Accuracy of computed tomographic colonography in a nationwide multicentre trial, and its relation to radiologist expertise

Héresbach, D.; Djabbari, M.; Riou, Françoise; Marcus, C.; Sidaner, Anne Le; Pierredon-Foulogne, Marie-Ange; Ponchon, Thierry; Boudiaf, Mourad; Seyrig, Jacques‐Arnaud; Laumonier, H.; Luet, Dominique; Giraud-Cohen, M; Pelletier, Anne-Laure; Charachon, Antoine; Ramaholimihaso, Fidy; Bouillet, Philippe; Veyrac, M.; Ficarelli, S.; Vahedi, Kouroche; Keruhel, J; Lamouliatte, H; Ridereau-Zins, C.; Bouhnik, Yoram; Tissier, Mathilde L.; Diris, B.; Zagdanski, A M; Josselin, Jean‐Michel; Hamonic, Stéphanie; Gandon, Y.

doi:10.1136/gut.2010.225623

Cited by 46 publications

(41 citation statements)

References 43 publications

(45 reference statements)

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“…Although the sensitivity of CT colonography for 6-9-mm polyps appeared to be higher than 85%-similar to the sensitivity of colonoscopy for such lesions-in studies performed in dedicated centers (5-8), it has been substantially lower in multicenter trials, ranging between 59% and 78% (5,6,9). Despite the fact that 6-9-mm polyps represent only a minor fraction of all the advanced neoplasia (,10%) present in screening population compared with lesions that are 10 mm or larger, they are still regarded as a suitable target for CRC screening and diagnosis, because of their nonnegligible risk of high-grade dysplasia and/or villous component…”

Section: Study Design and Populationmentioning

confidence: 99%

“…CT colonography interpretation is time consuming (5)(6)(7)(8)(9), and therefore the involvement of an additional expert for double reading would not be cost effective (16). CAD could help reduce the frequency of false-negative studies at CT colonography and improve sensitivity, especially in the detection of subcentimetric lesions.…”

Section: Gastrointestinal Imaging: Efficacy Of Computer-aided Detectimentioning

confidence: 99%

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Efficacy of Computer-aided Detection as a Second Reader for 6–9-mm Lesions at CT Colonography: Multicenter Prospective Trial

Regge

Monica²,

Galatola

et al. 2013

Radiology

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efficacy of computer-aided Detection as a second reader for 6-9-mm lesions at cT colonography: Multicenter Prospective Trial 1 Purpose:To assess the effect of computer-aided detection (CAD) as a second reader on the sensitivity and specificity of computed tomographic (CT) colonography in detecting 6-9-mm colorectal cancer (CRC) lesions. Materials and Methods:Individuals with clinical indications for colonoscopy-either for symptoms or as part of participating in a surveillance program or CRC screening-were prospectively enrolled at one of 10 academic centers between July 2007 and May 2009. Institutional review board approval was obtained at each clinical site, and all participants provided written informed consent. All participants underwent CT colonography and colonoscopy on the same day. Experienced readers interpreted the CT colonography images unassisted and then reviewed all colorectal lesion-like structures pinpointed by the CAD algorithm. Segmental unblinding of CT colonoscopy findings at colonoscopy was utilized. The sensitivity and specificity of unassisted and CAD-assisted reading in identifying individuals with 6-9-mm lesions were calculated and compared by means of pairwise analysis. Results:A total of 618 participants (mean age, 57.9 years; 54.5% male) were included in the final analysis. Of these participants, 464 (75.1%) had no lesions 6 mm or larger, and 52 (8.4%) had 6-9-mm lesions. The sensitivity of CT colonography with unassisted reading and that with CADassisted reading in identifying individuals with 6-9-mm lesions was 65.4% (95% confidence interval [CI]: 50.9%, 78.0%) and 76.9% (95% CI: 63.2%, 87.5%; P = .016), respectively. No significant change in specificity was observed: The specificity of CT colonography with unassisted and that with CAD-assisted reading was 91.8% (95% CI: 88.9%, 94.1%) and 90.9% (95% CI: 88.0%, 93.4%; P = .063), respectively. Evaluation of CAD candidates required an additional 1.6 minutes (25th-75th percentile: 1.0 minute to 3.4 minutes). Conclusion:The addition of CAD to reading performed by experienced readers resulted in a significant benefit in the detection of 6-9-mm polyps at CT colonography in this cohort.q RSNA, 2012 Supplemental material: http://radiology.rsna.org/lookup /suppl

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Section: Study Design and Populationmentioning

confidence: 99%

Section: Gastrointestinal Imaging: Efficacy Of Computer-aided Detectimentioning

confidence: 99%

Efficacy of Computer-aided Detection as a Second Reader for 6–9-mm Lesions at CT Colonography: Multicenter Prospective Trial

Regge

Monica²,

Galatola

et al. 2013

Radiology

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“…Two of these articles reported different primary outcome measures for the same patient cohort [26,27]. All four studies were performed in Europe: One in the Netherlands [26,27], one in Italy [29], one in France [30] and one international study in Italy and Belgium [28]. The Italian study was from a single centre, the Netherlands study used two centres, the French study used 26 centres and the international study used 21 centres initially, although only 12 contributed patients to the final analysis.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Five articles were included, reporting four distinct studies [26][27][28][29][30]. Two of these articles reported different primary outcome measures for the same patient cohort [26,27].…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Sensitivity and specificity of CT colonography for the detection of colonic neoplasia after positive faecal occult blood testing: systematic review and meta-analysis

et al. 2014

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Sensitivity and specificity of CT colonography for the detection of colonic neoplasia after positive faecal occult blood testing: Systematic review and meta-analysis. European Radiology, 24 (5) 1049 -1058. 10.1007/s00330-014-3106-0 Article Sensitivity and specificity of CTC for the detection of colonic neoplasia after positive fecal occult blood testing: Systematic review and meta-analysis Abstract Objective: CT colonography (CTC) is recommended after positive fecal occult blood testing (FOBt) when colonoscopy is incomplete or infeasible. We aimed to estimate the sensitivity and specificity of CTC for colorectal cancer and adenomatous polyps following positive FOBt via systematic review. Methods:The MEDLINE, EMBASE, AMED and Cochrane Library databases were searched for CTC studies reporting sensitivity and specificity for colorectal cancer and adenomatous polyps. Included subjects had tested FOBt-positive by guaiac or immunochemical methods. Per-patient detection rates were summarized via forest plots. Meta-analysis of sensitivity and specificity was conducted using a bivariate random effects model and the average operating point calculated.Results: Of 538 articles considered, 5 met inclusion criteria, describing results from 622 patients. Research study quality was good. CTC had a high per-patient average sensitivity of 88.8% (95%CI 83.6 to 92.5%) for ≥6mm adenomas or colorectal cancer, with low betweenstudy heterogeneity. Specificity was both more heterogeneous and lower, at an average of 75.4% (95%CI 58.6 to 86.8%). Conclusion:Few studies have investigated CTC in FOBt-positive individuals. CTC is sensitive at a ≥6mm threshold but specificity is lower and variable. Despite the limited data, these results suggest CTC may adequately substitute for colonoscopy when the latter is undesirable.Keywords CT colonography, Colorectal Neoplasms, Screening, Occult blood, Review, Systematic Key points Faecal occult blood testing is the commonest mass-screening test for colorectal cancer.  Few studies specifically evaluate CT colonography after positive faecal occult blood testing.  CTC is approximately 89% sensitive for ≥6mm adenomas/cancer in this setting.  Specificity is lower, at approximately 75%, and more variable.  CT colonography is a good alternative when colonoscopy is undesirable.Abbreviations CAD = computer assisted detection CTC = computed tomographic colonography CRC = colorectal cancer gFOBt = guaiac faecal occult blood test 2 FIT = faecal immunochemical test NPV = negative predictive value PPV = positive predictive value QUADAS-2 = quality assessment of diagnostic accuracy studies, second revision

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“…In the case of colonography, CAD systems have shown high sensitivity and specificity for the detection of colonic polyps. 3,[12][13][14][15][16][17][18][19][20][21][22]35 It has been shown that the use of second-read CAD significantly improves polyp detection. 22 While CAD systems for colonography get increasing popularity and endorsement from the radiological community, they have not been designed to cope with the presence of stool, although labeling the stool with high contrast agents replaces the use of laxatives and reduces patient discomfort.…”

Section: Introductionmentioning

confidence: 99%

Automated image‐based colon cleansing for laxative‐free CT colonography computer‐aided polyp detection

et al. 2011

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Purpose: To evaluate the performance of a computer-aided detection (CAD) system for detecting colonic polyps at noncathartic computed tomography colonography (CTC) in conjunction with an automated image-based colon cleansing algorithm. Methods: An automated colon cleansing algorithm was designed to detect and subtract taggedstool, accounting for heterogeneity and poor tagging, to be used in conjunction with a colon CAD system. The method is locally adaptive and combines intensity, shape, and texture analysis with probabilistic optimization. CTC data from cathartic-free bowel preparation were acquired for testing and training the parameters. Patients underwent various colonic preparations with barium or Gastroview in divided doses over 48 h before scanning. No laxatives were administered and no dietary modifications were required. Cases were selected from a polyp-enriched cohort and included scans in which at least 90% of the solid stool was visually estimated to be tagged and each colonic segment was distended in either the prone or supine view. The CAD system was run comparatively with and without the stool subtraction algorithm. Results: The dataset comprised 38 CTC scans from prone and/or supine scans of 19 patients containing 44 polyps larger than 10 mm (22 unique polyps, if matched between prone and supine scans). The results are robust on fine details around folds, thin-stool linings on the colonic wall, near polyps and in large fluid/stool pools. The sensitivity of the CAD system is 70.5% per polyp at a rate of 5.75 false positives/scan without using the stool subtraction module. This detection improved significantly (p ¼ 0.009) after automated colon cleansing on cathartic-free data to 86.4% true positive rate at 5.75 false positives/scan. Conclusions: An automated image-based colon cleansing algorithm designed to overcome the challenges of the noncathartic colon significantly improves the sensitivity of colon CAD by approximately 15%.

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Accuracy of computed tomographic colonography in a nationwide multicentre trial, and its relation to radiologist expertise

Abstract: Radiologist sensitivity CTC for detection of polyps ≥ 6 mm in training was the sole independent predictor for subsequent sensitivity in detection of such polyps.

Cited by 46 publications

References 43 publications

Efficacy of Computer-aided Detection as a Second Reader for 6–9-mm Lesions at CT Colonography: Multicenter Prospective Trial

Efficacy of Computer-aided Detection as a Second Reader for 6–9-mm Lesions at CT Colonography: Multicenter Prospective Trial

Sensitivity and specificity of CT colonography for the detection of colonic neoplasia after positive faecal occult blood testing: systematic review and meta-analysis

Automated image‐based colon cleansing for laxative‐free CT colonography computer‐aided polyp detection

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