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Greuter MJE, Berkhof J, Fijneman RJA, Demirel E, Lew JB, Meijer GA, Stoker J, Coupé VMH. The potential of imaging techniques as a screening tool for colorectal cancer: a cost-effectiveness analysis. Br J Radiol 2016; 89:20150910. [PMID: 27194458 DOI: 10.1259/bjr.20150910] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Imaging may be promising for colorectal cancer (CRC) screening, since it has test characteristics comparable with colonoscopy but is less invasive. We aimed to assess the potential of CT colonography (CTC) and MR colonography (MRC) in terms of (cost-effectiveness) using the Adenoma and Serrated pathway to Colorectal CAncer model. METHODS We compared several CTC and MRC strategies with 5- or 10-yearly screening intervals with no screening, 10-yearly colonoscopy screening and biennial faecal immunochemical test (FIT) screening. We assumed trial-based participation rates in the base-case analyses and varied the rates in sensitivity analyses. Incremental lifetime costs and health effects were estimated from a healthcare perspective. RESULTS The health gain of CTC and MRC was similar and ranged from 0.031 to 0.048 life-year gained compared with no screening, for 2-5 screening rounds. Lifetime costs per person for MRC strategies were €60-110 higher than those for CTC strategies with an equal number of screening rounds. All imaging-based strategies were cost-effective compared with no screening. FIT screening was the dominant screening strategy, leading to most LYG and highest cost-savings. Compared with three rounds of colonoscopy screening, CTC with five rounds was found to be cost-effective in an incremental analysis of imaging strategies. Assumptions on screening participation have a major influence on the ordering of strategies in terms of costs and effects. CONCLUSION CTC and MRC have potential for CRC screening, compared with no screening and compared with three rounds of 10-yearly colonoscopy screening. When taking FIT screening as the reference, imaging is not cost-effective. Participation is an important driver of effectiveness and cost estimates. ADVANCES IN KNOWLEDGE This is the first study to assess the cost-effectiveness of MRC screening for CRC.
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Affiliation(s)
- Marjolein J E Greuter
- 1 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Johannes Berkhof
- 1 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Remond J A Fijneman
- 2 Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Erhan Demirel
- 1 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Jie-Bin Lew
- 3 Cancer Research Division, Cancer Council NSW, NSW, Australia
| | - Gerrit A Meijer
- 2 Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Jaap Stoker
- 4 Department of Radiology, Academic Medical Center, Amsterdam, Netherlands
| | - Veerle M H Coupé
- 1 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
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Abstract
Introduction Computer tomography colonoscopy (CTC) is an increasingly prevalent procedure for the investigation of colorectal symptoms, or as a component of colorectal cancer screening. It is considered a low risk procedure, however colonic perforation is a recognized significant complication. Case Report We report the case of an 81-year-old female patient who underwent CTC after failed optical colonoscopy as part of routine colorectal cancer screening. Perforation of the rectum with surrounding pararectal air was confirmed on CTC. The patient had minimal symptoms and was treated successful non-operatively with bowel rest and antibiotics. Conclusion Perforation sustained during CTC is an uncommon complication. The incidence of perforation during CTC is still lower than that during optical colonoscopy. In the absence of significant abdominal signs and symptoms, this rare complication may be successfully managed non-operatively.
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Affiliation(s)
| | - Yasser Arafat
- Department of Surgery, Caboolture Hospital, Caboolture, Australia
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Lara LF, Avalos D, Huynh H, Jimenez-Cantisano B, Padron M, Pimentel R, Erim T, Schneider A, Ukleja A, Parlade A, Castro F. The safety of same-day CT colonography following incomplete colonoscopy with polypectomy. United European Gastroenterol J 2015; 3:358-63. [PMID: 26279844 DOI: 10.1177/2050640615577881] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/24/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Concerns about the risk of bowel perforation for same-day computed tomography colonography (CTC) following an incomplete colonoscopy with polypectomy may lead to unnecessarily postponing the CTC. OBJECTIVE The objective of this article is to describe the complications including colon perforations associated with same-day CTC in a cohort who had polypectomies but an incomplete colonoscopy. DESIGN We conducted a retrospective study. SETTING Our study took place in a single, tertiary referral center. PATIENTS We studied consecutive patients who had CTC the same day as an incomplete colonoscopy with polypectomy. INTERVENTIONS Interventions included optical colonoscopy (OC), endoscopic polypectomies, and same-day CTC. MAIN OUTCOME MEASUREMENTS Our main outcome measurements included perforation rate with long-term follow-up. RESULTS A total of 3% of patients undergoing colonoscopy from January 2008 to December 2012 had same-day CTC following incomplete OC, and 72 polypectomies were performed in 34 (or 17%) of these patients. Incomplete colonoscopies were due to colon tortuosity and looping (25), severe angulations (five), colon mass (two), colon stenosis (one), bradycardia (one). Fifty-three percent of the OCs were screening for colon neoplasia, 29% diagnostic and 18% were surveillance of colon polyps. Most polyps were ≤ 5 mm, and found in the left colon. There were no reported complications or perforations associated with same-day CTCs during short- and long-term follow-up. LIMITATIONS Limitations of our analysis included retrospective single-center design, small number of patients for the occurrence, referral to same-day CTC was not standardized, inability to establish safety of CTC for specific scenarios such as after complex polypectomies, strictures, or advanced IBD. CONCLUSIONS Radiologists' apprehension to perform a CTC the same day as an incomplete colonoscopy following polypectomies because of perceived risk of perforation may be unfounded. More data are needed to determine the safety of same-day CTC in patients with high-risk findings during colonoscopy such as a stricture, severe IBD, and after complex polypectomies.
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Kato T, Muroya T, Goda T, Takabayashi K, Sasaki K, Takahashi T, Horita S. Iatrogenic Colonic Perforation due to Computed Tomographic Colonography. Case Rep Gastroenterol 2015; 9:171-8. [PMID: 26120298 PMCID: PMC4478309 DOI: 10.1159/000430947] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Although the complications of computed tomographic colonography (CTC) are very rare, CTC is associated with potential risk of colonic perforation. In the present report we describe two cases of colonic perforation secondary to CTC. In the first case with ascending colonic carcinoma, insertion of a rigid double-balloon catheter caused direct rectal wall perforation. In the second case with obstructive colonic carcinoma, pneumoperitoneum developed due to automated carbon dioxide insufflation. Both patients were asymptomatic after examination and recovered without any complications. Based on the findings of the current cases, we recommend that a soft-tip catheter be used for CTC, and suggest that colonic perforation can occur even with automatic insufflation, depending on patient characteristics.
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Affiliation(s)
- Takashi Kato
- Departments of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan
| | - Tsukasa Muroya
- Departments of Radiology, Ishikari Hospital, Ishikari, Japan
| | - Takayuki Goda
- Departments of Gastroenterology, Ishikari Hospital, Ishikari, Japan
| | - Ken Takabayashi
- Departments of Radiology, Hokkaido Gastroenterology Hospital, Sapporo, Japan
| | - Kiyotaka Sasaki
- Departments of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan
| | - Toshiyuki Takahashi
- Departments of Pathology, Hokkaido Gastroenterology Hospital, Sapporo, Japan
| | - Shoichi Horita
- Departments of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan
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Non- or full-laxative CT colonography vs. endoscopic tests for colorectal cancer screening: a randomised survey comparing public perceptions and intentions to undergo testing. Eur Radiol 2014; 24:1477-86. [PMID: 24817084 PMCID: PMC4046085 DOI: 10.1007/s00330-014-3187-9] [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] [Received: 01/27/2014] [Revised: 03/14/2014] [Accepted: 04/10/2014] [Indexed: 12/17/2022]
Abstract
Objectives Compare public perceptions and intentions to undergo colorectal cancer screening tests following detailed information regarding CT colonography (CTC; after non-laxative preparation or full-laxative preparation), optical colonoscopy (OC) or flexible sigmoidoscopy (FS). Methods A total of 3,100 invitees approaching screening age (45-54 years) were randomly allocated to receive detailed information on a single test and asked to return a questionnaire. Outcomes included perceptions of preparation and test tolerability, health benefits, sensitivity and specificity, and intention to undergo the test. Results Six hundred three invitees responded with valid questionnaire data. Non-laxative preparation was rated more positively than enema or full-laxative preparations [effect size (r) = 0.13 to 0.54; p < 0.0005 to 0.036]; both forms of CTC and FS were rated more positively than OC in terms of test experience (r = 0.26 to 0.28; all p-values < 0.0005). Perceptions of health benefits, sensitivity and specificity (p = 0.250 to 0.901), and intention to undergo the test (p = 0.213) did not differ between tests (n = 144-155 for each test). Conclusions Despite non-laxative CTC being rated more favourably, this study did not find evidence that offering it would lead to substantially higher uptake than full-laxative CTC or other methods. However, this study was limited by a lower than anticipated response rate. Key Points • Improving uptake of colorectal cancer screening tests could improve health benefits • Potential invitees rate CTC and flexible sigmoidoscopy more positively than colonoscopy • Non-laxative bowel preparation is rated better than enema or full-laxative preparations • These positive perceptions alone may not be sufficient to improve uptake • Health benefits and accuracy are rated similarly for preventative screening tests Electronic supplementary material The online version of this article (doi:10.1007/s00330-014-3187-9) contains supplementary material, which is available to authorized users.
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Bellini D, Rengo M, De Cecco CN, Iafrate F, Hassan C, Laghi A. Perforation rate in CT colonography: a systematic review of the literature and meta-analysis. Eur Radiol 2014; 24:1487-96. [PMID: 24816935 DOI: 10.1007/s00330-014-3190-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/05/2014] [Accepted: 04/15/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE The primary aim was to assess the perforation rate of CTC; the secondary aim was to identify potential clinical/technical predictors of this complication. METHODS Methods for analysis were based on PRISMA (preferred reporting items for systematic reviews and meta-analyses). From the selected studies, the rate of CTC perforation and patient/technical characteristics potentially associated with this event were extracted. Forest plots showing individual and pooled estimates of the perforation rate were obtained for all analyses. I(2) was used to evaluate heterogeneity between studies. RESULTS Eleven articles out of the 187 initially identified were selected for the analysis (103,399 patients). There were 29,048 (28%) asymptomatic individuals and 30,773 (30%) symptomatic patients; this characteristic was not reported in the remaining subjects (42%). Colon distension was obtained manually in 69,222 (67%) and using an automated carbon dioxide insufflator in 26,479 (26%) patients; in the remaining 7% of patients, this information was missing. Twenty-eight colonic perforations were reported, with the CTC perforation rate estimated to be 0.04% (95% CI. 0.00-0.10), 19-fold higher in symptomatic than in screening subjects (OR: 19.2, CI 3.3-108 and P = 0.001). The surgical rate was 0.008%. No CTC-related deaths were reported. CONCLUSIONS The perforation rate in CTC is very low, particularly considering asymptomatic individuals. KEY POINTS • This is the first meta-analysis on this topic, based on 100,000 patients. • The CTC-related colorectal perforation rate is 0.04%, 0.02% in asymptomatic subjects. • The CTC-induced surgery rate is 0.008% (1:12,500). • The perforation rate in CTC is low, particularly in average-risk, asymptomatic individuals.
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Affiliation(s)
- Davide Bellini
- Department of Radiological Sciences, Oncology and Pathology, "Sapienza" University of Rome, ICOT Hospital, Via Franco Faggiana 34, 04100, Latina, Italy,
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Hong N, Park SH. CT colonography in the diagnosis and management of colorectal cancer: Emphasis on pre- and post-surgical evaluation. World J Gastroenterol 2014; 20:2014-2022. [PMID: 24587676 PMCID: PMC3934471 DOI: 10.3748/wjg.v20.i8.2014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 12/05/2013] [Accepted: 01/15/2014] [Indexed: 02/06/2023] Open
Abstract
This article addresses the use of computed tomographic colonography (CTC) for the diagnosis and management of colorectal cancer, focusing on presurgical evaluation of the colon proximal to an occlusive cancer and surveillance after cancer resection surgery. The key evidences accumulated in the literature and future work needed are summarized. CTC is a technically robust and the most practical method to evaluate the colon proximal to an occlusive cancer, which prevents colonoscopic examination past the occlusion, either before or after metallic stent placement. The high sensitivity of CTC for detecting cancers and advanced adenomas in the proximal colon can help prevent additional surgical procedures in patients showing negative results. However, the accuracy of CTC for distinguishing intramural cancers from adenomas is low, and the technique is limited in guiding management when a medium-sized lesion that do not show invasive features such as pericolic extension or nodal metastasis is found in the proximal colon. A maximal diameter ≥ 15 mm has been proposed as a criterion for surgical removal of proximal lesions. However, this needs to be verified in a larger cohort. In addition, the influence of presurgical CTC results on the current post-cancer resection colonic surveillance timeline remains to be determined. CTC can be readily added to the routine abdominopelvic CT in the form of contrast-enhanced CTC, which can serve as an effective stand-alone tool for post-cancer resection surveillance of both the colorectum and extracolonic organs. Although the accuracy of CTC has been demonstrated, its role in the current colonoscopy-based postoperative colonic surveillance protocols remains to be determined. Readers of CTC also need to be knowledgeable on the colonic lesions that are unique to the postoperative colon.
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Computed tomography colonography technique: the role of intracolonic gas volume. Radiol Res Pract 2013; 2013:517246. [PMID: 24455246 PMCID: PMC3880765 DOI: 10.1155/2013/517246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 11/29/2013] [Indexed: 01/22/2023] Open
Abstract
Introduction. Poor distention decreases the sensitivity and specificity of CTC. The total volume of gas administered will vary according to many factors. We aim to determine the relationship between the volume of retained gas at the time of image acquisition and colonic distention and specifically the presence of collapsed bowel segments at CTC.
Materials and Methods. All patients who underwent CTC over a 12-month period at a single institution were included in the study. Colonic luminal distention was objectively scored by 2 radiologists using an established 4-point scale. Quantitative analysis of the volume of retained gas at the time of image acquisition was conducted using the threshold 3D region growing function of OsiriX. Results. 108 patients were included for volumetric analysis. Mean retained gas volume was 3.3 L. 35% (38/108) of patients had at least one collapsed colonic segment. Significantly lower gas volumes were observed in the patients with collapsed colonic segments when compared with those with fully distended colons 2.6 L versus 3.5 L (P = 0.031). Retained volumes were significantly higher for the 78% of patients with ileocecal reflux at 3.4 L versus 2.6 L without ileocecal reflux (P = 0.014). Conclusion. Estimation of intraluminal gas volume at CTC is feasible using image segmentation and thresholding tools. An average of 3.5 L of retained gas was found in diagnostically adequate CTC studies with significantly lower mean gas volume observed in patients with collapsed colonic segments.
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The Challenges of CT Colonography Reimbursement. J Am Coll Radiol 2013; 10:937-42. [DOI: 10.1016/j.jacr.2013.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 09/13/2013] [Indexed: 12/21/2022]
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Iafrate F, Iussich G, Correale L, Hassan C, Regge D, Neri E, Baldassari P, Ciolina M, Pichi A, Iannitti M, Diacinti D, Laghi A. Adverse events of computed tomography colonography: an Italian National Survey. Dig Liver Dis 2013; 45:645-50. [PMID: 23643567 DOI: 10.1016/j.dld.2013.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 02/19/2013] [Accepted: 02/27/2013] [Indexed: 02/06/2023]
Abstract
AIM To retrospectively study the frequency and magnitude of complications associated with computed tomography (CT) colonography in clinical practice. METHODS A questionnaire on complications of CT colonography was sent to Italian public radiology departments identified as practicing CT colonography with a reasonable level of training. The frequency of complications and possible risk factors were retrospectively determined. Responses were collated and row frequencies determined. A multivariate analysis of the factors causing adverse events was also performed. RESULTS 40,121 examinations were performed in13 centers during the study period. No deaths were reported. Bowel perforations occurred in 0.02% (7 exams). All perforations were asymptomatic and occurred in patients undergoing manual insufflation. Five perforations (71%) occurred in procedures performed following a recent colonoscopy. There was no significant difference between perforations associated with rectal balloon (0.017%) and those that were not (0.02%). Complications related to vasovagal reaction (either with or without spasmolytic) occurred in 0.16% (63 exams). All vasovagal reactions resolved in less than 3h, without any sequelae. CONCLUSIONS Perforation rate at CT colonography in Italy is comparable with elsewhere in the world, occurring regardless of the experience of radiology centers. Although the risk is very small, it may not be negligible when compared with the risk of diagnostic colonoscopy.
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Affiliation(s)
- Franco Iafrate
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
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Pendsé DA, Taylor SA. Complications of CT colonography: a review. Eur J Radiol 2012; 82:1159-65. [PMID: 22595505 DOI: 10.1016/j.ejrad.2012.04.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 04/04/2012] [Indexed: 12/23/2022]
Abstract
Since its inception, one of the main advantages of computed tomography colonography (CTC) over colonoscopy has been its assumed superior safety profile. However CTC is not without complication and adverse events are well described. Although the risks of insufflation, bowel preparation, contrast media and radiation dose are very small, they are not insignificant. This review discusses the potential hazards and complications associated with the technique, and discuss precautions, which may lessen the risk of occurrence.
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Affiliation(s)
- D A Pendsé
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, UK.
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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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