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Rutter MD, Beintaris I, Valori R, Chiu HM, Corley DA, Cuatrecasas M, Dekker E, Forsberg A, Gore-Booth J, Haug U, Kaminski MF, Matsuda T, Meijer GA, Morris E, Plumb AA, Rabeneck L, Robertson DJ, Schoen RE, Singh H, Tinmouth J, Young GP, Sanduleanu S. World Endoscopy Organization Consensus Statements on Post-Colonoscopy and Post-Imaging Colorectal Cancer. Gastroenterology 2018; 155:909-925.e3. [PMID: 29958856 DOI: 10.1053/j.gastro.2018.05.038] [Citation(s) in RCA: 208] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/25/2018] [Accepted: 05/15/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Colonoscopy examination does not always detect colorectal cancer (CRC)- some patients develop CRC after negative findings from an examination. When this occurs before the next recommended examination, it is called interval cancer. From a colonoscopy quality assurance perspective, that term is too restrictive, so the term post-colonoscopy colorectal cancer (PCCRC) was created in 2010. However, PCCRC definitions and methods for calculating rates vary among studies, making it impossible to compare results. We aimed to standardize the terminology, identification, analysis, and reporting of PCCRCs and CRCs detected after other whole-colon imaging evaluations (post-imaging colorectal cancers [PICRCs]). METHODS A 20-member international team of gastroenterologists, pathologists, and epidemiologists; a radiologist; and a non-medical professional met to formulate a series of recommendations, standardize definitions and categories (to align with interval cancer terminology), develop an algorithm to determine most-plausible etiologies, and develop standardized methodology to calculate rates of PCCRC and PICRC. The team followed the Appraisal of Guidelines for Research and Evaluation II tool. A literature review provided 401 articles to support proposed statements; evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The statements were voted on anonymously by team members, using a modified Delphi approach. RESULTS The team produced 21 statements that provide comprehensive guidance on PCCRCs and PICRCs. The statements present standardized definitions and terms, as well as methods for qualitative review, determination of etiology, calculation of PCCRC rates, and non-colonoscopic imaging of the colon. CONCLUSIONS A 20-member international team has provided standardized methods for analysis of etiologies of PCCRCs and PICRCs and defines its use as a quality indicator. The team provides recommendations for clinicians, organizations, researchers, policy makers, and patients.
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Affiliation(s)
- Matthew D Rutter
- University Hospital of North Tees, Stockton-on-Tees, UK; Northern Institute for Cancer Research, Newcastle University, UK.
| | | | - Roland Valori
- Gloucestershire Hospitals National Health Service Foundation Trust, Gloucestershire, UK
| | | | - Douglas A Corley
- San Francisco Medical Center, Kaiser Permanente Division of Research, San Francisco, California
| | - Miriam Cuatrecasas
- Hospital Clínic and Tumour Bank-Biobank, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | | | - Anna Forsberg
- Institution of Medicine Solna Karolinska Institutet, Stockholm, Sweden
| | | | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology, Bremen Institute for Prevention Research and Social Medicine, Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Michal F Kaminski
- The Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland
| | | | - Gerrit A Meijer
- Netherlands Cancer Institute, Amsterdam, The Netherlands; University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eva Morris
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's Institute of Oncology, St James's University Hospital, Leeds, UK
| | | | - Linda Rabeneck
- Cancer Care Ontario, University of Toronto, Toronto, Ontario, Canada
| | - Douglas J Robertson
- Veterans Affairs Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | | | | | - Jill Tinmouth
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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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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The new view of colon cancer screening: forwards and backwards. Gastrointest Endosc Clin N Am 2013; 23:647-61. [PMID: 23735108 DOI: 10.1016/j.giec.2013.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Many different techniques for colon cancer screening are available. The fecal immunochemical test is best for fecal-based screening, although the DNA investigation may be more specific when further developed. Computed tomographic colonography is as good as colonoscopy for detecting colon cancer and is almost as good as colonoscopy for detecting advanced adenomas, but has limitations. The flexible sigmoidoscopic examination markedly decreases the incidence of cancer in the visualized segments, but colonoscopy is currently the best procedure for evaluating the large bowel. Techniques for retroflexion or backward view of the colon have been investigated, with all showing increased polyp detection.
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Moore H, Dodd N. Computed tomographic colonography (CTC); colorectal cancer diagnosis with CTC in an Auckland population. J Med Imaging Radiat Oncol 2013; 57:572-5. [DOI: 10.1111/1754-9485.12062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 03/20/2013] [Indexed: 12/20/2022]
Affiliation(s)
- Helen Moore
- Auckland Radiology Group; Auckland City Hospital; Newmarket; Auckland; New Zealand
| | - Nicholas Dodd
- Auckland Radiology Group; Auckland City Hospital; Newmarket; Auckland; New Zealand
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Neri E, Faggioni L, Regge D, Vagli P, Turini F, Cerri F, Picano E, Giusti S, Bartolozzi C. CT Colonography: Role of a second reader CAD paradigm in the initial training of radiologists. Eur J Radiol 2011; 80:303-9. [DOI: 10.1016/j.ejrad.2010.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 07/19/2010] [Accepted: 07/19/2010] [Indexed: 10/19/2022]
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Badiani S, Hernandez ST, Karandikar S, Roy-Choudhury S. CT Colonography to exclude colorectal cancer in symptomatic patients. Eur Radiol 2011; 21:2029-38. [DOI: 10.1007/s00330-011-2151-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 03/19/2011] [Accepted: 03/23/2011] [Indexed: 12/22/2022]
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Shariff MK, Sheikh K, Carroll NR, Whitley S, Greenberg D, Parkes M, Cameron EAB. Colorectal cancer detection: time to abandon barium enema? Frontline Gastroenterol 2011; 2:105-109. [PMID: 28839591 PMCID: PMC5517211 DOI: 10.1136/fg.2010.003616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2010] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To assess the sensitivity of double contrast barium enema (DCBE) for diagnosing colorectal cancer (CRC). DESIGN Retrospective evaluation of DCBE performed in the 2 years prior to diagnosis of CRC. SETTING Teaching hospital in Cambridge, UK. PATIENTS 1310 consecutive cases of CRC identified from cancer registry data. INTERVENTIONS DCBE and colonoscopy. MAIN OUTCOME MEASURES Sensitivity of DCBE for diagnosing CRC. RESULTS 215 patients had undergone a DCBE within the 2 years prior to diagnosis with CRC. After excluding those reported as inadequate, 37 of these were reported as normal, giving a sensitivity of 83% (81-85%). CONCLUSIONS The performance of DCBE is inadequate for the exclusion of CRC. Expansion of colonoscopy and CT colonography capacity is urgently required nationally so that DCBE can finally be abandoned as a firstline test in patients at risk of CRC.
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Affiliation(s)
- M K Shariff
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K Sheikh
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - N R Carroll
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S Whitley
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D Greenberg
- Eastern Cancer Registration and Information Centre, Unit C, Hinton Way, Cambridge, UK
| | - M Parkes
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - E A B Cameron
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Neri E, Faggioni L, Cini L, Bartolozzi C. Colonic polyps: inheritance, susceptibility, risk evaluation, and diagnostic management. Cancer Manag Res 2010; 3:17-24. [PMID: 21407996 PMCID: PMC3048090 DOI: 10.2147/cmr.s15705] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Colorectal cancer (CRC) is the third-ranked neoplasm in order of incidence and mortality, worldwide, and the second cause of cancer death in industrialized countries. One of the most important environmental risk factors for CRC is a Western-type diet, which is characterized by a low-fiber and high-fat content. Up to 25% of patients with CRC have a family history for CRC, and a fraction of these patients are affected by hereditary syndromes, such as familial adenomatous polyposis, Gardner or Turcot syndromes, or hereditary nonpolyposis colorectal cancer. The onset of CRC is triggered by a well-defined combination of genetic alterations, which form the bases of the adenoma-carcinoma sequence hypothesis and justify the set-up of CRC screening techniques. Several screening and diagnostic tests for CRC are illustrated, including rectosigmoidoscopy, optical colonoscopy (OC), double contrast barium enema (DCBE), and computed tomography colonography (CTC). The strengths and weaknesses of each technique are discussed. Particular attention is paid to CTC, which has evolved from an experimental technique to an accurate and mature diagnostic approach, and gained wide acceptance and clinical validation for CRC screening. This success of CTC is due mainly to its ability to provide cross-sectional analytical images of the entire colon and secondarily detect extracolonic findings, with minimal invasiveness and lower cost than OC, and with greater detail and diagnostic accuracy than DCBE. Moreover, especially with the advent and widespread availability of modern multidetector CT scanners, excellent quality 2D and 3D reconstructions of the large bowel can be obtained routinely with a relatively low radiation dose. Computer-aided detection systems have also been developed to assist radiologists in reading CTC examinations, improving overall diagnostic accuracy and potentially speeding up the clinical workflow of CTC image interpretation.
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Affiliation(s)
- Emanuele Neri
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Lorenzo Faggioni
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Lorenzo Cini
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Carlo Bartolozzi
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
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Waye JD. Finding polyps at colonoscopy previously noted on CT colonography. Gastrointest Endosc Clin N Am 2010; 20:293-304. [PMID: 20451818 DOI: 10.1016/j.giec.2010.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Colon screening examinations have been shown to discover neoplastic lesions at an early stage. Even the most careful studies by colonoscopy and by computed tomographic colonography (CTC) can overlook tumors with a diameter greater than 5 mm. Advances in technology have continually improved the ability to find polyps, which will lead to a real decrease in colorectal cancer incidence.
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Affiliation(s)
- Jerome D Waye
- Department of Medicine, Mount Sinai Medical Center, NY, USA; 650 Park Avenue, NY 10065, USA.
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McArthur DR, Mehrzad H, Patel R, Dadds J, Pallan A, Karandikar SS, Roy-Choudhury S. CT colonography for synchronous colorectal lesions in patients with colorectal cancer: initial experience. Eur Radiol 2009; 20:621-9. [PMID: 19727743 DOI: 10.1007/s00330-009-1589-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Revised: 06/21/2009] [Accepted: 07/01/2009] [Indexed: 02/07/2023]
Abstract
AIM To assess accuracy of CT colonography (CTC) in identifying synchronous lesions in patients with colorectal carcinoma. METHODS This study included 174 consecutive patients undergoing CTC as part of staging or primary investigation where a colorectal cancer was diagnosed between 2004 and 2007. Prone unenhanced and portal phase enhanced supine series with air or CO(2) distension were acquired using 4- or 16-slice CT (Toshiba) and read by 2D +/- 3D formats. Synchronous lesions were classified according to American College of Radiology's (ACR) polyp classification. Segmental gold standard was flexible sigmoidoscopy/colonoscopy within 1 year and/or histology of colonic resection supplemented by follow-up. Nine patients without gold standard were excluded. Sensitivity, specificity and accuracy were calculated on a per polyp, per patient and per segment basis and discrepancies analysed. RESULTS Direct comparable data were available for 764/990 colonic segments from 165 patients. Of 41 (C2-C4) synchronous lesions on "gold standard", 33 were correctly identified on virtual colonoscopy (VC), overall per polyp sensitivity was 80.5%, with detection rates of 20/24 C3 (83.3%) and 3/3 C4 (100%) with per patient and per segment specificity of 95.4% and 99.2%, respectively. CONCLUSION CTC is an accurate technique to assess for significant synchronous lesions in patients with colorectal cancer and is applicable for total pre-operative colonic visualisation.
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Affiliation(s)
- D R McArthur
- Department of Surgery, Heart of England NHS Foundation Trust (Teaching), Bordesley Green East, Birmingham, B9 5SS, UK
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