achieve excellent results with CT colonography (CTC). OBJECTIVES The aim of this article is to review current standards of the examination technique as well as indications and contraindications for CTC based on recent recommendations and guidelines. MATERIALS AND METHODS Based on extensive literature research, current knowledge about the examination technique and the indications and contraindications is summarized. RESULTS CTC is the radiological examination of choice for the detection of colorectal neoplasia. Beside incomplete or refused colonoscopy and contraindications to colonoscopy, CTC is also a noninvasive option for opportunistic colorectal cancer screening. The examination technique is based on a CTC-specific patient preparation scheme that includes fecal tagging, colonic distension, low-dose CT scans in two patient positions and a combined 2D and 3D data evaluation. CONCLUSIONS Performing CTC according to current technical standards is prerequisite for high-quality examinations and is, thus, also a key factor to obtain a correct diagnosis. CTC is a noninvasive examination, capable of providing clinically relevant diagnoses for a wide range of indications.
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Affiliation(s)
- Thomas Mang
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Katharina Lampichler
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Martina Scharitzer
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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Elnaggar M, Pratheepan P, Paramagurunathan B, Colemeadow J, Hussein B, Bashkirova V, Pillai K, Singh L, Chawla M. The Accuracy of Different Modalities Used for Preoperative Primary Tumour Localisation in Operated Colorectal Cancer Patients. Cureus 2023; 15:e36737. [PMID: 37009370 PMCID: PMC10049957 DOI: 10.7759/cureus.36737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
Aim Colonoscopy and computed tomography (CT) scans of the abdomen and pelvis are routine pre-operative assessment tools in colorectal cancer (CRC) patients. There have been some discrepancies regarding the location of cancer when seen by colonoscopy versus CT scan. The purpose of this study was to compare the accuracy of a colonoscopy with a computed tomography (CT) scan of the abdomen and pelvis with contrast, which is done routinely before surgery to localise the exact site of the tumour within the large bowel, whilst comparing both to the operative, gross and histopathology findings of the exact location. Methods A retrospective study was carried out on 165 colorectal cancer patients operated on between January 1, 2010, and December 31, 2014, using electronic hospital records that were reviewed anonymously, comparing the location of cancer within the large bowels as was found on colonoscopy and CT scan of the abdomen and pelvis with contrast, comparing both to post-operative histopathology specimen or intra-operative assessment in cases where no resection of the primary tumour was performed. Results CT and colonoscopy were both accurate in diagnosing 70.5% of cases that had done both investigations pre-operatively. The best results were obtained when the cancer was located in the caecum as confirmed post-operatively; the combined accuracy rate was 100%. CT was accurate, whilst colonoscopy was not in eight (6.2%) cases (all are rectal or sigmoid cancers), and colonoscopy was accurate and CT was not in 12 cases, 10 of them were rectal and two were ascending colonic. Colonoscopy was not performed in 36 (21%) cases for a variety of reasons, including large bowel obstruction or perforation on presentation. In 32 of these cases, CT scan managed to accurately predict the location of cancer (mostly rectal and caecal), and CT scan was inaccurate in 20.6% of cases (34 out of 165), whilst colonoscopy was inaccurate in 13.9% of cases (18 out of 129). Conclusion Colonoscopy is more accurate in localising colorectal cancers than CT scan of the abdomen and pelvis with contrast. CT scan diagnoses regional and distant spread of colorectal cancers such as nodal status, invasion of neighbouring organs and/or peritoneum and the presence of liver metastases, whilst colonoscopy is limited to intraluminal diagnosis but can be both a diagnostic and therapeutic tool, with higher accuracy, in general, in localising colorectal cancers. Both CT scan and colonoscopy were equal in appendicular, caecal, splenic flexure and descending colon cancer localisation accuracy.
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Colon capsule endoscopy following incomplete colonoscopy in routine clinical settings. Surg Endosc 2022; 37:2749-2755. [PMID: 36471059 DOI: 10.1007/s00464-022-09783-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colon capsule endoscopy (CCE) was introduced in our department on two indications; following incomplete colonoscopy as an alternative to CT colonography, and in patients with a history of incomplete colonoscopy as an alternative to anesthesia-assisted (AA) colonoscopy. We aimed to compare the quality of CCE, defined by completion rate and polyp detection rate (PDR), with that of CT colonography and AA colonoscopy, respectively. METHODS Patients referred for CCE from May 2020 until November 2021 were consecutively included in this prospective cohort study. Demographics, indication and CCE outcomes were registered from the electronic patient record. Completion rate and PDR in CCE as an alternative to CT colonography were compared with those of a historical cohort undergoing CT colonography following incomplete colonoscopy. Completion rate and PDR in CCE as an alternative to AA colonoscopy were compared with those of a time true parallel cohort undergoing AA colonoscopy. RESULTS In 65 patients undergoing CCE, 36 (57%) were referred as an alternative to CT colonography. The completion rate in this group was 44% compared to 96% in CT colonography (p < 0.001). The PDR in complete CCE in this group was 75% in CCE compared to 20% in CT colonography (p < 0.001). The remaining 27 (43%) of the sample were referred for CCE as an alternative to AA colonoscopy. The completion rate in this group was 33% compared to 100% in AA colonoscopy (p < 0.001). The PDR in complete CCE in this group was 78% in CCE compared to 35% in AA colonoscopy (p = 0.013). CONCLUSIONS The completion rate of CCE following incomplete colonoscopy is inferior to that of CT colonography and AA colonoscopy. The PDR of CCE was high, indicating an acceptable sensitivity in complete investigations, but in our settings the completion rate of CCE on this indication is unacceptably low. CLINICAL TRIAL REGISTRATION NCT04307901 (ClinicalTrials.gov, March 13, 2020).
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Obaro AE, Plumb AA, Halligan S, Mallett S, Bassett P, McCoubrie P, Baldwin-Cleland R, Ugarte-Cano C, Lung P, Muckian J, Ilangovan R, Gupta A, Robinson C, Higginson A, Britton I, Greenhalgh R, Patel U, Mainta E, Gangi A, Taylor SA, Burling D. Colorectal Cancer: Performance and Evaluation for CT Colonography Screening- A Multicenter Cluster-randomized Controlled Trial. Radiology 2022; 303:361-370. [PMID: 35166585 DOI: 10.1148/radiol.211456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Most radiologists reporting CT colonography (CTC) do not undergo compulsory performance accreditation, potentially lowering diagnostic sensitivity. Purpose To determine whether 1-day individualized training in CTC reporting improves diagnostic sensitivity of experienced radiologists for 6-mm or larger lesions, the durability of any improvement, and any associated factors. Materials and Methods This prospective, multicenter cluster-randomized controlled trial was performed in National Health Service hospitals in England and Wales between April 2017 and January 2020. CTC services were cluster randomized into intervention (1-day training plus feedback) or control (no training or feedback) arms. Radiologists in the intervention arm attended a 1-day workshop focusing on CTC reporting pitfalls with individualized feedback. Radiologists in the control group received no training. Sensitivity for 6-mm or larger lesions was tested at baseline and 1, 6, and 12 months thereafter via interpretation of 10 CTC scans at each time point. The primary outcome was the mean difference in per-lesion sensitivity between arms at 1 month, analyzed using multilevel regression after adjustment for baseline sensitivity. Secondary outcomes included per-lesion sensitivity at 6- and 12-month follow-up, sensitivity for flat neoplasia, and effect of prior CTC experience. Results A total of 69 hospitals were randomly assigned to the intervention (31 clusters, 80 radiologists) or control (38 clusters, 59 radiologists) arm. Radiologists were experienced (median, 500-999 CTC scans interpreted) and reported CTC scans routinely (median, 151-200 scans per year). One-month sensitivity improved after intervention (66.4% [659 of 992]) compared with sensitivity in the control group (42.4% [278 of 655]; difference = 20.8%; 95% CI: 14.6, 27.0; P < .001). Improvements were maintained at 6 (66.4% [572 of 861] vs 50.5% [283 of 560]; difference = 13.0%; 95% CI: 7.4, 18.5; P < .001) and 12 (63.7% [310 of 487] vs 44.4% [187 of 421]; difference = 16.7%; 95% CI: 10.3, 23.1; P < .001) months. This beneficial effect applied to flat lesions (difference = 22.7%; 95% CI: 15.5, 29.9; P < .001) and was independent of career experience (≥1500 CTC scans: odds ratio = 1.09; 95% CI: 0.88, 1.36; P = .22). Conclusion For radiologists evaluating CT colonography studies, a 1-day training intervention yielded sustained improvement in detection of clinically relevant colorectal neoplasia, independent of previous career experience. Clinical trial registration no. NCT02892721 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Pickhardt in this issue.
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Affiliation(s)
- Anu E Obaro
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Andrew A Plumb
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Steve Halligan
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Susan Mallett
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Paul Bassett
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Paul McCoubrie
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Rachel Baldwin-Cleland
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Carmen Ugarte-Cano
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Phillip Lung
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Janice Muckian
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Rajapandian Ilangovan
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Arun Gupta
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Charlotte Robinson
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Antony Higginson
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Ingrid Britton
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Rebecca Greenhalgh
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Uday Patel
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Evgenia Mainta
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Anmol Gangi
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Stuart A Taylor
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - David Burling
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
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7
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Lammertink MHA, Huisman JF, Bernsen MLE, Niekel RAM, van Westreenen HL, de Vos Tot Nederveen Cappel WH, Spanier BWM. Implications of colonic and extra-colonic findings on CT colonography in FIT positive patients in the Dutch bowel cancer screening program. Scand J Gastroenterol 2021; 56:1337-1342. [PMID: 34506230 DOI: 10.1080/00365521.2021.1966091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES In the Dutch National colorectal cancer (CRC) screening program, patients with a positive faecal immunochemical test (FIT) are referred for a colonoscopy. In a small proportion, because of contraindications, a computed tomographic colonography (CTC) is performed to rule out advanced neoplasia. The aim of our study is to evaluate the intra- and extra-colonic yield of CTC and its clinical implications. MATERIALS AND METHODS In this retrospective cohort study, all FIT positive patients who underwent primary (instead of colonoscopy) or secondary CTC (after incomplete colonoscopy) between January 2014 and January 2018 were included. Relevant intra-colonic lesions on CTC were defined as lesions suspected for CRC or >10 mm. Relevant extra-colonic findings were defined as E3 and E4 using the E-RADS classification. RESULTS Of the 268 included patients, 66 (24.6%) were suspected to have CRC or 10 mm + lesion on CTC and 56 of them (84.8%) underwent an additional endoscopy. Another 20 patients with <10 mm lesions on CTC underwent additional endoscopy. Overall, 76/268 patients (28.4%) underwent confirmatory endoscopy of which 50 (18.7%) had histologic confirmed advanced neoplasia; 4.9% had CRC and 13.8% advanced adenoma. New relevant extra-colonic findings were detected in 13.8%. CONCLUSIONS In the Dutch National CRC screening program, a CTC was followed by an endoscopic procedure in more than a quarter of patients, resulting in a significant number of advanced neoplasia. Overall, one out of seven CTCs showed new relevant extra-colonic findings which may lead to further diagnostic/therapeutic work-up. Our results can be important for the informed consent procedure.
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Affiliation(s)
- Marieke H A Lammertink
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jelle F Huisman
- Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, The Netherlands
| | - Marie L E Bernsen
- Department of Radiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Ronald A M Niekel
- Department of Radiology, Rijnstate Hospital, Arnhem, The Netherlands
| | | | | | - Bernhard W M Spanier
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
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8
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Valletta R, Faccioli N, Bonatti M, Foti G, Lombardo F, Santi E, Tagliamonte M, Ferro F. Role of CT colonography in differentiating sigmoid cancer from chronic diverticular disease. Jpn J Radiol 2021; 40:48-55. [PMID: 34297280 DOI: 10.1007/s11604-021-01176-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/16/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the accuracy of computed tomography colonography (CTC) in differentiating chronic diverticular disease from colorectal cancer (CRC), using morphological and textural parameters. MATERIALS AND METHODS We included 95 consecutive patients with histologically proven chronic diverticular disease (n = 53) or CRC (n = 42) who underwent CTC. One radiologist, unaware of histological findings, evaluated CTC studies for the presence of potential discriminators including: maximum thickness, involved segment length, shouldering phenomenon, growth pattern, diverticula, fascia thickening, fat tissue edema, loco-regional lymph nodes, mucosal pattern. Another radiologist performed volumetric texture analysis on the involved segment. RESULTS Several qualitative imaging parameters resulted to significantly correlated with colorectal cancer, including absence of diverticula in the affected segment, straightened growth pattern and shouldering phenomenon. A maximum wall thickness/involved segment length ratio < 0.1 had 98% specificity and 47% sensitivity in identifying diverticular disease. Regarding first-order texture analysis parameters, kurtosis resulted to be significantly different between the two groups. CONCLUSIONS Absence of diverticula, straightened growth pattern and shouldering phenomenon are significantly associated with CRC (71-91% sensitivity; 82-91%).
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Affiliation(s)
- Riccardo Valletta
- Department of Radiology, Bolzano Regional Hospital, 5 Böhler Street, 39100, Bolzano, Italy. .,Department of Radiology, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| | - Niccolò Faccioli
- Department of Radiology, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Matteo Bonatti
- Department of Radiology, Bolzano Regional Hospital, 5 Böhler Street, 39100, Bolzano, Italy
| | - Giovanni Foti
- Department of Radiology, IRCCS Ospedale Sacro Cuore-Don Calabria, via Don Sempreboni 5, 37024, Negrar, VR, Italy
| | - Fabio Lombardo
- Department of Radiology, IRCCS Ospedale Sacro Cuore-Don Calabria, via Don Sempreboni 5, 37024, Negrar, VR, Italy
| | - Elena Santi
- Department of Radiology, Mater Salutis Hospital Legnago, Via Gianella 1, 37045, Legnago, VR, Italy
| | - Micaela Tagliamonte
- Department of Radiology, Bolzano Regional Hospital, 5 Böhler Street, 39100, Bolzano, Italy
| | - Federica Ferro
- Department of Radiology, Bolzano Regional Hospital, 5 Böhler Street, 39100, Bolzano, Italy
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9
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Mohammed Nawi A. Public Health: Prevention. COLORECTAL CANCER 2021. [DOI: 10.5772/intechopen.94396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nowadays, colorectal cancer prevention strategies play an essential role in reducing the incidence and mortality of the cases. A well-designed and establishment of the clinical pathway of screening programme needed in all country. Types of screening tools used may vary between the country with the use of FOBT and colonoscopy. The standard guideline related to screening programme such as for high-risk group should be emphasized more as compared to the low-risk group. The uptake of screening for CRC should be highlighted more as the program have showed a significantly reduction of the cases and mortality. The barrier of CRC screening uptake mainly due to poor awareness, discomfort, low physician recommendation, low socioeconomic and improper screening programme. Therefore others prevention strategies beside screening program such as health education and interactive intervention strategies need to be empower.
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10
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Gerges C, Neumann H, Ishaq S, Sivanathan V, Galle PR, Neuhaus H, Neumann H. Evaluation of a novel colonoscope offering flexibility adjuster - a retrospective observational study. Therap Adv Gastroenterol 2021; 14:17562848211013494. [PMID: 34104209 PMCID: PMC8170286 DOI: 10.1177/17562848211013494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/07/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Although colonoscopy is the gold standard for colorectal cancer screening, colonic looping may make complete colonoscopy challenging. Commonly available stiffening device colonoscopy has been described as helpful but not effective enough to prevent looping. In this context the effect on cecal intubation time and rate was described differently in various studies and in some studies had no impact on cecal intubation time at all. The aim of this study was to evaluate whether a novel colonoscope with gradual stiffness (Fujifilm EC760R-V/I- flexibility adjuster, Tokyo, Japan) using four significantly different grades of stiffness can be an alternative to established devices in terms of loop prevention, cecal intubation rate and time, adverse events, and patient/examiner satisfaction. METHODS Consecutive patients without previous colorectal surgery were analyzed retrospectively. Colonoscopy was performed with the new colonoscope and performance characteristics, including time to cecum, withdrawal time, total examination time, and patient and endoscopist satisfaction were recorded. RESULTS Among 180 consecutive procedures, 98.3% of examinations were complete to the cecum. The endoscopic flexibility adjuster was used in 150 of 180 cases (83.3%). Overall, the device was scored by the examiner as helpful to prevent looping in 146 of the 150 cases (97.7%). Mean cecal intubation time was 6.5 min, with 35% of examination performed in under 5 min with a mean withdrawal time of 7 min. Mean total examination time was 18 min. Patient satisfaction was rated as high in all examinations performed. CONCLUSION The new flexibility adjuster colonoscope was shown to be helpful in loop prevention, allowed for fast and successful cecal intubation, and led to a high rate of patients satisfaction.
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Affiliation(s)
- Christian Gerges
- Department of Gastroenterology, Evangelisches
Krankenhaus Düsseldorf, Düsseldorf, Germany
| | | | - Sauid Ishaq
- Department of Gastroenterology, Dudley Group
NHS, Foundation Trust and Birmingham City University, Birmingham, UK
| | - Visvakanth Sivanathan
- Department of Interdisciplinary Endoscopy, I.
Medizinische Klinik und Poliklinik, University Hospital, Mainz,
Germany
| | - Peter R. Galle
- Department of Interdisciplinary Endoscopy, I.
Medizinische Klinik und Poliklinik, University Hospital, Mainz,
Germany
| | - Horst Neuhaus
- Department of Gastroenterology, Evangelisches
Krankenhaus Düsseldorf, Düsseldorf, Germany
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11
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Assessment of Imaging Protocol and Patients Radiation Exposure in Computed Tomography Colonography. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11114761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the screening and identifying of colon and rectum malignancy, computed tomography colonography (CTC) is a highly effective imaging technique, albeit patients receiving a significant effective dose. Accordingly, patient dose evaluation is an important need, seeking to ensure benefits outweigh the projected cancer risk. Objective: For CTC procedures carried out in the Radiology Department, Medical Imaging Operation Services, King Fahad Medical City (KFMC), evaluation is done using the current American College of Radiology (ACR) imaging protocol and concomitant patient-effective doses. Study is carried out on a sample size of 55 CTC procedures, involving 25 males (45%) and 30 females (55%). The patients were classified as follows: two groups based on CT machine; four groups based on the applied protocol; and three groups based on the procedure results. All procedures were carried out using two machines, the products of two different vendors (a GE Healthcare DISCOVERY CT 750 HD 64 slices dual-energy scanner and a Philips Brilliance CT 64 slices scanner). The overall mean, standard deviation (SD), median, and range of the effective dose (in mSv) were 11.57 ± 7.75, 9.25 (2.17–31.93). Automatic tube current modulation (ATCM) shows a significant increase in CTDIvol up to 69% and effective dose (mSv) up to 95% than the manual tube current (mA) compared to the standard protocol. The CT protocol variation results in a three-fold variation in patient-effective dose. The technologist role is crucial in selecting a noise reference based on patient weight and adjusting tube current per slice to avoid overexposure during ATCM protocol.
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12
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Calanzani N, Chang A, Van Melle M, Pannebakker MM, Funston G, Walter FM. Recognising Colorectal Cancer in Primary Care. Adv Ther 2021; 38:2732-2746. [PMID: 33864597 PMCID: PMC8052540 DOI: 10.1007/s12325-021-01726-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/24/2021] [Indexed: 12/15/2022]
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide. Primary care professionals can play an important role in both prevention and early detection of CRC. Most CRCs are attributed to modifiable lifestyle factors, which can be addressed within primary care, and promotion of population-based screening programmes can aid early cancer detection in asymptomatic patients. Primary care professionals have a vital role in clinically assessing patients presenting with symptoms that may indicate cancer, as most patients with CRC first present with symptoms. These assessments are often challenging—many of the symptoms of CRC are non-specific and commonly occur in patients presenting with non-malignant disease. The range of options for investigating symptomatic patients in primary care is rapidly growing. Simple tests, such as faecal immunochemical testing (FIT), are now being used to guide decisions around referral for more invasive tests, such as colonoscopy, while direct access to specialist investigations is also becoming more common. Clinical decision support tools (CDSTs) which calculate cancer risk based on symptomatology, patient characteristics and test results can provide an additional resource to guide decisions on further investigation. This article explores the challenges of CRC prevention and detection from the primary care perspective, discusses current evidence-based approaches for CRC detection used in primary care (with examples from UK guidelines), and highlights emerging research which may likely alter practice in the future.
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Affiliation(s)
- Natalia Calanzani
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Aina Chang
- School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Marije Van Melle
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Merel M Pannebakker
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Garth Funston
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Fiona M Walter
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK.
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia.
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13
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Colon Capsule Endoscopy vs. CT Colonography Following Incomplete Colonoscopy: A Systematic Review with Meta-Analysis. Cancers (Basel) 2020; 12:cancers12113367. [PMID: 33202936 PMCID: PMC7697096 DOI: 10.3390/cancers12113367] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
Following incomplete colonoscopy (IC) patients often undergo computed tomography colonography (CTC), but colon capsule endoscopy (CCE) may be an alternative. We compared the completion rate, sensitivity and diagnostic yield for polyp detection from CCE and CTC following IC. A systematic literature search resulted in twenty-six studies. Extracted data included inter alia, complete/incomplete investigations and polyp findings. Pooled estimates of completion rates of CCE and CTC and complete colonic view rates (CCE reaching the most proximal point of IC) of CCE were calculated. Per patient diagnostic yields of CCE and CTC were calculated stratified by polyp sizes. CCE completion rate and complete colonic view rate were 76% (CI 95% 68-84%) and 90% (CI 95% 83-95%). CTC completion rate was 98% (CI 95% 96-100%). Diagnostic yields of CTC and CCE were 10% (CI 95% 7-15%) and 37% (CI 95% 30-43%) for any size, 13% (CI 95% 9-18%) and 21% (CI 95% 12-32%) for >5-mm and 4% (CI 95% 2-7%) and 9% (CI 95% 3-17%) for >9-mm polyps. No study performed a reference standard follow-up after CCE/CTC in individuals without findings, rendering sensitivity calculations unfeasible. The increased diagnostic yield of CCE could outweigh its slightly lower complete colonic view rate compared to the superior CTC completion rate. Hence, CCE following IC appears feasible for an introduction to clinical practice. Therefore, randomized studies investigating CCE and/or CTC following incomplete colonoscopy with a golden standard reference for the entire population enabling estimates for sensitivity and specificity are needed.
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14
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Bai W, Yu D, Zhu B, Yu X, Duan R, Li Y, Yu W, Hua W, Kou C. Diagnostic accuracy of computed tomography colonography in patients at high risk for colorectal cancer: a meta-analysis. Colorectal Dis 2020; 22:1528-1537. [PMID: 32277562 DOI: 10.1111/codi.15060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/15/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim was to explore the diagnostic value of computed tomographic colonography (CTC) compared with conventional colonoscopy in individuals at high risk for colorectal cancer. METHOD PubMed, Embase, the Cochrane Library and the Web of Science were searched by two independent reviewers for potentially eligible studies published up to 31 October 2018 that were based on a per-patient analysis. stata, meta-disc and revman were used to perform this meta-analysis. A random-effect model was used, and a subgroup analysis was conducted to explore the sources of heterogeneity. RESULTS A total of 14 full-text articles, involving 3578 patients, were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and the area under the summary receiver operating characteristic curve of CTC for detecting polyps ≥ 6 mm were 0.87 (95% CI 0.83-0.90), 0.90 (95% CI 0.86-0.93), 9.08 (95% CI 6.28-13.13), 0.14 (95% CI 0.11-0.18) and 0.94 (95% CI 0.92-0.96), respectively. For polyps ≥ 10 mm, the pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of CTC were 0.91 (95% CI 0.86-0.94), 0.98 (95% CI 0.95-0.99), 40.36 (95% CI 19.16-85.03), 0.90 (95% CI 0.06-0.14) and 0.98 (95% CI 0.96-0.99), respectively. CONCLUSION In this meta-analysis, CTC had high diagnostic accuracy for detecting polyps ≥ 6 mm and ≥ 10 mm in patients at high risk of developing colorectal cancer and it had a higher sensitivity and specificity for detecting polyps ≥ 10 mm than polyps ≥ 6 mm. However, the results should be used cautiously due to the significant heterogeneity.
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Affiliation(s)
- W Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - D Yu
- Department of Surgical Oncology, Fifth People's Hospital of Shenyang, Shenyang, China
| | - B Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - X Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - R Duan
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Y Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - W Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - W Hua
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - C Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
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15
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Choo JM, Baek SJ, Kwak JM, Kim J, Kim SH. Clinical characteristics and oncologic outcomes in patients with preoperative clinical T3 and T4 colon cancer who were staged as pathologic T3. Ann Surg Treat Res 2020; 99:37-43. [PMID: 32676480 PMCID: PMC7332321 DOI: 10.4174/astr.2020.99.1.37] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/18/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Clinically suspected T4 stage colon cancer from a preoperative exam is often diagnosed as T3 stage colon cancer pathologically after surgery, raising concerns about understaging. The aims of this study were to compare the survival of clinical T3 and T4 colon cancer patients who had received a pathologic T3 stage diagnosis postoperatively. Methods Patients who were diagnosed with pathologic T3 stage colon cancer postoperatively were reviewed. Patients with clinically suspected T3 or T4 stage cancer on preoperative exam were enrolled in the study. We compared patient demographics and survival of the cT3 and cT4 groups. Results Out of the 536 patients with pT3 colon cancer, 503 patients were cT3 (93.8%) and 33 patients were cT4 (6.2%) preoperatively. The most common reason for suspected clinical T4 stage cancer was free perforation (78.8%). There were no statistically significant differences between the 5-year overall survival and the total 5-year disease-free survival (DFS) between the cT3 and cT4 groups; however, local recurrence was significantly higher in the cT4 group (local 5-year DFS: 98.6% vs. 84.0%, P < 0.001). Multivariate analysis showed cT stage was associated with local recurrence, but the association was not statistically significant (P = 0.056). Conclusion Preoperative clinically suspected T4 stage colon cancer showed inferior local recurrence despite a postoperative pathologic diagnosis of T3 stage cancer. It is necessary to address the shortcomings of pathologic exams in the matter of the understaging of T4 colon cancer, and to reinforce the treatment for local control in patients with cT4 colon cancer.
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Affiliation(s)
- Jeong-Min Choo
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Se-Jin Baek
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jung-Myun Kwak
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jin Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Seon-Hahn Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
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16
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Flor N, Ceretti AP, Luigiano C, Brambillasca P, Savoldi AP, Verrusio C, Ferrari D. Performance of CT Colonography in Diagnosis of Synchronous Colonic Lesions in Patients With Occlusive Colorectal Cancer. AJR Am J Roentgenol 2020; 214:348-354. [DOI: 10.2214/ajr.19.21810] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Nicola Flor
- Unità Operativa di Radiologia Diagnostica e Interventistica, Azienda Servizi Socio Territoriali Santi Paolo e Carlo, Presido San Paolo, via di Rudinì 8, 20142 Milan, Italy
| | - Andrea Pisani Ceretti
- Unità Operativa di Chirurgia II, Azienda Ospedaliera Santi Paolo e Carlo, Milan, Italy
| | - Carmelo Luigiano
- Unità Operativa di Endoscopia Digestiva, Azienda Ospedaliera Santi Paolo e Carlo, Milan, Italy
| | - Pietro Brambillasca
- Postgraduate School in Radiodiagnostics, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan, Italy
| | - Anna Paola Savoldi
- Postgraduate School in Radiodiagnostics, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan, Italy
| | - Clemente Verrusio
- Unità Operativa di Chirurgia I, Azienda Ospedaliera Santi Paolo e Carlo, Milan, Italy
| | - Daris Ferrari
- Unità Operativa di Oncologia, Azienda Ospedaliera Santi Paolo e Carlo, Milan, Italy
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17
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Zhu H, Li F, Tao K, Wang J, Scurlock C, Zhang X, Xu H. Comparison of the participation rate between CT colonography and colonoscopy in screening population: a systematic review and meta-analysis of randomized controlled trials. Br J Radiol 2019; 93:20190240. [PMID: 31651188 DOI: 10.1259/bjr.20190240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To compare the participation rate between CT colonography (CTC) and colonoscopy in screening population in randomized controlled trials (RCTs). METHODS A search was performed using the PubMed, Web of Science, and Cochrane databases. RCTs that included screening populations and reported participation number were assessed. Cochrane risk of bias tool was used to assess the bias and quality. Risk ratio (RR) was used to present the results. The non-participation rate was analyzed to verify the results of participation rate. RESULTS Five of 760 studies, with a total of 15,974 invitees, were included. The participation rate was higher at CTC (28.8%) than colonoscopy (20.8%), although the difference did not reach statistical significance (RR = 1.26; p = 0.070; I2 = 90.3%). The non-participation rate at CTC was significantly lower than colonoscopy (RR = 0.92; p = 0.012; I2 = 86.7%). Subgroup analysis suggested both the participation and non-participation rate were with significant difference between reduced/no cathartic preparation CTC and colonoscopy. Cumulative meta-analysis showed both the participation rate and non-participation rate exhibited a trend over time and sample size. CONCLUSION The participation rate was higher at CTC than colonoscopy, although the difference did not reach statistical significance. But the non-participation rate was with statistical difference. Screening population seemed more likely to participate the reduced/no cathartic preparation CTC. Statistical evidence was provided for more large RCTs are needed in the future. ADVANCES IN KNOWLEDGE The screening populations seem more likely to participate in the CTC, especially the reduced/no cathartic preparation CTC. The statistical evidence was provided for more large RCTs are needed in the future.
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Affiliation(s)
- He Zhu
- Department of Gastroenterology, The First Hospital of Jilin University, ChangChun, China
| | - Fudong Li
- Department of Gastroenterology, The First Hospital of Jilin University, ChangChun, China
| | - Ke Tao
- Department of Gastroenterology, The First Hospital of Jilin University, ChangChun, China
| | - Jing Wang
- Department of Gastroenterology, The First Hospital of Jilin University, ChangChun, China
| | - Carissa Scurlock
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Xiaofei Zhang
- Department of Clinical Epidemiology and Biostatistics, Beijing Tsinghua Changgung Hospital Affiliated With Tsinghua University, Beijing, China
| | - Hong Xu
- Department of Gastroenterology, The First Hospital of Jilin University, ChangChun, China
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Abstract
CLINICAL PROBLEM Colorectal cancer (CRC) is a major cause of cancer-related morbidity and mortality. Most colorectal cancers derive from benign precursor lesions, so-called adenomatous polyps, over a long period of time. Colorectal cancer screening is based on the detection of precancerous polyps and early stage CRC in asymptomatic individuals to reduce CRC incidence and mortality. The protective effect of screening programs can be improved by increasing the screening rates. PRACTICAL RECOMMENDATIONS Apart from the established examinations, CT colonography (CTC) has been proposed as an optional test for colorectal cancer screening. The detection rates of CTC for large polyps and cancer are similar to the ones of colonoscopy and superior to stool-based tests. CTC is therefore the radiological test of choice for the detection of colorectal neoplasia. It has replaced double contrast barium enema for almost all indications. As a minimally invasive procedure, CTC has a high safety profile and good patient acceptance. The evaluation of extracolonic organs in addition to the colon can increase examination efficacy. The option to choose CTC as a CRC screening test has the potential to increase the overall screening rates.
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Lynn W, Vadhwana B, Bell DJ, Borgstein R, Demetriou G, Nair MS, Meleagros L. Computed tomography colonography: a retrospective analysis of outcomes of 2 years experience in a district general hospital. ANZ J Surg 2019; 89:541-545. [PMID: 30884097 DOI: 10.1111/ans.15063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 11/02/2018] [Accepted: 12/09/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Colonoscopy is the gold-standard investigation for direct luminal visualization of the large bowel. Studies have shown the efficacy of computed tomography colonography (CTC) is equivalent to colonoscopy in both cancer and polyp detection. METHODS A retrospective review of patients undergoing CTC from January 2013 to October 2014 was performed. Patient demographics, indication for investigation, computed tomography findings, optical colonoscopy findings and histology results were recorded. RESULTS Seven hundred and fifty-eight CTC were performed. Three hundred and seventeen patients were male (42%) and 441 (58%) were female. Endoscopy was advised in 209 cases. One hundred and twenty (16%) were deemed suspicious for cancer of whom 96 (80%) had optical colonoscopy. A total of 12 colorectal cancers were detected. Potential polyps were noted in 58 cases (8%). Forty-four patients underwent endoscopy (75%) and 17 polyps confirmed (38%). Two patients had foci of invasive cancer histologically. Significant extracolonic findings were identified in 60%, including five cases of gastric carcinomas. The most common other findings were gallstones and hernias. CONCLUSION The rate of colorectal cancer detection in this study was 2%. The rate of biopsy proven cancer was 10% following a suspicious colonogram. Endoscopic correlation was not obtained in 20% of cases of radiological suspicion. CTC is as efficacious as optical colonoscopy for colorectal cancer and polyp detection.
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Affiliation(s)
- William Lynn
- Department of Colorectal Surgery, North Middlesex University Hospital, London, UK
| | - Bhamini Vadhwana
- Department of Colorectal Surgery, North Middlesex University Hospital, London, UK
| | - Daniel J Bell
- Department of Radiology, North Middlesex University Hospital, London, UK
| | - Rudi Borgstein
- Department of Radiology, North Middlesex University Hospital, London, UK
| | - George Demetriou
- Department of Colorectal Surgery, North Middlesex University Hospital, London, UK
| | - Manojkumar S Nair
- Department of Colorectal Surgery, North Middlesex University Hospital, London, UK
| | - Luke Meleagros
- Department of Colorectal Surgery, North Middlesex University Hospital, London, UK
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Sosna J, Kettanie A, Fraifeld S, Bar-Ziv J, Carel RS. Prevalence of polyps ≥6 mm on follow-up CT colonography in a cohort with no significant colon polyps at baseline. Clin Imaging 2019; 55:1-7. [PMID: 30690226 DOI: 10.1016/j.clinimag.2019.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 12/13/2022]
Abstract
AIM Assess the prevalence of neoplasia ≥6 mm at repeat CT colonoscopy (CTC) in individuals with no significant lesions at baseline. METHODS Individuals aged ≥18 years, with/without CRC risk factors, with no polyps ≥6 mm on baseline CTC (negative baseline) who underwent repeat CTC in a large HMO from 2001 to 2011 were retrospectively identified. Studies were reviewed by board-certified radiologists with experience interpreting CTC. Demographic details, CRC risk factors, and the number, size, and location of incident lesions were noted. Findings were classified using the C-RADS scale. Lesion prevalence at CTC-2 was determined, and study interval and risk characteristics of patients with- and without findings were compared. RESULTS Our study included 636 individuals (369 men [58.0%]; mean age 59.9 years) with negative baseline CTC who underwent repeat CTC after a mean 4.6 year interval (SD 1.6 years). At baseline, 469/636 (73.7%) were at average risk for CRC; 418 remained at average risk for CTC-2 with 51 (8.0%) developing new risk factors in the interval between studies. At CTC-2, 47 participants (7.4%) presented 52 significant neoplasia: 35 polyps 6-9 mm, 14 polyps ≥10 mm, and 3 masses in 3/636 participants (0.47%). 2/3 masses, 6/14 polyps ≥10 mm (42.9%), and 12/25 polyps 6-9 mm (48.0%) were in individuals with risk factors for CRC. Histopathology was available for 12/52 lesions (23.1%): 8 tubular adenomas, 2 villous adenomas, 1 hamartomatous polyp, 1 case of normal tissue. CONCLUSION A mean 4.6 years after negative-baseline CTC, neoplasia ≥6 mm were seen in 7.4% of participants, including masses in 0.47%, supporting recommendations for a 5-year study interval.
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Affiliation(s)
- Jacob Sosna
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem 91120l, Israel; Department of Radiology, Beth Israel Deaconess Medical Center, Harvard School of Medicine, Boston, MA 02215, USA; MOR Institute for Medical Data, Bnei Brak 51377, Israel.
| | - Amir Kettanie
- Hebrew University-Hadassah School of Medicine, Jerusalem 91120, Israel
| | - Shifra Fraifeld
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem 91120l, Israel
| | - Jacob Bar-Ziv
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem 91120l, Israel; University of Haifa, School of Public Health, Faculty of Social Welfare & Health Sciences, Haifa 34988, Israel.
| | - Rafael S Carel
- MOR Institute for Medical Data, Bnei Brak 51377, Israel; University of Haifa, School of Public Health, Faculty of Social Welfare & Health Sciences, Haifa 34988, Israel.
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Mitsuzaki K, Iinuma G, Morimoto T, Miyake M, Tomimatsu H. Computed tomographic colonography with a reduced dose of laxative using a novel barium sulfate contrast agent in Japan. Jpn J Radiol 2018; 37:245-254. [PMID: 30554302 DOI: 10.1007/s11604-018-0800-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/09/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE To test the tagging efficacy, patient acceptability, and accuracy of computed tomographic colonography (CTC) with a reduced dose of laxative using a novel barium sulfate (BaSO4) contrast agent. MATERIALS AND METHODS CTC followed by optical colonoscopy (OC) was performed on 73 patients with positive results in fecal occult blood tests. They were administrated a BaSO4 suspension and a magnesium citrate solution for bowel preparation. Patients completed a questionnaire about the acceptability of bowel preparation. Tagging efficacy was estimated using a novel categorization system, which classified all segments into 8 categories. The accuracy of detecting protruded lesions ≥ 6 mm was calculated from the comparison of CTC and OC results, using the latter as a reference standard. RESULTS Tagging efficacy was good in 77.3% of colonic segments where residue was observed. The acceptability of bowel preparation for CTC was significantly higher than that for OC. The sensitivity, specificity, and positive and negative predictive values were 0.778, 0.945, 0.824, and 0.929, respectively. All lesions ≥ 7 mm were successfully detected by CTC. CONCLUSION CTC with a reduced dose of laxative using a novel BaSO4 contrast agent has a favorable tagging efficacy, patient acceptability, and accuracy.
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Affiliation(s)
- Katsuhiko Mitsuzaki
- Center for Preventive Medicine, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, Kumamoto, Japan.
| | - Gen Iinuma
- Department of Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Tsuyoshi Morimoto
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Mototaka Miyake
- Department of Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Hideto Tomimatsu
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagito, Gifu, Gifu, Japan
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22
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Costi R, Ricco' M, Negrini G, Wind P, Violi V, Le Bian AZ. "Is CT Scan more Accurate than Endoscopy in Identifying Distance from the Anal Verge for Left Sided Colon Cancer? A Comparative Cohort Analysis". J INVEST SURG 2018; 33:273-280. [PMID: 30089423 DOI: 10.1080/08941939.2018.1492650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purposes: Accurately localizing colorectal cancer during surgery may be challenging due to intraoperative limitations. In the present study, localization of left-sided colon cancer (LCC) by CT scan is compared to colonoscopy. Material and methods: Consecutive patients with LCC located by colonoscopy and CT scan and undergoing left-hemicolectomy were included. Tumor distance from the anal verge (TDAV) was calculated by both CT-scan and colonoscopy, and then compared, using as reference TDAV measured intraoperatively. Statistical analysis was performed including (1) comparison of means between all three TDAVs, (2) comparison of mean differences between all three TDAVs, (3) comparison of number of patients with a difference between endoscopic TDAV and intraoperative TDAV ≤5 cm and the number of patients with a difference between CT scan TDAV and intraoperative TDAV ≤5 cm (4) statistical relationship between either CT scan and endoscopic and intraoperative TDAVs. Results: Both CT scan and endoscopy overestimate TDAV (25.8 ± 12.5 cm and 24.6 ± 10.6 cm vs. 21.5 ± 7.4 cm, p = 0.005), but CT scan TDAV resulted as being different from intraoperative TDAV (p < 0.01). Regression analysis reported an increasing divergence of measurements with increasing values of intraoperative TDAV, which resulted greater for CT. Tumors within 5 cm of intraoperative TDAV were 22/28 (78.6%) for endoscopy, and 17/28 (60.7%) for CT (p = 0.2448). Conclusions: Accuracy of both examinations seems poor, with a mean overestimation >3 cm and a significant number of tumors found at >5 cm from preoperative evaluation. Preoperative examinations' bias increase proportionally with TDAV length, decreasing their interest especially for tumors located at a greater distance from anal verge.
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Affiliation(s)
| | - Matteo Ricco'
- Dipartimento di Prevenzione, Unità Operativa di Prevenzione e Sicurezza sui Luoghi di Lavoro, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Giulio Negrini
- Servizio di Radiologia, Azienda Ospedaliero-Universita di Parma, Parma, Italia
| | - Philippe Wind
- Department of Digestive Surgery and Surgical Oncology, Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Université Paris XIII, Bobigny, France
| | - Vincenzo Violi
- Dipartimento di Scienze Chirurgiche, Università di Parma, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, Italia, Parma.,Dipartimento di Chirurgia Generale e Specialistica, Unità Operativa di Chirurgia Generale, Ospedale di Fidenza, AUSL Parma, Fidenza, Italia
| | - Alban Zarzavadjian Le Bian
- Department of Digestive Surgery and Surgical Oncology, Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Université Paris XIII, Bobigny, France
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23
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Obaro AE, Burling DN, Plumb AA. Colon cancer screening with CT colonography: logistics, cost-effectiveness, efficiency and progress. Br J Radiol 2018; 91:20180307. [PMID: 29927637 DOI: 10.1259/bjr.20180307] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Colorectal cancer (CRC) incidence and mortality can be significantly reduced by population screening. Several different screening methods are currently in use, and this review focuses specifically on the imaging technique computed tomographic colonography (CTC). The challenges and logistics of CTC screening, as well as the importance of test accuracy, uptake, quality assurance and cost-effectiveness will be discussed. With comparable advanced adenoma detection rates to colonoscopy (the most commonly used whole-colon investigation), CTC is a less-invasive alternative, requiring less laxative, and with the potential benefit that it permits assessment of extra colonic structures. Three large-scale European trials have contributed valuable evidence supporting the use of CTC in population screening, and highlight the importance of selecting appropriate clinical management pathways based on initial CTC findings. Future research into CTC-screening will likely focus on radiologist training and CTC quality assurance, with identification of evidence-based key performance indicators that are associated with clinically-relevant outcomes such as the incidence of post-test interval cancers (CRC occurring after a presumed negative CTC). In comparison to other CRC screening techniques, CTC offers a safe and accurate option that is particularly useful when colonoscopy is contraindicated. Forthcoming cost-effectiveness analyses which evaluate referral thresholds, the impact of extra-colonic findings and real-world uptake will provide useful information regarding the feasibility of future CTC population screening.
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Affiliation(s)
- Anu E Obaro
- 1 Centre for Medical Imaging, University College London , London , UK.,2 St Mark's Academic Institute, St Mark's Hospital , Harrow , UK
| | - David N Burling
- 2 St Mark's Academic Institute, St Mark's Hospital , Harrow , UK
| | - Andrew A Plumb
- 1 Centre for Medical Imaging, University College London , London , UK
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24
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Sub-millisievert CT colonography: effect of knowledge-based iterative reconstruction on the detection of colonic polyps. Eur Radiol 2018; 28:5258-5266. [DOI: 10.1007/s00330-018-5545-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/09/2018] [Accepted: 05/16/2018] [Indexed: 12/14/2022]
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25
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Mantellini P, Lippi G, Sali L, Grazzini G, Delsanto S, Mallardi B, Falchini M, Castiglione G, Carozzi FM, Mascalchi M, Milani S, Ventura L, Zappa M. Cost analysis of colorectal cancer screening with CT colonography in Italy. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:735-746. [PMID: 28681075 DOI: 10.1007/s10198-017-0917-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 06/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Unit costs of screening CT colonography (CTC) can be useful for cost-effectiveness analyses and for health care decision-making. We evaluated the unit costs of CTC as a primary screening test for colorectal cancer in the setting of a randomized trial in Italy. METHODS Data were collected within the randomized SAVE trial. Subjects were invited to screening CTC by mail and requested to have a pre-examination consultation. CTCs were performed with 64- and 128-slice CT scanners after reduced or full bowel preparation. Activity-based costing was used to determine unit costs per-process, per-participant to screening CTC, and per-subject with advanced neoplasia. RESULTS Among 5242 subjects invited to undergo screening CTC, 1312 had pre-examination consultation and 1286 ultimately underwent CTC. Among 129 subjects with a positive CTC, 126 underwent assessment colonoscopy and 67 were ultimately diagnosed with advanced neoplasia (i.e., cancer or advanced adenoma). Cost per-participant of the entire screening CTC pathway was €196.80. Average cost per-participant for the screening invitation process was €17.04 and €9.45 for the pre-examination consultation process. Average cost per-participant of the CTC execution and reading process was €146.08 and of the diagnostic assessment colonoscopy process was €24.23. Average cost per-subject with advanced neoplasia was €3777.30. CONCLUSIONS Cost of screening CTC was €196.80 per-participant. Our data suggest that the more relevant cost of screening CTC, amenable of intervention, is related to CTC execution and reading process.
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Affiliation(s)
- Paola Mantellini
- Cancer Prevention and Research Institute - ISPO, Via Cosimo il Vecchio 2, 50139, Florence, Italy.
| | - Giuseppe Lippi
- Azienda USL Toscana Centro, P.za S. Maria Nuova 1, Florence, Italy
| | - Lapo Sali
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, Florence, Italy
| | - Grazia Grazzini
- Cancer Prevention and Research Institute - ISPO, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | | | - Beatrice Mallardi
- Cancer Prevention and Research Institute - ISPO, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Massimo Falchini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, Florence, Italy
| | - Guido Castiglione
- Cancer Prevention and Research Institute - ISPO, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Francesca Maria Carozzi
- Cancer Prevention and Research Institute - ISPO, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Mario Mascalchi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, Florence, Italy
| | - Stefano Milani
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, Florence, Italy
| | - Leonardo Ventura
- Cancer Prevention and Research Institute - ISPO, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Marco Zappa
- Cancer Prevention and Research Institute - ISPO, Via Cosimo il Vecchio 2, 50139, Florence, Italy
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Sun K, Han R, Han Y, Shi X, Hu J, Lu B. Accuracy of Combined Computed Tomography Colonography and Dual Energy Iiodine Map Imaging for Detecting Colorectal masses using High-pitch Dual-source CT. Sci Rep 2018; 8:3790. [PMID: 29491380 PMCID: PMC5830575 DOI: 10.1038/s41598-018-22188-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/19/2018] [Indexed: 02/07/2023] Open
Abstract
To evaluate the diagnostic accuracy of combined computed tomography colonography (CTC) and dual-energy iodine map imaging for detecting colorectal masses using high-pitch dual-source CT, compared with optical colonography (OC) and histopathologic findings. Twenty-eight consecutive patients were prospectively enrolled in this study. All patients were underwent contrast-enhanced CTC acquisition using dual-energy mode and OC and pathologic examination. The size of the space-occupied mass, the CT value after contrast enhancement, and the iodine value were measured and statistically compared. The sensitivity, specificity, accuracy rate, and positive predictive and negative predictive values of dual-energy contrast-enhanced CTC were calculated and compared between conventional CTC and dual-energy iodine images. The iodine value of stool was significantly lower than the colonic neoplasia (P < 0.01). The sensitivity of conventional CTC was 95.6% (95% CI = 77.9%–99.2%), combined CTC and dual-energy iodine maps imaging was 95.6% (95% CI = 77.9%–99.2%). The specificity of the two methods was 42.8% (95% CI = 15.4%–93.5%) and 100% (95% CI = 47.9%–100%; P = 0.02), respectively. Compared with optical colonography and histopathology, combined CTC and dual-energy iodine maps imaging can distinguish stool and colonic neoplasia, distinguish between benign and malignant tumors initially and improve the diagnostic accuracy of CTC for colorectal cancer screening.
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Affiliation(s)
- Kai Sun
- Department of Radiology, Baotou Central Hospital, Baotou, 014040, China.,Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Ruijuan Han
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yang Han
- Department of Radiology, Baotou Central Hospital, Baotou, 014040, China
| | - Xuesen Shi
- Department of Gastroenterology, Baotou Central Hospital, Baotou, 014040, China
| | - Jiang Hu
- Department of of Surgery, Baotou Central Hospital, Baotou, 014040, China.
| | - Bin Lu
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China.
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van der Meulen MP, Lansdorp-Vogelaar I, Goede SL, Kuipers EJ, Dekker E, Stoker J, van Ballegooijen M. Colorectal Cancer: Cost-effectiveness of Colonoscopy versus CT Colonography Screening with Participation Rates and Costs. Radiology 2018; 287:901-911. [PMID: 29485322 DOI: 10.1148/radiol.2017162359] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose To compare the cost-effectiveness of computed tomographic (CT) colonography and colonoscopy screening by using data on unit costs and participation rates from a randomized controlled screening trial in a dedicated screening setting. Materials and Methods Observed participation rates and screening costs from the Colonoscopy or Colonography for Screening, or COCOS, trial were used in a microsimulation model to estimate costs and quality-adjusted life-years (QALYs) gained with colonoscopy and CT colonography screening. For both tests, the authors determined optimal age range and screening interval combinations assuming a 100% participation rate. Assuming observed participation for these combinations, the cost-effectiveness of both tests was compared. Extracolonic findings were not included because long-term follow-up data are lacking. Results The participation rates for colonoscopy and CT colonography were 21.5% (1276 of 5924 invitees) and 33.6% (982 of 2920 invitees), respectively. Colonoscopy was more cost-effective in the screening strategies with one or two lifetime screenings, whereas CT colonography was more cost-effective in strategies with more lifetime screenings. CT colonography was the preferred test for willingness-to-pay-thresholds of €3200 per QALY gained and higher, which is lower than the Dutch willingness-to-pay threshold of €20 000. With equal participation, colonoscopy was the preferred test independent of willingness-to-pay thresholds. The findings were robust for most of the sensitivity analyses, except with regard to relative screening costs and subsequent participation. Conclusion Because of the higher participation rates, CT colonography screening for colorectal cancer is more cost-effective than colonoscopy screening. The implementation of CT colonography screening requires previous satisfactory resolution to the question as to how best to deal with extracolonic findings. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Miriam P van der Meulen
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
| | - Iris Lansdorp-Vogelaar
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
| | - S Lucas Goede
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
| | - Ernst J Kuipers
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
| | - Evelien Dekker
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
| | - Jaap Stoker
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
| | - Marjolein van Ballegooijen
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
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28
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Holmer C, Kreis ME. [Update on colon cancer 2017]. MMW Fortschr Med 2018; 159:54-62. [PMID: 29468509 DOI: 10.1007/s15006-017-9592-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Christoph Holmer
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200, Berlin, Deutschland.
| | - Martin E Kreis
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200, Berlin, Deutschland
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29
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Duarte RB, Bernardo WM, Sakai CM, Silva GL, Guedes HG, Kuga R, Ide E, Ishida RK, Sakai P, de Moura EG. Computed tomography colonography versus colonoscopy for the diagnosis of colorectal cancer: a systematic review and meta-analysis. Ther Clin Risk Manag 2018; 14:349-360. [PMID: 29503554 PMCID: PMC5826249 DOI: 10.2147/tcrm.s152147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Colorectal cancer (CRC) is a significant cause of morbidity and mortality. Optical colonoscopy (OC) is the first choice of investigation for assessing the state of the colon and it is excellent for CRC screening. Newer technologies such as computed tomography colonography (CTC) may also be useful in CRC screening. This systematic review compares the benefits of CTC and OC for CRC screening. This review includes all the available randomized clinical trials comparing CTC and OC for CRC screening in asymptomatic patients. Three studies were included in the systematic review and were submitted for meta-analysis. In the analysis of participation rates, only 2,333 of 8,104 (29%) patients who were invited for screening underwent the CTC, and only 1,486 of the 7,310 (20%) patients who were invited for screening underwent OC. The absolute risk difference in participation rate in the two procedures was 0.1 (95% CI, 0.05–0.14) in favor of CTC. In the analysis of advanced colorectal neoplasia (ACN) detection rates, 2,357 patients undergoing CTC and 1,524 patients undergoing OC were included. Of these, 135 patients (5.7%) who underwent a CTC and 130 patients (8.5%) who underwent an OC were diagnosed with ACN. The absolute risk difference in ACN detection rate in the two procedure types was −0.02 (with a 95% CI between −0.04 and −0.00) in favor of OC. CTC is an option for CRC screening in asymptomatic patients. However, as CTC was inferior in detecting ACN, it should not replace OC, which remains the gold standard.
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Affiliation(s)
- Ralph B Duarte
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
| | - Wanderley M Bernardo
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
| | - Christiano M Sakai
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
| | - Gustavo Lr Silva
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
| | - Hugo G Guedes
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
| | - Rogerio Kuga
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
| | - Edson Ide
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
| | - Robson K Ishida
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
| | - Paulo Sakai
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
| | - Eduardo Gh de Moura
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
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Obaro AE, Plumb AA, Fanshawe TR, Torres US, Baldwin-Cleland R, Taylor SA, Halligan S, Burling DN. Post-imaging colorectal cancer or interval cancer rates after CT colonography: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2018; 3:326-336. [PMID: 29472116 DOI: 10.1016/s2468-1253(18)30032-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND CT colonography is highly sensitive for colorectal cancer, but interval or post-imaging colorectal cancer rates (diagnosis of cancer after initial negative CT colonography) are unknown, as are their underlying causes. We did a systematic review and meta-analysis of post-CT colonography and post-imaging colorectal cancer rates and causes to address this gap in understanding. METHODS We systematically searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. We included randomised, cohort, cross-sectional, or case-control studies published between Jan 1, 1994, and Feb 28, 2017, using CT colonography done according to international consensus standards with the aim of detecting cancer or polyps, and reporting post-imaging colorectal cancer rates or sufficient data to allow their calculation. We excluded studies in which all CT colonographies were done because of incomplete colonoscopy or if CT colonography was done with knowledge of colonoscopy findings. We contacted authors of component studies for additional data where necessary for retrospective CT colonography image review and causes for each post-imaging colorectal cancer. Two independent reviewers extracted data from the study reports. Our primary outcome was prevalence of post-imaging colorectal cancer 36 months after CT colonography. We used random-effects meta-analysis to estimate pooled post-imaging colorectal cancer rates, expressed using the total number of cancers and total number of CT colonographies as denominators, and per 1000 person-years. This study is registered with PROSPERO, number CRD42016042437. FINDINGS 2977 articles were screened and 12 studies were eligible for analysis. These studies reported data for 19 867 patients (aged 18-96 years; of 11 590 with sex data available, 6532 [56%] were female) between March, 2002, and May, 2015. At a mean of 34 months' follow-up (range 3-128·4 months), CT colonography detected 643 colorectal cancers. 29 post-imaging colorectal cancers were subsequently diagnosed. The pooled post-imaging colorectal cancer rate was 4·42 (95% CI 3·03-6·42) per 100 cancers detected, corresponding to 1·61 (1·11-2·33) post-imaging colorectal cancers per 1000 CT colonographies or 0·64 (0·44-0·92) post-imaging colorectal cancers per 1000 person-years. Heterogeneity was low (I2=0%). 17 (61%) of 28 post-imaging colorectal cancers were attributable to perceptual error and were visible in retrospect. INTERPRETATION CT colonography does not lead to an excess of post-test cancers relative to colonoscopy within 3-5 years, and the low 5-year post-imaging colorectal cancer rate confirms that the recommended screening interval of 5 years is safe. Since most post-imaging colorectal cancers arise from perceptual errors, radiologist training and quality assurance could help to reduce post-imaging colorectal cancer rates. FUNDING St Mark's Hospital Foundation and the UK National Institute for Health Research via the UCL/UCLH Biomedical Research Centre.
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Affiliation(s)
- Anu E Obaro
- Centre for Medical Imaging, University College London, London, UK; St Mark's Academic Institute, St Mark's Hospital, Harrow, London, UK
| | - Andrew A Plumb
- Centre for Medical Imaging, University College London, London, UK.
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | | | | | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - David N Burling
- St Mark's Academic Institute, St Mark's Hospital, Harrow, London, UK
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So JS, Cheong C, Oh SY, Lee JH, Kim YB, Suh KW. Accuracy of Preoperative Local Staging of Primary Colorectal Cancer by Using Computed Tomography: Reappraisal Based on Data Collected at a Highly Organized Cancer Center. Ann Coloproctol 2017; 33:192-196. [PMID: 29159167 PMCID: PMC5683970 DOI: 10.3393/ac.2017.33.5.192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/15/2017] [Indexed: 12/25/2022] Open
Abstract
Purpose In patients with colorectal cancer, preoperative staging using various imaging technologies is important for establishing the treatment plan and predicting the prognosis. Although computed tomography (CT) has been used most widely, the versatility of CT accuracy was primarily because of the lack of specialization. In this study, we aimed to identify whether any advancement in abdominal CT accuracy in the prediction of local staging has occurred. Methods Between December 2014 and November 2015, patients with colorectal cancer were retrospectively enrolled. All CT findings were retrospectively reported. A total of 285 patients were included, and their retrospectively collected data were retrospectively reviewed, focusing on a comparison between preoperative and postoperative staging. Results The overall prediction accuracy of the T stage was 55.1%, with overstaging occurring in 63 (22.1%) and understaging in 65 patients (22.8%). The sensitivity and specificity were 90.0% and 68.4%, respectively. The overall prediction accuracy of the N stage was 54.7%, with overstaging occurring in 89 (31.2%) and understaging in 40 patients (14.1%). The sensitivity and specificity were 71.9% and 63.2%, respectively. The CT accuracies by pathologic stage were 0%, 62.2%, 25.3%, and 81.2% for stages 0 (Tis N0), I, II, and III, respectively. Conclusion CT has good sensitivity for detecting colon cancers with tumor invasion beyond the bowel wall. However, detection of nodal involvement using CT is unreliable. In our opinion, abdominal CT alone has limitations in predicting the local staging of colorectal cancer, and additional technologies, such as CT plus positron emission tomography and/or colonography, will improve its accuracy.
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Affiliation(s)
- Jung Sub So
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Chinock Cheong
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Seung Yeop Oh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Jei Hee Lee
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Young Bae Kim
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Kwang Wook Suh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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32
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Hadjipetrou A, Anyfantakis D, Galanakis CG, Kastanakis M, Kastanakis S. Colorectal cancer, screening and primary care: A mini literature review. World J Gastroenterol 2017; 23:6049-6058. [PMID: 28970720 PMCID: PMC5597496 DOI: 10.3748/wjg.v23.i33.6049] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/19/2017] [Accepted: 08/01/2017] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is a common health problem, representing the third most commonly diagnosed cancer worldwide and causing a significant burden in terms of morbidity and mortality, with annual deaths estimated at 700000. The western way of life, that is being rapidly adopted in many regions of the world, is a well discussed risk factor for CRC and could be targeted in terms of primary prevention. Furthermore, the relatively slow development of this cancer permits drastic reduction of incidence and mortality through secondary prevention. These facts underlie primary care physicians (PCPs) being assigned a key role in health strategies that enhance prevention and prompt diagnosis. Herein, we review the main topics of CRC in the current literature, in order to better understand its pathogenesis, risk and protective factors, as well as screening techniques. Furthermore, we discuss preventive and screening policies to combat CRC and the crucial role served by PCPs in their successful implementation. Relevant articles were identified through electronic searches of MEDLINE and through manual searches of reference lists.
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Affiliation(s)
- Athanasios Hadjipetrou
- Primary Health Care Centre of Kissamos, Chania, 73400 Crete, Greece
- First Department of Surgery, Saint George General Hospital of Chania, 73300 Crete, Greece
| | - Dimitrios Anyfantakis
- Primary Health Care Centre of Kissamos, Chania, 73400 Crete, Greece
- First Department of Surgery, Saint George General Hospital of Chania, 73300 Crete, Greece
| | | | - Miltiades Kastanakis
- First Department of Surgery, Saint George General Hospital of Chania, 73300 Crete, Greece
| | - Serafim Kastanakis
- Department of Internal Medicine, Saint George General Hospital of Chania, 73300 Crete, Greece
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33
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Bhattacharyya D, Kumar P, Mohanty SK, Smith YR, Misra M. Detection of Four Distinct Volatile Indicators of Colorectal Cancer using Functionalized Titania Nanotubular Arrays. SENSORS (BASEL, SWITZERLAND) 2017; 17:E1795. [PMID: 28777343 PMCID: PMC5580033 DOI: 10.3390/s17081795] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 12/30/2022]
Abstract
Screening of colorectal cancer is crucial for early stage diagnosis and treatment. Detection of volatile organic compounds (VOCs) of the metabolome present in exhaled breath is a promising approach to screen colorectal cancer (CRC). Various forms of volatile organic compounds (VOCs) that show the definitive signature for the different diseases including cancers are present in exhale breathe. Among all the reported CRC VOCs, cyclohexane, methylcyclohexane, 1,3-dimethyl- benzene and decanal are identified as the prominent ones that can be used as the signature for CRC screening. In the present investigation, detection of the four prominent VOCs related to CRC is explored using functionalized titania nanotubular arrays (TNAs)-based sensor. These signature biomarkers are shown to be detected using nickel-functionalized TNA as an electrochemical sensor. The sensing mechanism is based on the electrochemical interaction of nickel-functionalized nanotubes with signature biomarkers. A detailed mechanism of the sensor response is also presented.
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Affiliation(s)
- Dhiman Bhattacharyya
- Department of Metallurgical Engineering, University of Utah, Salt Lake City, UT 84112, USA.
| | - Pankaj Kumar
- Department of Metallurgical Engineering, University of Utah, Salt Lake City, UT 84112, USA.
| | - Swomitra K Mohanty
- Department of Metallurgical Engineering, University of Utah, Salt Lake City, UT 84112, USA.
- Department of Chemical Engineering, University of Utah, Salt Lake City, UT 84112, USA.
| | - York R Smith
- Department of Metallurgical Engineering, University of Utah, Salt Lake City, UT 84112, USA.
| | - Mano Misra
- Department of Metallurgical Engineering, University of Utah, Salt Lake City, UT 84112, USA.
- Department of Chemical Engineering, University of Utah, Salt Lake City, UT 84112, USA.
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34
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Regge D, Iussich G, Segnan N, Correale L, Hassan C, Arrigoni A, Asnaghi R, Bestagini P, Bulighin G, Cassinis MC, Ederle A, Ferraris A, Galatola G, Gallo T, Gandini G, Garretti L, Martina MC, Molinar D, Montemezzi S, Morra L, Motton M, Occhipinti P, Pinali L, Soardi GA, Senore C. Comparing CT colonography and flexible sigmoidoscopy: a randomised trial within a population-based screening programme. Gut 2017; 66:1434-1440. [PMID: 27196588 DOI: 10.1136/gutjnl-2015-311278] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 12/16/2022]
Abstract
IMPORTANCE AND AIMS The role of CT colonography (CTC) as a colorectal cancer (CRC) screening test is uncertain. The aim of our trial was to compare participation and detection rate (DR) with sigmoidoscopy (flexible sigmoidoscopy (FS)) and CTC in a screening setting. DESIGN SETTING AND PARTICIPANTS We conducted two randomised clinical trials (RCTs). (1) Participation RCT: individuals, aged 58 years, living in Turin (Italy), were randomly assigned to be invited to FS or CTC screening; (2) detection RCT: residents in northern Italy, aged 58-60, giving their consent to recruitment, were randomly allocated to CTC or FS. Polyps ≥6 mm at CTC, or 'high-risk' distal lesions at FS, were referred for colonoscopy (TC). MAIN OUTCOME MEASURES Participation rate (proportion of invitees examined); DR of advanced adenomas or CRC (advanced neoplasia (AN)). RESULTS Participation was 30.4% (298/980) for CTC and 27.4% (267/976) for FS (relative risk (RR) 1.1; 95% CI 0.98 to 1.29). Among men, participation was higher with CTC than with FS (34.1% vs 26.5%, p=0.011). In the detection RCT, 2673 subjects had FS and 2595 had CTC: the AN DR was 4.8% (127/2673, including 9 CRCs) with FS and 5.1% (133/2595, including 10 CRCs) with CTC (RR 1.08; 95% CI 0.85 to 1.37). Distal AN DR was 3.9% (109/2673) with FS and 2.9% (76/2595) with CTC (RR 0.72; 95% CI 0.54 to 0.96); proximal AN DR was 1.2% (34/2595) for FS vs 2.7% (69/2595) for CTC (RR 2.06; 95% CI 1.37 to 3.10). CONCLUSIONS AND RELEVANCE Participation and DR for FS and CTC were comparable. AN DR was twice as high in the proximal colon and lower in the distal colon with CTC than with FS. Men were more likely to participate in CTC screening. TRIAL REGISTRATION NUMBER NCT01739608; Pre-results.
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Affiliation(s)
- Daniele Regge
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | | | - Nereo Segnan
- AOU S Giovanni Battista-CPO Piemonte, SCDO Epidemiologia dei Tumori 2, Turin, Italy
| | - Loredana Correale
- im3D S.p.A., Turin, Italy
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Cesare Hassan
- AOU Città della Salute e della Scienza, CPO Piemonte, SCDO Epidemiologia screening e registro tumori, Turin, Italy
| | - Arrigo Arrigoni
- Endoscopy Unit, Ospedale San Giovanni Antica Sede, Turin, Italy
| | - Roberto Asnaghi
- Radiology Unit, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy
| | | | - Gianmarco Bulighin
- Endoscopy and Gastroenterology Unit, U.l.s.s. 20 Verona, Ospedale G. Fracastoro-San Bonifacio, Verona, Italy
| | - Maria Carla Cassinis
- Radiology Unit, Department of Surgical Science, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Andrea Ederle
- Endoscopy and Gastroenterology Unit, U.l.s.s. 20 Verona, Ospedale G. Fracastoro-San Bonifacio, Verona, Italy
| | - Andrea Ferraris
- Radiology Unit, Department of Surgical Science, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Teresa Gallo
- Radiology Unit, Ospitale Mauriziano, Turin, Italy
| | - Giovanni Gandini
- Radiology Unit, Department of Surgical Science, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Licia Garretti
- Radiology Unit, Ospedale San Giovanni Antica Sede, Turin, Italy
| | - Maria Cristina Martina
- Radiology Unit, Department of Surgical Science, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Stefania Montemezzi
- Radiology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Lia Morra
- im3D S.p.A., Turin, Italy
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Massimiliano Motton
- Radiology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | | | - Lucia Pinali
- Radiology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Gian Alberto Soardi
- Radiology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Carlo Senore
- AOU S Giovanni Battista-CPO Piemonte, SCDO Epidemiologia dei Tumori 2, Turin, Italy
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Sa S, Li J, Li X, Li Y, Liu X, Wang D, Zhang H, Fu Y. Development and validation of a preoperative prediction model for colorectal cancer T-staging based on MDCT images and clinical information. Oncotarget 2017; 8:55308-55318. [PMID: 28903421 PMCID: PMC5589660 DOI: 10.18632/oncotarget.19427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/12/2017] [Indexed: 12/11/2022] Open
Abstract
Objectives This study aimed to establish and evaluate the efficacy of a prediction model for colorectal cancer T-staging. Results T-staging was positively correlated with the level of carcinoembryonic antigen (CEA), expression of carbohydrate antigen 19-9 (CA19-9), wall deformity, blurred outer edges, fat infiltration, infiltration into the surrounding tissue, tumor size and wall thickness. Age, location, enhancement rate and enhancement homogeneity were negatively correlated with T-staging. The predictive results of the model were consistent with the pathological gold standard, and the kappa value was 0.805. The total accuracy of staging improved from 51.04% to 86.98% with the proposed model. Materials and Methods The clinical, imaging and pathological data of 611 patients with colorectal cancer (419 patients in the training group and 192 patients in the validation group) were collected. A spearman correlation analysis was used to validate the relationship among these factors and pathological T-staging. A prediction model was trained with the random forest algorithm. T staging of the patients in the validation group was predicted by both prediction model and traditional method. The consistency, accuracy, sensitivity, specificity and area under the curve (AUC) were used to compare the efficacy of the two methods. Conclusions The newly established comprehensive model can improve the predictive efficiency of preoperative colorectal cancer T-staging.
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Affiliation(s)
- Sha Sa
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Jing Li
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Xiaodong Li
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Yongrui Li
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Xiaoming Liu
- College of Electronic Science and Engineering, Jilin University, Changchun, China
| | - Defeng Wang
- Research Center for Medical Image Computing, Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.,Union Medical Imaging Research Institute, Shenzhen, China
| | - Huimao Zhang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Yu Fu
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
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36
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Plumb AA, Obaro A, Fanshawe T, Torres US, Baldwin-Cleland R, Halligan S, Burling D. Prevalence and risk factors for post-investigation colorectal cancer ("interval cancer") after computed tomographic colonography: protocol for a systematic review. Syst Rev 2017; 6:36. [PMID: 28222812 PMCID: PMC5320676 DOI: 10.1186/s13643-017-0432-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/13/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a common and important disease. There are different tests for diagnosis, one of which is computed tomographic colonography (CTC). No test is perfect, and patients with normal CTC may subsequently develop CRC (either because it was overlooked originally, or because it has developed in the interim). This is termed post-investigation colorectal cancer (PICRC) or "interval cancer". How frequently this occurs after CTC is not known. The purpose of this systematic review and meta-analysis is to use the primary literature to estimate the PICRC rate after CTC, and explore associated factors. METHODS Primary studies reporting post-investigation colorectal cancer (PICRC) rates after CTC will be identified from PubMed, Embase and Cochrane Register of Controlled Trials databases. Peer-reviewed studies published after 1994 (the year CTC was introduced) will be included and the rate of PICRC within 36 months of CTC recorded. Data will be extracted from selected studies for a random effects meta-analysis. Heterogeneity, risk of bias and publication bias will be assessed, and exploratory analysis will examine factors associated with higher PICRC rates in the literature. CONCLUSION PICRC rates are the ultimate benchmark of diagnostic quality for colonic investigations. This systematic review and meta-analysis will identify and synthesise evidence to determine PICRC rates after CTC and explore factors that may contribute to higher rates. SYSTEMATIC REVIEW REGISTRATION PROSPERO (registration number CRD42016042437 ).
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Affiliation(s)
- Andrew A Plumb
- Centre for Medical Imaging, University College London, 3rd Floor East, 250 Euston Rd, London, NW, NW1 2PG, UK.
| | - Anu Obaro
- Centre for Medical Imaging, University College London, 3rd Floor East, 250 Euston Rd, London, NW, NW1 2PG, UK.,St. Mark's Academic Institute, St. Mark's Hospital, Harrow, UK
| | - Thomas Fanshawe
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Ulysses S Torres
- Centre for Medical Imaging, University College London, 3rd Floor East, 250 Euston Rd, London, NW, NW1 2PG, UK.,Department of Radiology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Steve Halligan
- Centre for Medical Imaging, University College London, 3rd Floor East, 250 Euston Rd, London, NW, NW1 2PG, UK
| | - David Burling
- St. Mark's Academic Institute, St. Mark's Hospital, Harrow, UK
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37
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Plumb AA, Pathiraja F, Nickerson C, Wooldrage K, Burling D, Taylor SA, Atkin WS, Halligan S. Appearances of screen-detected versus symptomatic colorectal cancers at CT colonography. Eur Radiol 2016; 26:4313-4322. [PMID: 27048534 PMCID: PMC5101282 DOI: 10.1007/s00330-016-4293-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/29/2015] [Accepted: 02/18/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to compare the morphology, radiological stage, conspicuity, and computer-assisted detection (CAD) characteristics of colorectal cancers (CRC) detected by computed tomographic colonography (CTC) in screening and symptomatic populations. METHODS Two radiologists independently analyzed CTC images from 133 patients diagnosed with CRC in (a) two randomized trials of symptomatic patients (35 patients with 36 tumours) and (b) a screening program using fecal occult blood testing (FOBt; 98 patients with 100 tumours), measuring tumour length, volume, morphology, radiological stage, and subjective conspicuity. A commercial CAD package was applied to both datasets. We compared CTC characteristics between screening and symptomatic populations with multivariable regression. RESULTS Screen-detected CRC were significantly smaller (mean 3.0 vs 4.3 cm, p < 0.001), of lower volume (median 9.1 vs 23.2 cm3, p < 0.001) and more frequently polypoid (34/100, 34 % vs. 5/36, 13.9 %, p = 0.02) than symptomatic CRC. They were of earlier stage than symptomatic tumours (OR = 0.17, 95 %CI 0.07-0.41, p < 0.001), and were judged as significantly less conspicuous (mean conspicuity 54.1/100 vs. 72.8/100, p < 0.001). CAD detection was significantly lower for screen-detected (77.4 %; 95 %CI 67.9-84.7 %) than symptomatic CRC (96.9 %; 95 %CI 83.8-99.4 %, p = 0.02). CONCLUSIONS Screen-detected CRC are significantly smaller, more frequently polypoid, subjectively less conspicuous, and less likely to be identified by CAD than those in symptomatic patients. KEY POINTS • Screen-detected colorectal cancers (CRC) are significantly smaller than symptomatic CRC. • Screening cases are significantly less conspicuous to radiologists than symptomatic tumours. • Screen-detected CRC have different morphology compared to symptomatic tumours (more polypoid, fewer annular). • A commercial computer-aided detection (CAD) system was significantly less likely to note screen-detected CRC.
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Affiliation(s)
- Andrew A Plumb
- Centre for Medical Imaging, University College London, London, UK
| | - Fiona Pathiraja
- Centre for Medical Imaging, University College London, London, UK
| | | | | | - David Burling
- Intestinal Imaging Centre, St Mark's Hospital, Harrow, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Wendy S Atkin
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK.
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Sekiguchi M, Kakugawa Y, Terauchi T, Matsumoto M, Saito H, Muramatsu Y, Saito Y, Matsuda T. Sensitivity of 2-[ 18F]fluoro-2-deoxyglucose positron emission tomography for advanced colorectal neoplasms: a large-scale analysis of 7505 asymptomatic screening individuals. J Gastroenterol 2016; 51:1122-1132. [PMID: 27021493 DOI: 10.1007/s00535-016-1201-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 03/14/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The sensitivity of 2-[18F]fluoro-2-deoxyglucose positron emission tomography (FDG-PET) for advanced colorectal neoplasms among healthy subjects is not yet fully understood. The present study aimed to clarify the sensitivity by analyzing large-scale data from an asymptomatic screening population. METHODS A total of 7505 asymptomatic screenees who underwent both FDG-PET and colonoscopy at our Cancer Screening Division between February 2004 and March 2013 were analyzed. FDG-PET and colonoscopy were performed on consecutive days, and each examination was interpreted in a blinded fashion. The results of the two examinations were compared for each of the divided six colonic segments, with those from colonoscopy being set as the reference. The relationships between the sensitivity of FDG-PET and clinicopathological features of advanced neoplasms were also evaluated. RESULTS Two hundred ninety-one advanced neoplasms, including 24 invasive cancers, were detected in 262 individuals. Thirteen advanced neoplasms (advanced adenomas) were excluded from the analysis because of the coexistence of lesions in the same colonic segment. The sensitivity, specificity, and positive and negative predictive values of FDG-PET for advanced neoplasms were 16.9 % [95 % confidence interval (CI) 12.7-21.8 %], 99.3 % (95 % CI 99.2-99.4 %), 13.5 % (95 % CI 10.1-17.6 %), and 99.4 % (95 % CI 99.3-99.5 %), respectively. The sensitivity was lower for lesions with less advanced histological grade, of smaller size, and flat-type morphology, and for those located in the proximal part of the colon. CONCLUSIONS FDG-PET is believed to be difficult to use as a primary screening tool in population-based colorectal cancer screening because of its low sensitivity for advanced neoplasms. Even when it is used in opportunistic cancer screening, the limit of its sensitivity should be considered.
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Affiliation(s)
- Masau Sekiguchi
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Yasuo Kakugawa
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Takashi Terauchi
- Cancer Screening Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Minori Matsumoto
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hiroshi Saito
- Screening Assessment and Management Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Yukio Muramatsu
- Cancer Screening Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Cancer Screening Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
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Spada C, Pasha SF, Gross SA, Leighton JA, Schnoll-Sussman F, Correale L, González Suárez B, Costamagna G, Hassan C. Accuracy of First- and Second-Generation Colon Capsules in Endoscopic Detection of Colorectal Polyps: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2016; 14:1533-1543.e8. [PMID: 27165469 DOI: 10.1016/j.cgh.2016.04.038] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/09/2016] [Accepted: 04/26/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Colon capsule endoscopy (CCE) is a noninvasive technique used to explore the colon without sedation or air insufflation. A second-generation capsule was recently developed to improve accuracy of detection, and clinical use has expanded globally. We performed a systematic review and meta-analysis to assess the accuracy of CCE in detecting colorectal polyps. METHODS We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and other databases from 1966 through 2015 for studies that compared accuracy of colonoscopy with histologic evaluation with CCE. The risk of bias within each study was ascertained according to Quality Assessment of Diagnostic Accuracy in Systematic Reviews recommendations. Per-patient accuracy values were calculated for polyps, overall and for first-generation (CCE-1) and second-generation (CCE-2) capsules. We analyzed data by using forest plots, the I2 statistic to calculate heterogeneity, and meta-regression analyses. RESULTS Fourteen studies provided data from 2420 patients (1128 for CCE-1 and 1292 for CCE-2). CCE-2 and CCE-1 detected polyps >6 mm with 86% sensitivity (95% confidence interval [CI], 82%-89%) and 58% sensitivity (95% CI, 44%-70%), respectively, and 88.1% specificity (95% CI, 74.2%-95.0%) and 85.7% specificity (95% CI, 80.2%-90.0%), respectively. CCE-2 and CCE-1 detected polyps >10 mm with 87% sensitivity (95% CI, 81%-91%) and 54% sensitivity (95% CI, 29%-77%), respectively, and 95.3% specificity (95% CI, 91.5%-97.5%) and 97.4% specificity (95% CI, 96.0%-98.3%), respectively. CCE-2 identified all 11 invasive cancers detected by colonoscopy. CONCLUSIONS The sensitivity in detection of polyps >6 mm and >10 mm increased substantially between development of first-generation and second-generation colon capsules. High specificity values for detection of polyps by CCE-2 seem to be achievable with a 10-mm cutoff and in a screening setting.
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Affiliation(s)
- Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy.
| | - Shabana F Pasha
- Division of Gastroenterology, Mayo Clinic School of Medicine, Scottsdale, Arizona
| | - Seth A Gross
- Department of Gastroenterology, Tisch Hospital, NYU Langone Medical Center, New York, New York
| | - Jonathan A Leighton
- Division of Gastroenterology, Mayo Clinic School of Medicine, Scottsdale, Arizona
| | - Felice Schnoll-Sussman
- Department of Gastroenterology, Weill Medical College of Cornell University, New York, New York
| | | | | | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy; Department of Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
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Sali L, Regge D. CT colonography for population screening of colorectal cancer: hints from European trials. Br J Radiol 2016; 89:20160517. [PMID: 27542076 DOI: 10.1259/bjr.20160517] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
CT colonography (CTC) is a minimally invasive radiological investigation of the colon. Robust evidence indicates that CTC is safe, well tolerated and highly accurate for the detection of colorectal cancer (CRC) and large polyps, which are the targets of screening. Randomized controlled trials were carried out in Europe to evaluate CTC as the primary test for population screening of CRC in comparison with faecal immunochemical test (FIT), sigmoidoscopy and colonoscopy. Main outcomes were participation rate and detection rate. Participation rate for screening CTC was in the range of 25-34%, whereas the detection rate of CTC for CRC and advanced adenoma was in the range of 5.1-6.1%. Participation for CTC screening was lower than that for FIT, similar to that for sigmoidoscopy and higher than that for colonoscopy. The detection rate of CTC was higher than that of one FIT round, similar to that of sigmoidoscopy and lower than that of colonoscopy. However, owing to the higher participation rate in CTC screening with respect to colonoscopy screening, the detection rates per invitee of CTC and colonoscopy would be comparable. These results justify consideration of CTC in organized screening programmes for CRC. However, assessment of other factors such as polyp size threshold for colonoscopy referral, management of extracolonic findings and, most importantly, the forthcoming results of cost-effectiveness analyses are crucial to define the role of CTC in primary screening.
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Affiliation(s)
- Lapo Sali
- 1 Department of Biomedical Experimental and Clinical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Daniele Regge
- 2 Dipartimento di Scienze Chirurgiche, Università di Torino, Turin, Italy.,3 Candiolo Cancer Institute FPO, IRCCS, Turin, Italy
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Abstract
Computed tomographic colonography (CTC) is a minimally invasive, patient-friendly, safe and robust colonic imaging modality. The technique is standardized and consolidated evidence from the literature shows that the diagnostic performances for the detection of colorectal cancer and large polyps are similar to colonoscopy (CS) and largely superior to alternative radiological exams, like barium enema. A clear understanding of the exact role of CTC will be beneficial to maximize the benefits and minimize the potential sources of frustration or disappointment for both referring clinicians and patients. Incomplete, failed, or unfeasible CS; investigation of elderly, and frail patients and assessment of diverticular disease are major indications supported by evidence-based data and agreed by the endoscopists. The use of CTC for symptomatic patients, colorectal cancer screening and colonic surveillance is still under debate and, thus, recommended only if CS is unfeasible or refused by patients.
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Affiliation(s)
- Andrea Laghi
- a Department of Radiological Sciences, Oncology and Pathology , Sapienza - University of Rome, ICOT Hospital , Latina , Italy
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Abstract
BACKGROUND Radiological imaging plays an important role in the setting of staging, follow-up, and imaging-guided treatment of colorectal carcinoma (CRC). METHODS This review aims to summarize the current state of the art of the different radiological imaging procedures in CRC including an overview over recently published national and European guidelines and consensus statements concerning the imaging of CRC patients. RESULTS AND CONCLUSION Radiological imaging is widely embedded in national and international guidelines, and structured reporting is recommended.
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Affiliation(s)
- Bettina Baeßler
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - David Maintz
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
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Scalise P, Mantarro A, Pancrazi F, Neri E. Computed tomography colonography for the practicing radiologist: A review of current recommendations on methodology and clinical indications. World J Radiol 2016; 8:472-483. [PMID: 27247713 PMCID: PMC4882404 DOI: 10.4329/wjr.v8.i5.472] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 12/23/2015] [Accepted: 02/24/2016] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) represents one of the most relevant causes of morbidity and mortality in Western societies. CRC screening is actually based on faecal occult blood testing, and optical colonoscopy still remains the gold standard screening test for cancer detection. However, computed tomography colonography (CT colonography) constitutes a reliable, minimally-invasive method to rapidly and effectively evaluate the entire colon for clinically relevant lesions. Furthermore, even if the benefits of its employment in CRC mass screening have not fully established yet, CT colonography may represent a reasonable alternative screening test in patients who cannot undergo or refuse colonoscopy. Therefore, the purpose of our review is to illustrate the most updated recommendations on methodology and the current clinical indications of CT colonography, according to the data of the existing relevant literature.
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Greuter MJE, Berkhof J, Fijneman RJA, Demirel E, Lew JB, Meijer GA, Stoker J, Coupé VMH. The potential of imaging techniques as a screening tool for colorectal cancer: a cost-effectiveness analysis. Br J Radiol 2016; 89:20150910. [PMID: 27194458 DOI: 10.1259/bjr.20150910] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Imaging may be promising for colorectal cancer (CRC) screening, since it has test characteristics comparable with colonoscopy but is less invasive. We aimed to assess the potential of CT colonography (CTC) and MR colonography (MRC) in terms of (cost-effectiveness) using the Adenoma and Serrated pathway to Colorectal CAncer model. METHODS We compared several CTC and MRC strategies with 5- or 10-yearly screening intervals with no screening, 10-yearly colonoscopy screening and biennial faecal immunochemical test (FIT) screening. We assumed trial-based participation rates in the base-case analyses and varied the rates in sensitivity analyses. Incremental lifetime costs and health effects were estimated from a healthcare perspective. RESULTS The health gain of CTC and MRC was similar and ranged from 0.031 to 0.048 life-year gained compared with no screening, for 2-5 screening rounds. Lifetime costs per person for MRC strategies were €60-110 higher than those for CTC strategies with an equal number of screening rounds. All imaging-based strategies were cost-effective compared with no screening. FIT screening was the dominant screening strategy, leading to most LYG and highest cost-savings. Compared with three rounds of colonoscopy screening, CTC with five rounds was found to be cost-effective in an incremental analysis of imaging strategies. Assumptions on screening participation have a major influence on the ordering of strategies in terms of costs and effects. CONCLUSION CTC and MRC have potential for CRC screening, compared with no screening and compared with three rounds of 10-yearly colonoscopy screening. When taking FIT screening as the reference, imaging is not cost-effective. Participation is an important driver of effectiveness and cost estimates. ADVANCES IN KNOWLEDGE This is the first study to assess the cost-effectiveness of MRC screening for CRC.
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Affiliation(s)
- Marjolein J E Greuter
- 1 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Johannes Berkhof
- 1 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Remond J A Fijneman
- 2 Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Erhan Demirel
- 1 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Jie-Bin Lew
- 3 Cancer Research Division, Cancer Council NSW, NSW, Australia
| | - Gerrit A Meijer
- 2 Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Jaap Stoker
- 4 Department of Radiology, Academic Medical Center, Amsterdam, Netherlands
| | - Veerle M H Coupé
- 1 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
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van Roon AHC, van Dam L, Spaander MC, Lansdorp-Vogelaar I, Dekker E, van Leerdam ME. Different modalities for colorectal cancer screening: experiences in The Netherlands so far. COLORECTAL CANCER 2016. [DOI: 10.2217/crc.2015.0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In 2014, a nation-wide colorectal cancer (CRC) screening program was launched in The Netherlands. Every 2 years, men and women aged 55–75 years will be invited to participate in fecal immunochemical test screening. Participants with a positive test result will be scheduled for colonoscopy. Starting from 2006, screening pilots have been performed to ascertain the choice of an optimal screening modality, population acceptance, logistics and cost effectiveness, in order to ensure that a screening program with maximal benefits and the least amount of harms was offered to the Dutch population. In this overview, we will discuss the results of Dutch CRC screening pilots in which different screening modalities were studied, the preparations made before the launch of the nation-wide screening program, and finally the initial results and lessons learned so far from the Dutch CRC screening program.
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Affiliation(s)
- Aafke HC van Roon
- Department of Gastroenterology & Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Leonie van Dam
- Department of Gastroenterology & Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Manon C Spaander
- Department of Gastroenterology & Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology & Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology & Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Kuipers EJ, Grady WM, Lieberman D, Seufferlein T, Sung JJ, Boelens PG, van de Velde CJH, Watanabe T. Colorectal cancer. Nat Rev Dis Primers 2015; 1:15065. [PMID: 27189416 PMCID: PMC4874655 DOI: 10.1038/nrdp.2015.65] [Citation(s) in RCA: 971] [Impact Index Per Article: 107.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Colorectal cancer had a low incidence several decades ago. However, it has become a predominant cancer and now accounts for approximately 10% of cancer-related mortality in western countries. The 'rise' of colorectal cancer in developed countries can be attributed to the increasingly ageing population, unfavourable modern dietary habits and an increase in risk factors, such as smoking, low physical exercise and obesity. New treatments for primary and metastatic colorectal cancer have emerged, providing additional options for patients; these treatments include laparoscopic surgery for primary disease, more-aggressive resection of metastatic disease (such as liver and pulmonary metastases), radiotherapy for rectal cancer, and neoadjuvant and palliative chemotherapies. However, these new treatment options have had limited impact on cure rates and long-term survival. For these reasons, and the recognition that colorectal cancer is long preceded by a polypoid precursor, screening programmes have gained momentum. This Primer provides an overview of the current state of the art of knowledge on the epidemiology and mechanisms of colorectal cancer, as well as on diagnosis and treatment.
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Affiliation(s)
- Ernst J. Kuipers
- Erasmus MC University Medical Center, s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - William M. Grady
- Clinical Research Division, Fred Hutchinson Cancer Research Center; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - David Lieberman
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, OR, USA
| | | | - Joseph J. Sung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Petra G. Boelens
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Toshiaki Watanabe
- Department of Surgical Oncology and Vascular Surgery, University of Tokyo, and the University of Tokyo Hospital, Tokyo, Japan
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Schreuders EH, Ruco A, Rabeneck L, Schoen RE, Sung JJY, Young GP, Kuipers EJ. Colorectal cancer screening: a global overview of existing programmes. Gut 2015; 64:1637-49. [PMID: 26041752 DOI: 10.1136/gutjnl-2014-309086] [Citation(s) in RCA: 819] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 05/13/2015] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) ranks third among the most commonly diagnosed cancers worldwide, with wide geographical variation in incidence and mortality across the world. Despite proof that screening can decrease CRC incidence and mortality, CRC screening is only offered to a small proportion of the target population worldwide. Throughout the world there are widespread differences in CRC screening implementation status and strategy. Differences can be attributed to geographical variation in CRC incidence, economic resources, healthcare structure and infrastructure to support screening such as the ability to identify the target population at risk and cancer registry availability. This review highlights issues to consider when implementing a CRC screening programme and gives a worldwide overview of CRC burden and the current status of screening programmes, with focus on international differences.
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Affiliation(s)
- Eline H Schreuders
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Arlinda Ruco
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Linda Rabeneck
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada Department of Medicine, University of Toronto, Toronto, Ontario, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Robert E Schoen
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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Diagnostic performance of CT colonography with limited cathartic preparation in colorectal cancer screening; comparison with conventional colonoscopy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline. Eur Radiol 2015; 25:331-45. [PMID: 25278245 PMCID: PMC4291518 DOI: 10.1007/s00330-014-3435-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
Colorectal cancer (CRC) is a leading cause of cancer morbidity and mortality in the Western world. Advances in surgical and medical management have led to improved outcomes; however, the prognosis of CRC is often poor when detected at a symptomatic stage. Most cases of CRC develop over years from removable well-defined precursor lesions, and asymptomatic, curable disease may be detected by convenient noninvasive tests. These features make CRC a suitable candidate for screening, and several options are available. This article outlines the evidence for established CRC screening tests along with a discussion on newer tests and ongoing research.
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Affiliation(s)
- Kjetil Garborg
- Department of Transplantation Medicine, Oslo University Hospital, P.b. 4950 Nydalen, 0424 Oslo, Norway; Department of Medicine, Sørlandet Hospital HF, P.b. 416, 4604 Kristiansand, Norway.
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