1
|
Thorén F, Johnsson ÅA, Hellström M, Båth M. EXTRACOLONIC FINDINGS-IDENTIFICATION AT LOW-DOSE CTC. RADIATION PROTECTION DOSIMETRY 2021; 195:188-197. [PMID: 33855447 PMCID: PMC8507454 DOI: 10.1093/rpd/ncab054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/07/2021] [Indexed: 06/12/2023]
Abstract
In contrast to optical colonoscopy, computed tomography colonography (CTC) has the ability to reveal pathology outside of the colon. While identification of colorectal lesions at CTC requires only limited radiation dose, the detection of abnormalities in extracolonic soft tissue requires more radiation. The purpose of this study was to investigate the influence of ultra-low-dose (ULD) CTC on the detection and characterisation of extracolonic findings. In a prospective study 49 patients with colorectal symptoms were examined with CTC adding a ULD series (mean effective dose 0.9 ± 0.4 mSv) to the normal unenhanced standard dose (SD) series (mean effective dose 3.6 ± 1.2 mSv). Five radiologists individually and blindly evaluated the ULD, followed by evaluation of the SD after ≥9 weeks (median 35 weeks). A ViewDEX-based examination protocol was used, including a confidence scale and a graded assessment of need for follow-up according to the CTC Reporting and Data System (C-RADS E0-E4). The reference findings comprised the combined information from CTC (ULD, SD and contrast-enhanced CTC series) and a 4-year radiological and clinical follow-up. For the overall detection of reference findings (E2-E4) we found a statistically significant difference in favour of SD. This, however, was not the case when looking at classification of possibly important/important reference findings (E3-E4). Our results suggest that CTC with ULD (0.9 mSv) is comparable to SD (3.6 mSv) for identification of clinically relevant extracolonic pathology, but there is a large inter-observer variability.
Collapse
Affiliation(s)
| | - Åse A Johnsson
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Mikael Hellström
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Magnus Båth
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| |
Collapse
|
2
|
Lin JS, Perdue LA, Henrikson NB, Bean SI, Blasi PR. Screening for Colorectal Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 325:1978-1998. [PMID: 34003220 DOI: 10.1001/jama.2021.4417] [Citation(s) in RCA: 241] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Colorectal cancer (CRC) remains a significant cause of morbidity and mortality in the US. OBJECTIVE To systematically review the effectiveness, test accuracy, and harms of screening for CRC to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials for relevant studies published from January 1, 2015, to December 4, 2019; surveillance through March 26, 2021. STUDY SELECTION English-language studies conducted in asymptomatic populations at general risk of CRC. DATA EXTRACTION AND SYNTHESIS Two reviewers independently appraised the articles and extracted relevant study data from fair- or good-quality studies. Random-effects meta-analyses were conducted. MAIN OUTCOMES AND MEASURES Colorectal cancer incidence and mortality, test accuracy in detecting cancers or adenomas, and serious adverse events. RESULTS The review included 33 studies (n = 10 776 276) on the effectiveness of screening, 59 (n = 3 491 045) on the test performance of screening tests, and 131 (n = 26 987 366) on the harms of screening. In randomized clinical trials (4 trials, n = 458 002), intention to screen with 1- or 2-time flexible sigmoidoscopy vs no screening was associated with a decrease in CRC-specific mortality (incidence rate ratio, 0.74 [95% CI, 0.68-0.80]). Annual or biennial guaiac fecal occult blood test (gFOBT) vs no screening (5 trials, n = 419 966) was associated with a reduction of CRC-specific mortality after 2 to 9 rounds of screening (relative risk at 19.5 years, 0.91 [95% CI, 0.84-0.98]; relative risk at 30 years, 0.78 [95% CI, 0.65-0.93]). In observational studies, receipt of screening colonoscopy (2 studies, n = 436 927) or fecal immunochemical test (FIT) (1 study, n = 5.4 million) vs no screening was associated with lower risk of CRC incidence or mortality. Nine studies (n = 6497) evaluated the test accuracy of screening computed tomography (CT) colonography, 4 of which also reported the test accuracy of colonoscopy; pooled sensitivity to detect adenomas 6 mm or larger was similar between CT colonography with bowel prep (0.86) and colonoscopy (0.89). In pooled values, commonly evaluated FITs (14 studies, n = 45 403) (sensitivity, 0.74; specificity, 0.94) and stool DNA with FIT (4 studies, n = 12 424) (sensitivity, 0.93; specificity, 0.85) performed better than high-sensitivity gFOBT (2 studies, n = 3503) (sensitivity, 0.50-0.75; specificity, 0.96-0.98) to detect cancers. Serious harms of screening colonoscopy included perforations (3.1/10 000 procedures) and major bleeding (14.6/10 000 procedures). CT colonography may have harms resulting from low-dose ionizing radiation. It is unclear if detection of extracolonic findings on CT colonography is a net benefit or harm. CONCLUSIONS AND RELEVANCE There are several options to screen for colorectal cancer, each with a different level of evidence demonstrating its ability to reduce cancer mortality, its ability to detect cancer or precursor lesions, and its risk of harms.
Collapse
Affiliation(s)
- Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Leslie A Perdue
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nora B Henrikson
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Sarah I Bean
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Paula R Blasi
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| |
Collapse
|
3
|
The yield and patient factors associated with CT colonography C-RADS results in a non-screening patient population. Abdom Radiol (NY) 2019; 44:2971-2977. [PMID: 31197463 DOI: 10.1007/s00261-019-02099-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine the proportion of diagnostic computed tomography colonography (CTC) Reporting and Data System (C-RADS) categories in a non-screening population, and which patient factors are associated with a positive CTC (C2-4), a non-diagnostic CTC (C0), and potentially relevant extracolonic findings (ECF, E3-4). METHODS Diagnostic CTCs performed at a single academic center from 2017 to 2018 were retrospectively reviewed. For each examination, the indications, age, sex, admission status, and C-RADS categories were recorded. Multivariate logistic regression was performed of patient demographic factors and clinical indications, with adjusted odds ratios (OR) and 95% confidence intervals. RESULTS 1373 CTCs were included. The mean age was 66.4 ± 13 years (range 24-97). There were 782 women and 75 inpatients. The number of CTCs reported as C0-C4 were 194/1373 (14.1%), 970/1373 (70.6%), 77/1373 (5.6%), 86/1373 (6.3%), and 46/1373 (3.4%), respectively, and 134/1373 (9.8%), 960/1373 (69.9%), 173/1373 (12.6%), and 106/1373 (7.7%) CTCs were reported as E1-4, respectively. Factors that demonstrated the strongest associations were as follows: with C2-4, age groups 50-79 (OR 2.8, 95% confidence interval 1.4-6.1), 80-89 (6.2, 2.9-14.5) and ≥ 90 (7.6, 2.0-29.1), and inpatients (3.4, 1.8-6.4); with C0, age groups 50-79 (5.9, 2.2-24.4), 80-89 (9.8, 3.4-41.8), and ≥ 90 (22.5, 5.8-113.0), incomplete colonoscopy (3.2, 2.0-5.1) and melena or gastrointestinal bleeding (4.1, 1.8-9.4); and with E3-4, age groups 50-79 (1.6, 1.0-2.9), 80-89 (2.0, 1.1-3.9), and ≥ 90 (3.2, 1.2-8.8), and inpatients (2.3, 1.3-3.9). CONCLUSION Older age is increasingly associated with a positive test, a non-diagnostic test and potentially relevant ECF. Inpatients are also associated with positive tests and E3-4 findings. Symptoms are not strongly associated with a positive CTC.
Collapse
|
4
|
Moreno C, Kim DH, Bartel TB, Cash BD, Chang KJ, Feig BW, Fowler KJ, Garcia EM, Kambadakone AR, Lambert DL, Levy AD, Marin D, Peterson CM, Scheirey CD, Smith MP, Weinstein S, Carucci LR. ACR Appropriateness Criteria ® Colorectal Cancer Screening. J Am Coll Radiol 2019; 15:S56-S68. [PMID: 29724427 DOI: 10.1016/j.jacr.2018.03.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/19/2022]
Abstract
This review summarizes the relevant literature regarding colorectal screening with imaging. For individuals at average or moderate risk for colorectal cancer, CT colonography is usually appropriate for colorectal cancer screening. After positive results on a fecal occult blood test or immunohistochemical test, CT colonography is usually appropriate for colorectal cancer detection. For individuals at high risk for colorectal cancer (eg, hereditary nonpolyposis colorectal cancer, ulcerative colitis, or Crohn colitis), optical colonoscopy is preferred because of its ability to obtain biopsies to detect dysplasia. After incomplete colonoscopy, CT colonography is usually appropriate for colorectal cancer screening for individuals at average, moderate, or high risk. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | | | - David H Kim
- Co-author and Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | | | - Brooks D Cash
- University of South Alabama, Mobile, Alabama; American Gastroenterological Association
| | | | - Barry W Feig
- University of Texas MD Anderson Cancer Center, Houston, Texas; American College of Surgeons
| | | | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | | | - Drew L Lambert
- University of Virginia Health System, Charlottesville, Virginia
| | - Angela D Levy
- Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Martin P Smith
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
| |
Collapse
|
5
|
Comparison of extracolonic findings and clinical outcomes in a screening and diagnostic CT colonography population. Abdom Radiol (NY) 2019; 44:429-437. [PMID: 30209542 DOI: 10.1007/s00261-018-1753-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To compare the distribution of extracolonic findings and clinical outcomes between screening and diagnostic CT colonography (CTC) populations. METHODS 388 consecutive patients (369 men, 19 women; mean ± SD age 67.8 ± 10 years) who underwent first-time CTC (4/2011-4/2017) at a Veteran's Affairs Medical Center were divided into screening (asymptomatic) or diagnostic (symptomatic) cohorts based on CTC indication. CTC reporting and data system E-scores for extracolonic findings were retrospectively assigned based on prospective CTC radiologic reports. Multinomial logistic regression was used to examine the association between E-scores and CTC indication. Electronic medical records of all patients with E3 or E4 scores were reviewed (median follow-up 2.8 years) to determine clinical outcomes. RESULTS 68% (262/388) underwent screening and 32% (126/388) diagnostic CTC. 7.2% (28/388) had extracolonic findings considered potentially significant (E4), 4.4% (17/388) had indeterminate but likely unimportant findings (E3), and 88.4% (347/388) had normal or unimportant findings (E1 or E2). E-scores were not significantly different between screening and diagnostic CTC when adjusted for age, gender, and prior imaging (p = 0.44). 4.6% (12/262) of patients with E3/E4 findings in the screening cohort demonstrated clinically significant outcomes, compared with 4.0% (5/126) in the diagnostic cohort, including a total of three extracolonic malignancies (0.8%) and three abdominal aortic aneurysms (0.8%). 4.6% (18/388) underwent follow-up imaging studies to confirm a benign outcome after detection of a category E3/E4 finding. CONCLUSIONS The distribution of extracolonic findings and clinical outcomes were not statistically significantly different between screening and diagnostic CTC populations.
Collapse
|
6
|
JOURNAL CLUB: Extracolonic Findings at CT Colonography: Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018; 211:25-39. [DOI: 10.2214/ajr.17.19495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
7
|
CT Colonography Performance for the Detection of Polyps and Cancer in Adults ≥ 65 Years Old: Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018; 211:40-51. [DOI: 10.2214/ajr.18.19515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
8
|
Yee J, McFarland E. Extracolonic findings and radiation at CT colonography: what the referring provider needs to know. Abdom Radiol (NY) 2018; 43:554-565. [PMID: 29450613 DOI: 10.1007/s00261-018-1461-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A better understanding of the risks and benefits of extracolonic findings and radiation dose will aid in the safe and proper implementation of CT colonography in clinical practice. The majority of extracolonic findings in screening patients are benign and can be ignored by referring physicians. Radiologists also need to be responsible in reporting extracolonic findings. Referring providers must be knowledgeable about the theoretic risks and controversies regarding the use of ionizing radiation. Screening CT colonography imparts a low-level of radiation to patients that is equivalent or less than annual background dose.
Collapse
Affiliation(s)
- Judy Yee
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th St, Bronx, NY, 10467, USA.
| | - Elizabeth McFarland
- SSM St. Joseph Health Center, 300 Capitol Drive, St. Charles, MO, 63301, USA
| |
Collapse
|
9
|
Detection of potentially relevant extracolonic and colorectal findings at CT colonography in a low-risk symptomatic patient population. Abdom Radiol (NY) 2017. [PMID: 28647771 DOI: 10.1007/s00261-017-1221-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE CT colonography (CTC) is a widely accepted examination tool for detection of colorectal lesions but evidence of the proportions of relevant extracolonic findings (ECF) in a large symptomatic but still relatively low-risk cohort is lacking, as well as their relationship to symptoms, age, and sex. METHODS All patients (n = 3208) with colorectal symptoms, imaged between January 2007 and September 2016 with first-time CTC, were retrospectively selected. The majority (96.7%) was examined with low-dose unenhanced protocol. The most relevant ECF and colorectal lesions (≥6 mm) were prospectively assessed according to C-RADS classifications. Follow-up was elaborated based on the electronic record review. Chi-square test was utilized for evaluating the associations between relevant findings and symptoms, age, and sex. RESULTS A total of 270 (8.4%) patients were classified as C-RADS E3, 63 (2.0%) patients as C-RADS E4, and 437 (13.6%) patients were assessed with colorectal lesions (C-RADS C2-4). At follow-up, two thirds of ECF turned out to be a malignancy or relevant disease that required further medical attention. The proportion of ECF was not related to specific colorectal symptoms. Patients aged ≥65 years and men had significantly higher proportions of ECF than younger patients (C-RADS E3 p = 0.005; C-RADS E4 p < 0.001) and women (C-RADS E3 p = 0.013; C-RADS E4 p = 0.009), respectively. CONCLUSION Proportions of relevant ECF and colorectal findings are relatively low in symptomatic low-risk patients. By use of CTC as a singular examination, especially in elderly patients, most colonoscopies can be avoided with the benefit of diagnosing relevant ECF without introducing substantial over-diagnosis.
Collapse
|
10
|
Extracolonic Findings at Screening CT Colonography: Prevalence, Benefits, Challenges, and Opportunities. AJR Am J Roentgenol 2017; 209:94-102. [DOI: 10.2214/ajr.17.17864] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
11
|
Abstract
OPINION STATEMENT Colorectal cancer (CRC) is a common cancer among throughout the world with the highest rates in developed countries such as the USA. There is ample evidence demonstrating the beneficial effects of colorectal cancer screening and, largely thanks to screening initiatives and insurance coverage, epidemiologic analyses show a steady decline in both CRC incidence and mortality rates over the last several decades. However, screening rates for CRC in the US remain low and approximately 1 in 3 adults between the ages of 50 and 75 years has not undergone any form of CRC screening, highlighting the need for additional accurate, minimally invasive, and acceptable screening options. Computed tomography colonography (CTC) has emerged as a viable alternative to existing CRC screening tests and research continues to enhance our knowledge regarding the ability of CTC to play a meaningful role in optimizing CRC screening in areas where it is available. This review highlights recent publications of salient research in the field of CTC. CTC continues to evolve, with lower radiation doses and greater evidence of its ability to identify clinical relevant colonic and extracolonic abnormalities. Recent evidence has bolstered the currently recommended CTC screening interval of 5 years and has reiterated the cost-effectiveness of CTC as a CRC screening examination. Additionally, emerging evidence suggests a role for CTC as a polyp and CRC surveillance modality as well as a preoperative adjunct in patients with established CRC. Data supporting the safety and patient acceptance of CTC also has continued to accumulate and CTC has recently been endorsed as an appropriate test for CRC screening in multiple important guidelines and recommendations. CTC is poised to become an important option in the CRC screening and surveillance arena.
Collapse
|
12
|
Lee BJ, Balasingam A, Van den Bosch R. Retrospective analysis of computed tomographic colonography in a rural hospital. J Med Imaging Radiat Oncol 2017; 61:476-480. [PMID: 28105788 DOI: 10.1111/1754-9485.12586] [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: 07/24/2016] [Accepted: 12/14/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The aims of this study were to investigate the diagnostic performance of computed tomography colonography (CTC) performed in a rural secondary hospital, and to describe the local pattern of CTC service provision. METHOD A single site, retrospective observational analysis was conducted for all patients undergoing CTC during the 12-month period from 1st of January to 31st of December 2014 with comparison to available colonoscopy. RESULTS There were 639 CTCs performed during the 12-months period. The average time from referral to performance of CTC scan was 21.3 days. The diagnostic yield of CTC for CRC was 5.8%; and for large polyps ≥10 mm was 8.0%. The sensitivity and specificity of CTC for detecting CRC were 97.1% and 88.2% respectively. The most predictive symptoms for finding colorectal lesions were rectal bleeding and anaemia. The referral rate from CTC to colonoscopy was 16.9%. 63 patients (9.9%) had follow up recommendations made in their reports due to extracolonic findings. CONCLUSION Computed tomography colonography performed in a rural secondary hospital provided sufficient sensitivity to detect large polyps or CRC. The specificity for CRC was lower than reported figures in the literature. Technical issue of CTC performance due to poor insufflation techniques was identified as a main contributing factor reducing CTC accuracy. CTCs were performed with acceptable waiting time and showed high overall diagnostic yield for colorectal neoplasm in a rural hospital.
Collapse
Affiliation(s)
- Beom Jun Lee
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Adrian Balasingam
- Department of Radiology, Christchurch Hospital, Christchurch, New Zealand
| | | |
Collapse
|
13
|
Indeterminate but Likely Unimportant Extracolonic Findings at Screening CT Colonography (C-RADS Category E3): Incidence and Outcomes Data From a Clinical Screening Program. AJR Am J Roentgenol 2016; 207:996-1001. [PMID: 27505184 DOI: 10.2214/ajr.16.16275] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the incidence and outcomes of unsuspected indeterminate but likely unimportant extracolonic findings (CT Colonography Reporting and Data System [C-RADS] category E3) at screening CT colonography (CTC). MATERIALS AND METHODS Over 99 months (April 2004 through June 2012), 7952 consecutive adults without symptoms of colorectal cancer (4277 women, 3675 men; mean age ± SD, 56.7 ± 7.3 years) underwent first-time screening CTC. Findings prospectively placed into C-RADS category E3 were retrospectively reviewed, including follow-up (range, 2-10 years) and ultimate clinical outcome. RESULTS Unsuspected C-RADS category E3 extracolonic findings were detected in 9.1% (725/7952) of our patient population. A total of 751 category E3 findings were detected among these 725 patients; 25 patients had multiple findings. Commonly involved organ systems included gynecologic (24.4%, 183/751), genitourinary (20.9%, 157/751), lung (20.6%, 155/751), and gastrointestinal (16.1%, 121/751). Consideration for further imaging, if clinically warranted, was suggested in 83.8% (608/725). Sixty-five patients were lost to follow-up. Conditions requiring treatment or surveillance were ultimately diagnosed in 8.3% (55/660), including eight malignant neoplasms. In the remaining 605 patients, 25 (4.1%) underwent invasive biopsy or surgery to prove benignity (including 18 complex adnexal masses), and 278 (46.0%) received additional imaging follow-up. CONCLUSION Indeterminate but likely unimportant extracolonic findings (C-RADS category E3) occurred in less than 10% of adults without symptoms of colorectal cancer who underwent screening CTC. Over 90% of these findings ultimately proved to be clinically insignificant, with fewer than 5% requiring an invasive procedure to prove benign disease, the majority of which (> 70%) were complex adnexal lesions in women.
Collapse
|
14
|
Yee J, Chang KJ, Dachman AH, Kim DH, McFarland EG, Pickhardt PJ, Cash BD, Bruining DH, Zalis ME. The Added Value of the CT Colonography Reporting and Data System. J Am Coll Radiol 2016; 13:931-5. [DOI: 10.1016/j.jacr.2016.04.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 04/28/2016] [Indexed: 12/20/2022]
|
15
|
Maggialetti N, Capasso R, Pinto D, Carbone M, Laporta A, Schipani S, Piccolo CL, Zappia M, Reginelli A, D'Innocenzo M, Brunese L. Diagnostic value of computed tomography colonography (CTC) after incomplete optical colonoscopy. Int J Surg 2016; 33 Suppl 1:S36-44. [PMID: 27255132 DOI: 10.1016/j.ijsu.2016.05.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION This study evaluated the role of computed tomography colonography (CTC) in patients who previously underwent incomplete optical colonoscopy (OC). We analyzed the impact of colonic lesions in intestinal segments not studied by OC and extracolonic findings in these patients. METHODS Between January 2014 and May 2015, 61 patients with a history of abdominal pain and incomplete OC examination were studied by CTC. CTCs were performed by 320-row CT scan in both the supine and the prone position, without intravenous administration of contrast medium. In all patients both colonic findings and extracolonic findings were evaluated. RESULTS Among the study group, 24 CTC examinations were negative for both colonic and extracolonic findings while 6 examinations revealed the presence of both colonic and extracolonic findings. In 24 patients CTC depicted colonic anomalies without extracolonic ones, while in 7 patients it showed extracolonic findings without colonic ones. DISCUSSION CTC is a noninvasive imaging technique with the advantages of high diagnostic performance, rapid data acquisition, minimal patient discomfort, lack of need for sedation, and virtually no recovery time. CTC accurately allows the evaluation of the nonvisualized part of the colon after incomplete OC and has the distinct advantage to detect clinically important extracolonic findings in patients with incomplete OC potentially explaining the patient's symptoms and conditioning their therapeutic management. CONCLUSION CTC accurately allows the assessment of both colonic and extracolonic pathologies representing a useful diagnostic tool in patients for whom complete OC is not achievable.
Collapse
Affiliation(s)
- N Maggialetti
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
| | - R Capasso
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
| | - D Pinto
- Radiological Research, Molfetta, BA, Italy.
| | - M Carbone
- Department of Radiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
| | - A Laporta
- Department of Radiology, A.O. Solofra, Italy.
| | - S Schipani
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
| | - C L Piccolo
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
| | - M Zappia
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
| | - A Reginelli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
| | | | - L Brunese
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
| |
Collapse
|
16
|
Assessing the prevalence and clinical relevance of positive abdominal and pelvic CT findings in senior patients presenting to the emergency department. Emerg Radiol 2015; 23:111-5. [PMID: 26607149 DOI: 10.1007/s10140-015-1362-1] [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: 09/07/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
The purpose of our study was to retrospectively evaluate the prevalence and clinical relevance of positive abdominal and pelvic CT findings for patients 65 years of age and older, when compared with all other scanned adult Emergency Department (ED) patients, at a single tertiary care hospital. Our hypothesis was that there is an increased prevalence and clinical relevance of positive abdominal/pelvic CT findings in senior patients. A research ethics board-approved retrospective review of all adult patients who underwent an emergency CT of the abdomen and pelvis for acute nontraumatic abdominal and/or pelvic signs and symptoms was performed. Two thousand one hundred two patients between October 1, 2011, and September 30, 2013, were reviewed. Six hundred thirty-one patients were included in the <65 group (298 men and 333 women; mean age 46, age range 18-64), and 462 were included in the >65 group (209 men and 253 women; mean age 77.6, age range 65-99). Overall, there were more positive CT findings for patients <65 (389 positive cases, 61.6 %) compared with the >65 group (257 positive cases, 55.6 %), which was a statistically significant difference (p < 0.03). Moreover, with the exception of complicated appendicitis cases, which were more common in the >65 group, there were no statistically significant differences in the clinical/surgical relevance of the positive CT findings between the two groups. The findings of our retrospective study therefore refute our hypothesis that there is an increased prevalence of positive abdominal CT findings in patients >65. This may be related to ED physicians at our institution being more hesitant to order CT examinations for the younger population, presumably due to radiation concerns. However, older patients in our series were more likely to present with complicated appendicitis, and a lower threshold for ordering CT examinations of the abdomen and pelvis in this patient population should therefore be considered.
Collapse
|
17
|
Tutein Nolthenius CJ, Boellaard TN, de Haan MC, Nio CY, Thomeer MGJ, Bipat S, Montauban van Swijndregt AD, van de Vijver MJ, Biermann K, Kuipers EJ, Dekker E, Stoker J. Computer tomography colonography participation and yield in patients under surveillance for 6-9 mm polyps in a population-based screening trial. Eur Radiol 2015; 26:2762-70. [PMID: 26560732 PMCID: PMC4927597 DOI: 10.1007/s00330-015-4081-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/05/2015] [Accepted: 10/22/2015] [Indexed: 12/21/2022]
Abstract
Purpose Surveillance CT colonography (CTC) is a viable option for 6-9 mm polyps at CTC screening for colorectal cancer. We established participation and diagnostic yield of surveillance and determined overall yield of CTC screening. Material and methods In an invitational CTC screening trial 82 of 982 participants harboured 6-9 mm polyps as the largest lesion(s) for which surveillance CTC was advised. Only participants with one or more lesion(s) ≥6 mm at surveillance CTC were offered colonoscopy (OC); 13 had undergone preliminary OC. The surveillance CTC yield was defined as the number of participants with advanced neoplasia in the 82 surveillance participants, and was added to the primary screening yield. Results Sixty-five of 82 participants were eligible for surveillance CTC of which 56 (86.2 %) participated. Advanced neoplasia was diagnosed in 15/56 participants (26.8 %) and 9/13 (69.2 %) with preliminary OC. Total surveillance yield was 24/82 (29.3 %). No carcinomas were detected. Adding surveillance results to initial screening CTC yield significantly increased the advanced neoplasia yield per 100 CTC participants (6.1 to 8.6; p < 0.001) and per 100 invitees (2.1 to 2.9; p < 0.001). Conclusion Surveillance CTC for 6-9 mm polyps has a substantial yield of advanced adenomas and significantly increased the CTC yield in population screening. Key Points • The participation rate in surveillance CT colonography (CTC) is 86 %. • Advanced adenoma prevalence in a 6-9 mm CTC surveillance population is high. • Surveillance CTC significantly increases the yield of population screening by CTC. • Surveillance CTC for 6-9 mm polyps is a safe strategy. • Surveillance CTC is unlikely to yield new important extracolonic findings.
Collapse
Affiliation(s)
- Charlotte J Tutein Nolthenius
- Department of Radiology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DD, Amsterdam, The Netherlands. .,Department of Radiology, Onze Lieve Vrouwe Gasthuis, PO Box 95500, 1090 HM, Amsterdam, The Netherlands. .,Department of Radiology, G1-215, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Thierry N Boellaard
- Department of Radiology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DD, Amsterdam, The Netherlands
| | - Margriet C de Haan
- Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - C Yung Nio
- Department of Radiology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DD, Amsterdam, The Netherlands
| | - Maarten G J Thomeer
- Department of Radiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Shandra Bipat
- Department of Radiology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DD, Amsterdam, The Netherlands
| | | | - Marc J van de Vijver
- Department of Pathology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DD, Amsterdam, The Netherlands
| | - Katharina Biermann
- Department of Pathology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DD, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DD, Amsterdam, The Netherlands
| |
Collapse
|
18
|
Potentially Important Extracolonic Findings at Screening CT Colonography: Incidence and Outcomes Data From a Clinical Screening Program. AJR Am J Roentgenol 2015; 206:313-8. [PMID: 26491809 DOI: 10.2214/ajr.15.15193] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The effect of detection of extracolonic findings at screening CT colonography (CTC) remains controversial. Our objective is to analyze the incidence and outcomes of unsuspected potentially significant (CT Colonography Reporting and Data System [C-RADS] extracolonic category E4) findings in a population undergoing clinical CTC screening. SUBJECTS AND METHODS Over the course of 99 months (April 1, 2004, through June 30, 2012), 7952 consecutive asymptomatic adults (3675 men and 4277 women; mean [± SD] age, 56.7 ± 7.3 years) underwent first-time screening CTC. Examinations were prospectively interpreted by radiologists within our abdominal imaging section, and extracolonic findings were recorded and categorized. Potentially significant (i.e., C-RADS extracolonic category E4) findings were retrospectively reviewed with additional analysis of follow-up (range, 2-10 years) and ultimate clinical outcome. RESULTS Overall, 2.5% (202/7952) of patients had a potentially significant (C-RADS category E4) extracolonic finding for which further imaging (56%; 113/202) or clinical follow-up (44%; 89/202) was recommended. No patients had multiple category E4 findings. Twenty-two patients were lost to follow-up. Of the remaining 180 patients, 68% (123/180) proved to have clinically significant disease, including 23% (42/180) with malignant or potentially malignant neoplasms and 32% (57/180) with abdominal aortic or other visceral artery aneurysms requiring treatment or surveillance. The most commonly involved organs and systems included the vascular system (26%; 53/202), the genitourinary system (18%; 36/202), the liver (15%; 30/202), the gastrointestinal system (9.9%; 20/202), the lungs (9.4%; 19/202), and the gynecologic system (6.9%; 14/202). CONCLUSION Potentially significant extracolonic findings in asymptomatic adults at screening CTC are uncommon (2-3% of cases). However, most of these findings (68%) will prove to be clinically significant, including a number of malignancies and aneurysms requiring treatment or surveillance.
Collapse
|
19
|
Patel JD, Chang KJ. The role of virtual colonoscopy in colorectal screening. Clin Imaging 2015; 40:315-20. [PMID: 26298421 DOI: 10.1016/j.clinimag.2015.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/06/2015] [Indexed: 02/07/2023]
Abstract
Colorectal cancer is the second leading cause of cancer-related deaths in the United States. The earlier colorectal cancer is detected, the better chance a person has of surviving 5 years after being diagnosed, emphasizing the need for effective and regular colorectal screening. Computed tomographic colonography has repeatedly demonstrated sensitivities equivalent to the current gold standard, optical colonoscopy, in the detection of clinically relevant polyps. It is an accurate, safe, affordable, available, reproducible, quick, and cost-effective option for colorectal screening and should be considered for mass screening.
Collapse
Affiliation(s)
- Jay D Patel
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, 593 Eddy St., Providence, RI 02903.
| | - Kevin J Chang
- Director of CT Colonography, Division of Body Imaging, Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, 593 Eddy St., Providence, RI 02908.
| |
Collapse
|
20
|
Halligan S, Dadswell E, Wooldrage K, Wardle J, von Wagner C, Lilford R, Yao GL, Zhu S, Atkin W. Computed tomographic colonography compared with colonoscopy or barium enema for diagnosis of colorectal cancer in older symptomatic patients: two multicentre randomised trials with economic evaluation (the SIGGAR trials). Health Technol Assess 2015; 19:1-134. [PMID: 26198205 PMCID: PMC4781284 DOI: 10.3310/hta19540] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Computed tomographic colonography (CTC) is a relatively new diagnostic test that may be superior to existing alternatives to investigate the large bowel. OBJECTIVES To compare the diagnostic efficacy, acceptability, safety and cost-effectiveness of CTC with barium enema (BE) or colonoscopy. DESIGN Parallel randomised trials: BE compared with CTC and colonoscopy compared with CTC (randomisation 2 : 1, respectively). SETTING A total of 21 NHS hospitals. PARTICIPANTS Patients aged ≥ 55 years with symptoms suggestive of colorectal cancer (CRC). INTERVENTIONS CTC, BE and colonoscopy. MAIN OUTCOME MEASURES For the trial of CTC compared with BE, the primary outcome was the detection rate of CRC and large polyps (≥ 10 mm), with the proportion of patients referred for additional colonic investigation as a secondary outcome. For the trial of CTC compared with colonoscopy, the primary outcome was the proportion of patients referred for additional colonic investigation, with the detection rate of CRC and large polyps as a secondary outcome. Secondary outcomes for both trials were miss rates for cancer (via registry data), all-cause mortality, serious adverse events, patient acceptability, extracolonic pathology and cost-effectiveness. RESULTS A total of 8484 patients were registered and 5384 were randomised and analysed (BE trial: 2527 BE, 1277 CTC; colonoscopy trial: 1047 colonoscopy, 533 CTC). Detection rates in the BE trial were 7.3% (93/1277) for CTC, compared with 5.6% (141/2527) for BE (p = 0.0390). The difference was due to better detection of large polyps by CTC (3.6% vs. 2.2%; p = 0.0098), with no significant difference for cancer (3.7% vs. 3.4%; p = 0.66). Significantly more patients having CTC underwent additional investigation (23.5% vs. 18.3%; p = 0.0003). At the 3-year follow-up, the miss rate for CRC was 6.7% for CTC (three missed cancers) and 14.1% for BE (12 missed cancers). Significantly more patients randomised to CTC than to colonoscopy underwent additional investigation (30% vs. 8.2%; p < 0.0001). There was no significant difference in detection rates for cancer or large polyps (10.7% for CTC vs. 11.4% for colonoscopy; p = 0.69), with no difference when cancers (p = 0.94) and large polyps (p = 0.53) were analysed separately. At the 3-year follow-up, the miss rate for cancer was nil for colonoscopy and 3.4% for CTC (one missed cancer). Adverse events were uncommon for all procedures. In 1042 of 1748 (59.6%) CTC examinations, at least one extracolonic finding was reported, and this proportion increased with age (p < 0.0001). A total of 149 patients (8.5%) were subsequently investigated, and extracolonic neoplasia was diagnosed in 79 patients (4.5%) and malignancy in 29 (1.7%). In the short term, CTC was significantly more acceptable to patients than BE or colonoscopy. Total costs for CTC and colonoscopy were finely balanced, but CTC was associated with higher health-care costs than BE. The cost per large polyp or cancer detected was £4235 (95% confidence interval £395 to £9656). CONCLUSIONS CTC is superior to BE for detection of cancers and large polyps in symptomatic patients. CTC and colonoscopy detect a similar proportion of large polyps and cancers and their costs are also similar. CTC precipitates significantly more additional investigations than either BE or colonoscopy, and evidence-based referral criteria are needed. Further work is recommended to clarify the extent to which patients initially referred for colonoscopy or BE undergo subsequent abdominopelvic imaging, for example by computed tomography, which will have a significant impact on health economic estimates. TRIAL REGISTRATION Current Controlled Trials ISRCTN95152621.
Collapse
Affiliation(s)
- Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Edward Dadswell
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kate Wooldrage
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
| | - Christian von Wagner
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
| | - Richard Lilford
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK
- Population Evidence and Technologies, University of Warwick, Warwick, UK
| | - Guiqing L Yao
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Shihua Zhu
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Wendy Atkin
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| |
Collapse
|
21
|
Halligan S, Wooldrage K, Dadswell E, Shah U, Kralj-Hans I, von Wagner C, Faiz O, Teare J, Edwards R, Kay C, Yao G, Lilford RJ, Morton D, Wardle J, Atkin W. Identification of Extracolonic Pathologies by Computed Tomographic Colonography in Colorectal Cancer Symptomatic Patients. Gastroenterology 2015; 149:89-101.e5. [PMID: 25796362 DOI: 10.1053/j.gastro.2015.03.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 02/12/2015] [Accepted: 03/06/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Symptoms suggestive of colorectal cancer may originate outside the colorectum. Computed tomographic colonography (CTC) is used to examine the colorectum and abdominopelvic organs simultaneously. We performed a prospective randomized controlled trial to quantify the frequency, nature, and consequences of extracolonic findings. METHODS We studied 5384 patients from 21 UK National Health Service hospitals referred by their family doctor for the investigation of colorectal cancer symptoms from March 2004 through December 2007. The patients were assigned randomly to groups that received the requested test (barium enema or colonoscopy, n = 3574) or CTC (n = 1810). We determined the frequency and nature of extracolonic findings, subsequent investigations, ultimate diagnosis, and extracolonic cancer diagnoses 1 and 3 years after testing patients without colorectal cancer. RESULTS Extracolonic pathologies were detected in 959 patients by CTC (58.7%), in 42 patients by barium enema analysis (1.9%), and in no patients by colonoscopy. Extracolonic findings were investigated in 142 patients (14.2%) and a diagnosis was made for 126 patients (88.1%). Symptoms were explained by extracolonic findings in 4 patients analyzed by barium enema (0.2%) and in 33 patients analyzed by CTC (2.8%). CTC identified 72 extracolonic neoplasms, however, barium enema analysis found only 3 (colonoscopy found none). Overall, CTC diagnosed extracolonic neoplasms in 72 of 1634 patients (4.4%); 26 of these were malignant (1.6%). There were significantly more extracolonic malignancies detected than expected 1 year after examination, but these did not differ between patients evaluated by CTC (22.2/1000 person-years), barium enema (26.5/1000 person-years; P = .43), or colonoscopy (32.0/1000 person-years; P = .88). CONCLUSIONS More than half of the patients with symptoms of colorectal cancer are found to have extracolonic pathologies by CTC analysis. However, the proportion of patients found to have extracolonic malignancies after 1 year of CTC examination is not significantly greater than after barium enema or colonoscopy examinations. International Standard Randomised Controlled Trials no: 95152621.isrctn.com.
Collapse
Affiliation(s)
| | | | | | - Urvi Shah
- Imperial College London, London, United Kingdom
| | | | | | - Omar Faiz
- Imperial College London, London, United Kingdom
| | | | - Rob Edwards
- Queen Mary University of London, London, United Kingdom
| | - Clive Kay
- Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, United Kingdom
| | - Guiqing Yao
- University of Southampton, Southampton, United Kingdom
| | | | - Dion Morton
- University of Birmingham, Birmingham, United Kingdom
| | - Jane Wardle
- University College London, London, United Kingdom
| | - Wendy Atkin
- Imperial College London, London, United Kingdom
| |
Collapse
|
22
|
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]
|
23
|
Levine MS, Yee J. History, evolution, and current status of radiologic imaging tests for colorectal cancer screening. Radiology 2015; 273:S160-80. [PMID: 25340435 DOI: 10.1148/radiol.14140531] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Colorectal cancer screening is thought to be an effective tool with which to reduce the mortality from colorectal cancer through early detection and removal of colonic adenomas and early colon cancers. In this article, we review the history, evolution, and current status of imaging tests of the colon-including single-contrast barium enema, double-contrast barium enema, computed tomographic (CT) colonography, and magnetic resonance (MR) colonography-for colorectal cancer screening. Despite its documented value in the detection of colonic polyps, the double-contrast barium enema has largely disappeared as a screening test because it is widely perceived as a labor-intensive, time-consuming, and technically demanding procedure. In the past decade, the barium enema has been supplanted by CT colonography as the major imaging test in colorectal cancer screening in the United States, with MR colonography emerging as another viable option in Europe. Although MR colonography does not require ionizing radiation, the radiation dose for CT colonography has decreased substantially, and regular screening with this technique has a high benefit-to-risk ratio. In recent years, CT colonography has been validated as an effective tool for use in colorectal cancer screening that is increasingly being disseminated.
Collapse
Affiliation(s)
- Marc S Levine
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (M.S.L.); and Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, Calif (J.Y.)
| | | |
Collapse
|
24
|
Yee J, Kim DH, Rosen MP, Lalani T, Carucci LR, Cash BD, Feig BW, Fowler KJ, Katz DS, Smith MP, Yaghmai V. ACR Appropriateness Criteria colorectal cancer screening. J Am Coll Radiol 2014; 11:543-51. [PMID: 24793959 DOI: 10.1016/j.jacr.2014.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 02/06/2023]
Abstract
Colorectal cancer is the third leading cause of cancer deaths in the United States. Most colorectal cancers can be prevented by detecting and removing the precursor adenomatous polyp. Individual risk factors for the development of colorectal cancer will influence the particular choice of screening tool. CT colonography (CTC) is the primary imaging test for colorectal cancer screening in average-risk individuals, whereas the double-contrast barium enema (DCBE) is now considered to be a test that may be appropriate, particularly in settings where CTC is unavailable. Single-contrast barium enema has a lower performance profile and is indicated for screening only when CTC and DCBE are not available. CTC is also the preferred test for colon evaluation following an incomplete colonoscopy. Imaging tests including CTC and DCBE are not indicated for colorectal cancer screening in high-risk patients with polyposis syndromes or inflammatory bowel disease. This paper presents the updated colorectal cancer imaging test ratings and is the result of evidence-based consensus by the ACR Appropriateness Criteria Expert Panel on Gastrointestinal Imaging. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
Collapse
Affiliation(s)
- Judy Yee
- University of California, San Francisco, San Francisco, California.
| | - David H Kim
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Max P Rosen
- UMass Memorial Medical Center & UMass School of Medicine, Worcester, Massachusetts
| | - Tasneem Lalani
- Inland Imaging Associates and University of Washington, Seattle, Washington
| | - Laura R Carucci
- Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Brooks D Cash
- University of South Alabama, Mobile, Alabama; American Gastroenterological Association, Bethesda, Maryland
| | - Barry W Feig
- University of Texas MD Anderson Cancer Center, Houston, Texas, American College of Surgeons, Chicago, Illinois
| | | | | | - Martin P Smith
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | |
Collapse
|
25
|
Adverse events Following Computed Tomographic Colonography compared to Optical Colonoscopy in the Elderly. Prev Med Rep 2014; 1:3-8. [PMID: 25530940 PMCID: PMC4266938 DOI: 10.1016/j.pmedr.2014.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate gastrointestinal and cardiovascular adverse event risks associated with optical colonoscopy (OC) among Medicare outpatients who received computed tomography colonography (CTC) as their initial method of colorectal evaluation. METHODS Medicare claims were compared between 6,114 outpatients ≥ 66 years who received initial CTC and 149,202 outpatients who received initial OC between January 2007 and December 2008. OC patients were matched on county of residence and year of evaluation. Outcomes included lower gastrointestinal bleeding, gastrointestinal perforation, other gastrointestinal events and cardiovascular events resulting in an emergency department visit or hospitalization within 30 days. RESULTS Among 1,000 outpatients undergoing initial CTC, 12.4 experienced lower gastrointestinal bleeding, 0.7 perforation, 18.0 other gastrointestinal events and 45.5 cardiovascular events within 30 days. After multivariate adjustment, risks of lower gastrointestinal bleeding, other gastrointestinal events and cardiovascular events were higher with initial OC than CTC, with or without subsequent OC (OR 1.91 95CI [1.47,2.49], OR 1.35 95CI [1.07,1.69] and OR 1.38 95CI [1.18,1.62], respectively); however, perforation risk did not differ (p=0.10). This pattern is similar in older and symptomatic populations. CONCLUSION Rates of gastrointestinal bleeding, other gastrointestinal events and cardiovascular events are lower following initial CTC than OC, but rates of perforation do not differ.
Collapse
|
26
|
Badiani S, Tomas-Hernandez S, Karandikar S, Roy-Choudhury S. Extracolonic findings (ECF) on CT colonography (CTC) in patients presenting with colorectal symptoms. Acta Radiol 2013; 54:851-62. [PMID: 23761550 DOI: 10.1177/0284185113486371] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Computed tomographic colonography (CTC) is now an established method for imaging the colon and rectum in the screening and symptomatic setting. Additional benefit of CTC is the ability to assess for extracolonic findings especially in patients presenting with colorectal symptoms. PURPOSE To determine prevalence of extracolonic findings (ECF) in symptomatic patients undergoing CTC and determine accuracy of CTC for exclusion of significant abdominal disease and extracolonic malignancy (ECM). MATERIAL AND METHODS A total of 1359 unenhanced prone and postcontrast supine CTC studies were performed between March 2002 and December 2007. ECF were retrospectively classified according to C-RADS criteria into E1 to E4 findings. For ECM, a gold standard of clinical and/or radiological follow-up supplemented with data from the regional cancer registry with a median follow-up of 42 months was created. Sensitivity and negative predictive values for ECM was calculated. RESULTS Following exclusions, 1177 CTCs were analyzed. Of 1423 extracolonic findings reported, 328/1423 (23%) E3 and 100/1423 (7%) E4 (including six eventual FP studies) findings were identified. Thirty-two ECMs were confirmed following further investigations. Seven further small ECMs were detected during the entire follow-up, of which two were potentially visible in retrospect (false-negative studies). Additional tests were generated from 55/1177 (4.7%) studies. Sensitivity and negative predictive value for ECM was 94.1% (95% CI 78.9-98.9%) and 99.8% (95% CI 99.3-99.9%), respectively. CONCLUSION One in 37 patients were found to have an ECM. Two potentially detectable cancers were missed. Only a small proportion of patients underwent additional work-up.
Collapse
|
27
|
The time has arrived for national reimbursement of screening CT colonography. AJR Am J Roentgenol 2013; 201:73-9. [PMID: 23789660 DOI: 10.2214/ajr.13.10656] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE CT colonography (CTC) has been fully validated as an accurate screening test for colorectal carcinoma and is being disseminated globally. There is an abundance of new literature addressing the prior concerns of the U.S. Preventive Services Task Force and the Centers for Medicare & Medicaid Services. Specific areas related to radiation dose, extracolonic findings, and generalizability of CTC to senior patients are discussed. CONCLUSION The time has arrived for national reimbursement of CTC in the United States.
Collapse
|
28
|
|
29
|
Kahi CJ, Anderson JC, Rex DK. Screening and surveillance for colorectal cancer: state of the art. Gastrointest Endosc 2013; 77:335-50. [PMID: 23410695 DOI: 10.1016/j.gie.2013.01.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 01/01/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Charles J Kahi
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | |
Collapse
|
30
|
Yee J, Weinstein S, Morgan T, Alore P, Aslam R. Advances in CT Colonography for Colorectal Cancer Screening and Diagnosis. J Cancer 2013; 4:200-9. [PMID: 23459511 PMCID: PMC3584833 DOI: 10.7150/jca.5858] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 02/07/2013] [Indexed: 12/13/2022] Open
Abstract
CT colonography (CTC) is a validated colorectal cancer test that provides an additional minimally-invasive screening option which is likely to be preferred by some patients. Important examination prerequisites include adequate colonic cleansing and distention. Tagging of residual material aids in the differentiation of true polyps from stool. Low radiation dose technique should be employed routinely for screening studies. Readers must be skilled in the use of both 2D and 3D interpretation methods.
Collapse
Affiliation(s)
- Judy Yee
- Dept. of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94121, USA
| | | | | | | | | |
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW Computed tomography colonography (CTC) continues to mature and evolve as a noninvasive imaging test of the large intestine. The aim of this review is to provide an update on the recent and emerging data that further supports the clinical effectiveness of CTC. RECENT FINDINGS The diagnostic performance of CTC for detecting colorectal polyps and masses is well established, but its precise clinical role is yet to be determined. Recent data on test performance, patient acceptance, and study technique may help to clarify the role of CTC and accelerate its clinical implementation. SUMMARY Recent advances and refinements in CTC should help to clarify and expand its clinical role, both as a screening and diagnostic test. High patient acceptance for CTC could lead to increased adherence rates. Ultimately, the complementary nature of CTC and optical colonoscopy should result in improved patient care.
Collapse
|
32
|
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.
Collapse
|
33
|
CT colonography of a Medicare-aged population: outcomes observed in an analysis of more than 1400 patients. AJR Am J Roentgenol 2012; 199:W27-34. [PMID: 22733929 DOI: 10.2214/ajr.11.7729] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We evaluated outcomes of patients 65 years old and older who underwent CT colonography (CTC) between 2004 and 2009. CONCLUSION The frequency of referral to colonoscopy based on a polyp size threshold of 6 mm was 14.5%. Colorectal neoplasia was found in 9.3% of patients, with advanced neoplasia in 3.3%. Potentially important extracolonic findings were observed in 2.9% of patients. The low rates of referral to colonoscopy, prevalence of advanced neoplasia, and prevalence of extracolonic findings make CTC a viable option for Medicare-aged patients.
Collapse
|
34
|
Lee SY, Landis MS, Ross IG, Goela A, Leung AE. Extraspinal Findings at Lumbar Spine CT Examinations: Prevalence and Clinical Importance. Radiology 2012; 263:502-9. [DOI: 10.1148/radiol.12112152] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|