1
|
Hsu WF, Su CW, Hsu CY, Yen AMF, Chen SLS, Chiu SYH, Lee YC, Hsu TH, Lin LJ, Chia SL, Wu MS, Chen HH, Chiu HM. Double-contrast barium enema is no longer justified as a backup examination for colonoscopy in the population screening program: Population study in an organized fecal immunochemical test-based screening program. J Gastroenterol Hepatol 2023; 38:1299-1306. [PMID: 37078599 DOI: 10.1111/jgh.16191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/12/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND AND AIM Currently, some countries still acknowledge double-contrast barium enema (DCBE) as a backup confirmatory examination when colonoscopy is not feasible or incomplete in colorectal cancer (CRC) screening programs. This study aims to compare the performance of colonoscopy and DCBE in terms of the risk of incident CRC after negative results in the fecal immunochemical test (FIT)-based Taiwan Colorectal Cancer Screening Program. METHODS Subjects who had positive FITs and received confirmatory exams, either colonoscopy or DCBE, without the findings of neoplastic lesions from 2004 to 2013 in the screening program comprised the study cohort. Both the colonoscopy and DCBE subcohorts were followed until the end of 2018 and linked to the Taiwan Cancer Registry to identify incident CRC cases. Multivariate analysis was conducted to compare the risk of incident CRC in both subcohorts after controlling for potential confounders. RESULTS A total of 102 761 colonoscopies and 5885 DCBEs were performed after positive FITs without neoplastic findings during the study period. By the end of 2018, 2113 CRCs (2.7 per 1000 person-years) and 368 CRCs (7.6 per 1000 person-years) occurred in the colonoscopy and DCBE subcohorts, respectively. After adjusting for major confounders, DCBE had a significantly higher risk of incident CRC than colonoscopy, with an adjusted HR of 2.81 (95% CI = 2.51-3.14). CONCLUSIONS In the FIT screening program, using DCBE as a backup examination was associated with a nearly threefold risk of incident CRC compared with colonoscopy, demonstrating that it is no longer justified as a backup examination for incomplete colonoscopy.
Collapse
Affiliation(s)
- Wen-Feng Hsu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chiu-Wen Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Yang Hsu
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan
| | - Yi-Chia Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsui-Hsia Hsu
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Li-Ju Lin
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Shu-Li Chia
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
2
|
Kawasaki K, Nakamura S, Eizuka M, Tanaka Y, Kumei T, Yanai S, Toya Y, Urushikubo J, Torisu T, Moriyama T, Umeno J, Sugai T, Matsumoto T. Is barium enema examination negligible for the management of colorectal cancer? Comparison with conventional colonoscopy and magnifying colonoscopy. Jpn J Radiol 2021; 39:1159-1167. [PMID: 34164768 DOI: 10.1007/s11604-021-01157-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/12/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this investigation was to evaluate the clinical value of barium enema (BE) examination for the management of colorectal epithelial neoplasms. METHODS We reviewed the colonoscopy records at our institution from 2014 to 2019 and identified cases of endoscopically or surgically resected colorectal epithelial neoplasms evaluated by BE, conventional colonoscopy, magnifying narrow-band imaging colonoscopy (M-NBI), and magnifying chromoendoscopy (MCE). The yield of each modality for the diagnosis of massively submucosal invasive (mSM) colorectal cancer was evaluated by a receiver-operating characteristic analysis including the area under the curve (AUC). RESULTS We analyzed the records of 105 patients (17 adenomas, 53 high-grade dysplasias (HGDs), and 35 cancers). Smooth surface, irregularity in depression, and eccentric deformity on the profile view with BE were observed more frequently in mSM cancers than adenomas/HGDs/slightly submucosal invasive cancers (p < 0.01). The AUC of BE was 0.8355, the value of which was not different from the other three modalities (conventional colonoscopy 0.7678; M-NBI 0.7835; MCE 0.8376). Although the specificity, PPV, and accuracy of BE were lower than those of M-NBI and MCE, the sensitivity and NPV of BE were the highest among the four types of examinations. CONCLUSION BE is still available and may serve as a supplementary modality for the diagnosis of mSM cancers.
Collapse
Affiliation(s)
- Keisuke Kawasaki
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan. .,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Shotaro Nakamura
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Makoto Eizuka
- Department of Diagnostic Pathology, Iwate Medical University, Yahaba, Japan
| | - Yoshihito Tanaka
- Department of Diagnostic Pathology, Iwate Medical University, Yahaba, Japan
| | - Tomo Kumei
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Shunichi Yanai
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Yosuke Toya
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Jun Urushikubo
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Takehiro Torisu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohiko Moriyama
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junji Umeno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tamotsu Sugai
- Department of Diagnostic Pathology, Iwate Medical University, Yahaba, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| |
Collapse
|
3
|
Screening computed tomography colonography with 256-slice scanning: should patient radiation burden and associated cancer risk constitute a major concern? Invest Radiol 2012; 47:451-6. [PMID: 22766908 DOI: 10.1097/rli.0b013e318250a58c] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of this study was to determine the radiation burden and the lifetime attributable risk (LAR) of radiation-induced cancer in patients undergoing screening 256-slice computed tomography colonography (CTC) and compare CTC-related radiogenic risks to corresponding nominal lifetime intrinsic risk of cancer. MATERIALS AND METHODS A Monte Carlo simulation software dedicated for computed tomography (CT) dosimetry was used to determine absorbed doses to primarily exposed radiosensitive organs of 31 women and 29 men subjected to screening CTC on a 256-slice CT scanner. Effective dose was estimated from (a) organ dose data and (b) dose-length product. Organ-specific and total LARs of cancer were estimated using published risk factors. Cumulative LARs from repeated CTC studies on individuals participating in a colorectal cancer screening program were compared with corresponding lifetime intrinsic risks. RESULTS The mean organ dose-derived effective dose was estimated to be 2.92 and 2.61 mSv for female and male individuals, respectively. The dose-length product method was found to overestimate effective dose from CTC by 26% and 13% in female and male individuals, respectively. Compared with previously published results for 64-slice CT scanners, 256-slice CTC was found to be associated with up to 45% less radiation burden. The cumulative LAR of radiation-induced cancer from repeated quinquennial screening CTC studies between the ages of 50 and 80 years was estimated to increase the lifetime intrinsic risk of cancer by less than 0.2%. CONCLUSION The level of patient radiation burden and theoretical radiogenic cancer risks associated with screening CTC performed using modern low-dose protocols and techniques may not justify disapproval of CTC as a mass screening tool.
Collapse
|
4
|
Chang ML, Hou JK. Cancer risk related to gastrointestinal diagnostic radiation exposure. Curr Gastroenterol Rep 2011; 13:449-457. [PMID: 21833692 DOI: 10.1007/s11894-011-0214-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Exposure to ionizing radiation is associated with an increased risk of cancer. With the growing use of diagnostic imaging studies, there is concern for increasing the risk of radiation associated malignancy of the gastrointestinal tract. The purpose of this review is to summarize the existing literature for risk of gastrointestinal malignancy after ionizing radiation exposure from diagnostic imaging studies. Estimates of organ specific effective doses of radiation vary widely based on the method of measurement and patient factors. Most of the current data are based on calculations of organ effective doses from anthropomorphic phantoms and estimated cancer risk based on radiation exposure from environmental sources. Radiation associated cancer risk is dependent on both the cumulative radiation dose and the radiosensitivity of the particular organ. The majority of radiation exposure and risk associated with gastrointestinal malignancy comes from CT scans, especially of the abdomen/pelvis. Of the abdominal organs, the colon carries the highest lifetime attributable risk of radiation associated malignancy. The attributable risk of malignancy for an individual diagnostic imaging study is low, but measurable, and therefore imaging studies without radiation such as MRI and ultrasound should be considered, especially in patients who require repeated imaging studies. There is a shortage of epidemiological data and an absence of prospective data with adequate follow-up to describe accurate risk estimates of gastrointestinal cancers after diagnostic imaging. More studies are needed to better determine the risks of malignancy from diagnostic imaging.
Collapse
Affiliation(s)
- Mimi L Chang
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, 1709 Dryden Road, Suite 8.40, MS: BCM 620, Houston, TX 77030, USA
| | | |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
|
7
|
Neri E, Faggioni L, Cerri F, Turini F, Angeli S, Cini L, Perrone F, Paolicchi F, Bartolozzi C. CT colonography versus double-contrast barium enema for screening of colorectal cancer: comparison of radiation burden. ACTA ACUST UNITED AC 2009; 35:596-601. [PMID: 19777290 DOI: 10.1007/s00261-009-9568-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Accepted: 08/20/2009] [Indexed: 12/18/2022]
Abstract
Our aim is to compare the radiation dose associated with a low-dose CT colonography (CTC) protocol for colorectal cancer screening with that delivered by double-contrast barium enema (DCBE). CTC of twenty asymptomatic individuals (M:F = 10:10) participating to a colorectal cancer screening program and DCBE of fifteen patients (M:F = 6:9) were evaluated. For CTC, absorbed dose was determined by calculating the dose-length product for each CTC examination from measurements on a CT dose phantom equipped with a CT ion chamber. For DCBE, the free-in-air Kerma at the patient's X-ray entry surface and the Kerma-area product during fluoroscopy and fluorography were measured with a Barracuda system, with fluoroscopy times being recorded blinded to the performing operator. Effective dose at CTC was 2.17 ± 0.12 mSv, with good and excellent image quality in 14/20 (70%) and 6/20 cases (30%), respectively. With DCBE, effective patient dose was 4.12 ± 0.17 mSv, 1.9 times greater than CTC (P < 0.0001). Our results show that effective dose from screening CTC is substantially lower than that from DCBE, suggesting that CTC is the radiological imaging technique of the large bowel with the lowest risk of stochastic radiation effects.
Collapse
Affiliation(s)
- Emanuele Neri
- Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa, 2, 56100, Pisa, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|