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Radiologic Imaging Modalities for Colorectal Cancer. Dig Dis Sci 2022; 67:2792-2804. [PMID: 34328590 DOI: 10.1007/s10620-021-07166-0] [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: 01/15/2021] [Accepted: 07/07/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Studies reported various diagnostic value of radiologic imaging modalities for diagnosis and management of colorectal cancer (CRC). AIMS To summary the diagnosis and management of CRC using computed tomography colonography (CTC), magnetic resonance colonography (MRC), and positron emission tomography (PET)/computed tomography (CT). METHODS Comprehensive literature searches were conducted in PubMed, EmBase, and the Cochrane library for studies published before April 2021. The diagnostic performance of CTC, MRC, and PET/CT for CRC was summarized. RESULTS A total of 54 studies (17 studies for CTC, 8 studies for MRC, and 29 studies for PET/CT) were selected for final analysis. The sensitivity and specificity for CTC ranged from 27 to 100%, 88 to 100%, respectively, and the pooled sensitivity and specificity for CTC were 0.97 (95% CI 0.88-0.99) and 0.99 (95% CI 0.99-1.00). The sensitivity and specificity for MRC ranged from 48 to 100%, 60 to 100%, respectively, and the pooled sensitivity and specificity for MRC were 0.98 (95% C: 0.77-1.00) and 0.94 (95% CI 0.84-0.98). The sensitivity and specificity for PET/CT ranged from 84 to 100%, 33 to 100%, respectively, and the pooled sensitivity and specificity for PET/CT were 0.94 (95% CI 0.92-0.96) and 0.94 (95% CI 0.90-0.97). The area under the receiver operating characteristic curve for CTC, MRC, and PET/CT was 1.00 (95% CI 0.99-1.00), 0.99 (95% CI 0.98-1.00), and 0.97 (0.95% CI 0.95-0.98), respectively. CONCLUSIONS This study suggested both CTC and MRC with relative higher diagnostic value for diagnosing CRC, while PET/CT with higher diagnostic value in detecting local recurrence for patients with CRC.
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Gao Y, Wang J, Lv H, Xue Y, Jia R, Liu G, Bai W, Wu Y, Zhang L, Yang J. Diagnostic value of magnetic resonance and computed tomography colonography for the diagnosis of colorectal cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17187. [PMID: 31574825 PMCID: PMC6775409 DOI: 10.1097/md.0000000000017187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Surgical resection is the recommended procedure for colorectal cancer (CRC), but majority of the patients were diagnosed with advanced or metastatic CRC. Currently, there were inconsistent results about the diagnostic value of magnetic resonance colonography (MRC) and computed tomography colonography (CTC) in early CRC diagnosis. Our study conducted this meta-analysis to investigate the diagnostic value of MRC and CTC for CRC surveillance. METHODS A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane library to select relevant studies. The summary sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curves (AUC) were calculated to evaluate the diagnostic value of MRC and CTC, respectively. RESULT Twenty-five studies including 2985 individuals were selected in the final analysis. Eight studies evaluated the diagnostic value of MRC, and 17 studies assessed CTC. The summary sensitivity, specificity, PLR, NLR, DOR, and AUC in MRC for early detection of CRC were 0.98 (95% confidence interval, CI: 0.80-1.00), 0.94 (95% CI: 0.85-0.97), 15.48 (95% CI: 6.30-38.04), 0.02 (95% CI: 0.00-0.25), 115.09 (95% CI: 15.37-862.01), and 0.98 (95% CI: 0.97-0.99), respectively. In addition, the sensitivity, specificity, PLR, NLR, DOR, and AUC of CTC for diagnosing CRC were 0.97 (95% CI: 0.88-0.99), 0.99 (95% CI: 0.99-1.00), 154.11 (95% CI: 67.81-350.22), 0.03 (95% CI: 0.01-0.13), 642.51 (95% CI: 145.05-2846.02), and 1.00 (95% CI: 0.99-1.00). No significant differences were found between MRC and CTC for DOR in all the subsets. CONCLUSION The findings of meta-analysis indicated that MRC and CTC have higher diagnostic values for early CRC diagnosis. However, the DOR for diagnosing CRC between MRC and CTC showed no significance.
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Affiliation(s)
- Yanjun Gao
- Department of Medical Imaging, Xi’an No. 3 Hospital
| | - Jing Wang
- Department of Medical Imaging, Xi’an Hospital of TCM
| | - Hairong Lv
- Department of Medical Imaging, Xi’an No. 3 Hospital
| | - Yongjie Xue
- Department of Medical Imaging, Xi’an No. 3 Hospital
| | - Rongrong Jia
- Department of Medical Imaging, Xi’an No. 3 Hospital
| | - Ge Liu
- Department of Medical Imaging, Xi’an No. 3 Hospital
| | - Weixian Bai
- Department of Medical Imaging, Xi’an No. 3 Hospital
| | - Yi Wu
- Department of Medical Imaging, Xi’an No. 3 Hospital
| | - Lang Zhang
- Department of Medical Imaging, Xi’an No. 3 Hospital
| | - Junle Yang
- Department of Medical Imaging, Xi’an Central Hospital, Xi’an, China
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Sun S, Yang C, Huang Z, Jiang W, Liu Y, Wu H, Zhao J. Diagnostic value of magnetic resonance versus computed tomography colonography for colorectal cancer: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e10883. [PMID: 29851808 PMCID: PMC6393025 DOI: 10.1097/md.0000000000010883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Advanced colorectal cancers were associated with poor prognosis, and early diagnosis was important for high-risk patients. Colonography is commonly used for diagnosing colorectal cancer. However, a few studies reported the diagnostic value of magnetic resonance colonography (MRC) versus computed tomography colonography (CTC). This study aimed to compare the diagnostic value of MRC versus CTC for colorectal cancer. METHODS Twenty-three studies on the diagnosis of colorectal cancer using MRC or CTC were obtained from PubMed, Embase, and the Cochrane Library databases until July 2017. The ratios of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and receiver operating characteristic (ROC) curve were calculated to compare the diagnostic value of MRC versus CTC. RESULTS The summary sensitivity, specificity, PLR, NLR, and area under the ROC for MRC were 0.97 (0.81-1.00), 0.92 (0.80-0.97), 11.71 (4.46-30.73), 0.03 (0.00-0.24), and 0.98 (0.97-0.99), respectively, for diagnosing colorectal cancer. The pooled estimates for CTC in diagnosing colorectal cancer were as follows: sensitivity, 0.96 (0.90-0.98); specificity, 1.00 (0.99-1.00); PLR, 197.32 (73.21-531.85); NLR, 0.04 (0.02-0.11); and area under the ROC, 1.00 (0.99-1.00). No significant differences were found between MRC and CTC for sensitivity, specificity, and NLR. MRC was associated with lower PLR and area under the ROC for diagnosing colorectal cancer compared with CTC. CONCLUSION This study demonstrated MRC and CTC as potential diagnostic approaches for colorectal cancer. CTC had a higher diagnostic value of PLR and area under the ROC for colorectal cancer.
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Affiliation(s)
| | | | | | | | - Yan Liu
- Medical Oncology Translational Research Lab
| | - Hongfen Wu
- Department of Radiation Oncology, Jilin Cancer Hospital, Changchun, Jilin, China
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Cossu G, Saba L, Minerba L, Mascalchi M. Colorectal Cancer Screening: The Role of Psychological, Social and Background Factors in Decision-making Process. Clin Pract Epidemiol Ment Health 2018; 14:63-69. [PMID: 29643929 PMCID: PMC5872199 DOI: 10.2174/1745017901814010063] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/08/2018] [Accepted: 02/19/2018] [Indexed: 12/27/2022]
Abstract
Since ColoRectal Cancer (CRC) remains the third cause of cancer death in the world, a better understanding of the reasons underlying poor adherence to and delay in undergoing CRC screening programs is important. CRC screening decision-making process can be conceptualized as the relationship between intention and behavior and needs to be investigated including the impact on patients' decision of a broad range of psychological factors and personal predisposition as fear of a positive screening test, poor understanding of the procedure, psychological distress, anxiety, anticipation of pain, feelings of embarrassment and vulnerability. Also socioeconomic, ethnic and sociological influences, and organizational barriers have been identified as factors influencing CRC screening adherence. Decision-making process can finally be influenced by the healthcare background in which the intervention is promoted and screening programs are carried out. However, there is still a gap on the scientific knowledge about the influences of diverse elements on screening adherence and this deserves further investigations in order to carry out more focused and effective prevention programs.
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Affiliation(s)
- Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luca Saba
- Department of Radiology, AOU, University of Cagliari, Cagliari, Italy
| | - Luigi Minerba
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mario Mascalchi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Sali L, Grazzini G, Mascalchi M. CT colonography: role in FOBT-based screening programs for colorectal cancer. Clin J Gastroenterol 2017; 10:312-319. [PMID: 28447326 DOI: 10.1007/s12328-017-0744-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/18/2017] [Indexed: 01/28/2023]
Abstract
Computed tomographic colonography (CTC) is a minimally invasive imaging examination for the colon, and is safe, well tolerated and accurate for the detection of colorectal cancer (CRC) and advanced adenoma. While the role of CTC as a primary test for population screening of CRC is under investigation, the fecal occult blood test (FOBT) has been recommended for population screening of CRC in Europe. Subjects with positive FOBT are invited to undergo total colonoscopy, which has some critical issues, such as suboptimal compliance, contraindications and the possibility of an incomplete exploration of the colon. Based on available data, the integration of CTC in FOBT-based population screening programs for CRC may fall into three scenarios. First, CTC is recommended in FOBT-positive subjects when colonoscopy is refused, incomplete or contraindicated. For these indications CTC should replace double-contrast barium enema. Second, conversely, CTC is not currently recommended as a second-level examination prior to colonoscopy in all FOBT-positive subjects, as this strategy is most probably not cost-effective. Finally, CTC may be considered instead of colonoscopy for surveillance after adenoma removal, but specific studies are needed.
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Affiliation(s)
- Lapo Sali
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, 50134, Florence, Italy.
| | - Grazia Grazzini
- 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, 50134, Florence, 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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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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Plumb AA, Halligan S, Pendsé DA, Taylor SA, Mallett S. Sensitivity and specificity of CT colonography for the detection of colonic neoplasia after positive faecal occult blood testing: systematic review and meta-analysis. Eur Radiol 2014; 24:1049-58. [PMID: 24519111 DOI: 10.1007/s00330-014-3106-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/06/2014] [Accepted: 01/23/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE CT colonography (CTC) is recommended after positive faecal occult blood testing (FOBt) when colonoscopy is incomplete or infeasible. We aimed to estimate the sensitivity and specificity of CTC for colorectal cancer and adenomatous polyps following positive FOBt via systematic review. METHODS The MEDLINE, EMBASE, AMED and Cochrane Library databases were searched for CTC studies reporting sensitivity and specificity for colorectal cancer and adenomatous polyps. Included subjects had tested FOBt-positive by guaiac or immunochemical methods. Per-patient detection rates were summarized via forest plots. Meta-analysis of sensitivity and specificity was conducted using a bivariate random effects model and the average operating point calculated. RESULTS Of 538 articles considered, 5 met inclusion criteria, describing results from 622 patients. Research study quality was good. CTC had a high per-patient average sensitivity of 88.8 % (95 % CI 83.6 to 92.5 %) for ≥6 mm adenomas or colorectal cancer, with low between-study heterogeneity. Specificity was both more heterogeneous and lower, at an average of 75.4 % (95 % CI 58.6 to 86.8 %). CONCLUSION Few studies have investigated CTC in FOBt-positive individuals. CTC is sensitive at a ≥6 mm threshold but specificity is lower and variable. Despite the limited data, these results suggest that CTC may adequately substitute for colonoscopy when the latter is undesirable. KEY POINTS • FOBt is the most common mass screening test for colorectal cancer. • Few studies evaluate CT colonography after positive FOBt. • CTC is approximately 89 % sensitive for ≥6 mm adenomas/cancer in this setting. • Specificity is lower, at approximately 75 %, and more variable. • CT colonography is a good alternative when colonoscopy is undesirable.
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Affiliation(s)
- Andrew A Plumb
- Centre for Medical Imaging, University College London, London, UK
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Sali L, Grazzini G, Ventura L, Falchini M, Borgheresi A, Castiglione G, Grimaldi M, Ianniciello N, Mallardi B, Zappa M, Mascalchi M. Computed tomographic colonography in subjects with positive faecal occult blood test refusing optical colonoscopy. Dig Liver Dis 2013; 45:285-9. [PMID: 23266193 DOI: 10.1016/j.dld.2012.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 10/29/2012] [Accepted: 11/12/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Refusal of colonoscopy is a drawback of colorectal cancer screening programmes based on faecal occult blood test. Computed-tomographic-colonography is generally more accepted than colonoscopy. AIM To compare adherence to computed-tomographic-colonography and second-invitation colonoscopy in subjects with positive faecal test refusing colonoscopy. METHODS We performed a prospective study in 198 subjects with positive faecal test who refused first referral to colonoscopy in one endoscopy service of the Florence screening programme. Subjects were randomly invited to computed-tomographic-colonography (n = 100) or re-invited to colonoscopy (n = 98). Mail invitation was followed by a questionnaire administered by phone. Computed-tomographic-colonography findings were verified with colonoscopy. RESULTS 32 subjects could not be reached, 71 (35.9%) had undergone colonoscopy on their own; 4 were excluded for contraindications; 30/48 (62.5%) in the computed-tomographic-colonography arm and 11/43 (25.6%) in the colonoscopy arm accepted the proposed examinations (p < 0.001). Four advanced adenomas and 1 cancer were found in the 28 subjects who ultimately underwent computed-tomographic-colonography and 2 advanced adenomas and 2 cancers in the 9 subjects who ultimately underwent second-invitation colonoscopy. CONCLUSION Subjects with positive faecal occult blood test refusing colonoscopy show a higher adherence to computed-tomographic-colonography than to second invitation colonoscopy.
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Affiliation(s)
- Lapo Sali
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Viale G. Pieraccini 6, 50139 Florence, Italy.
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Evolving role of computed tomographic colonography in colon cancer screening and diagnosis. South Med J 2012; 105:551-7. [PMID: 23038488 DOI: 10.1097/smj.0b013e318268c602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Computed tomographic colonography (CTC) is a relatively new imaging modality for the examination of patients for colorectal polyps and cancer. It has been validated in its accuracy for the detection of colon cancer and larger polyps (more than likely premalignant). CTC, however, is not widely accepted as a primary screening modality in the United States at present by many third-party payers, including Medicare, and its exact role in screening is evolving. Moreover, there has been opposition to incorporating CTC as an accepted screening instrument, especially by gastroenterologists. Heretofore, optical colonoscopy has been the mainstay in this screening. We discuss these issues and the continuing controversies concerning CTC.
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Boone D, Halligan S, Taylor SA. Evidence review and status update on computed tomography colonography. Curr Gastroenterol Rep 2011; 13:486-494. [PMID: 21773705 DOI: 10.1007/s11894-011-0217-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Computed tomographic (CT) colonography is being implemented increasingly in the USA and Europe, and in many centers it has become the radiological technique of choice for imaging the whole colorectum. Although high diagnostic accuracy has been demonstrated in both screening and symptomatic populations, controversy persists regarding implementation, who should interpret the examination, and its cost effectiveness, particularly in the context of primary colorectal cancer screening. Published research in recent years has demonstrated efficacy in a wide range of patient groups, striking technical improvements, and high levels of patient acceptability. New developments continue in the fields of computer aided detection, digital cleansing, and integration into positron emission tomography. The purpose of this review is to bring the reader up-to-date with the latest developments in CT colonography, in particular, those of the last year.
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Affiliation(s)
- Darren Boone
- Centre for Medical Imaging, University College Hospital, 250 Euston Road, London NW1 2BU, UK
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