Computed Tomographic Virtual Colonoscopy to Screen for Colorectal Neoplasia in Asymptomatic Adults

Pickhardt, Perry J.; Choi, Jeewook; Hwang, Inku; Butler, James A.; Puckett, Michael L.; Hildebrandt, Hans A.; Wong, Roy K.H.; Nugent, Pamela A.; Mysliwiec, Pauline A.; Schindler, William R.

doi:10.1056/nejmoa031618

Cited by 1,814 publications

(1,252 citation statements)

References 28 publications

Supporting

Mentioning

1,141

Contrasting

Unclassified

Order By: Relevance

“…Our results are consistent with much of the previously published literature [3][4][5][6][7][8][9][10][11][12][13][14][15][20][21][22][23][24][25][26][27] , particularly reports from the last 10 years ( Table 2). As noted earlier, the trends toward decreasing prevalence rates of cancer in small and diminutive polyps may reflect the improved imaging capabilities of colonoscopes, and increasing emphasis on identification of flat lesions which do not increase the risk of cancer compared to polypoid lesions [16][17][18] .…”

supporting

confidence: 93%

“…The overall distribution of polyp sizes in this study suggests that the tendency of endoscopists in our unit is to underestimate polyp size, particularly since the percentage of all polyps < 1 cm in size was comparable to other studies [3][4][5][6][7][8][9][10][11][12][13][14][15][21][22][23][24][25][26][27] , despite our center receiving many referrals for large and complex polypectomies 28 . Further the fraction of polyps ≤ 5 mm and 6-9 mm in size was comparable to or higher than prior studies [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][22][23][24][25][26][27][28][29] .…”

supporting

confidence: 79%

“…Further the fraction of polyps ≤ 5 mm and 6-9 mm in size was comparable to or higher than prior studies [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][22][23][24][25][26][27][28][29] . Any underestimation of polyp size would tend to cause the apparent prevalence of cancer in polyps of different size ranges to increase.…”

supporting

confidence: 78%

See 2 more Smart Citations

Risk of cancer in small and diminutive colorectal polyps

Ponugoti

Cummings

Rex

2017

Digestive and Liver Disease

118

View full text Add to dashboard Cite

The prevalence of cancer in small and diminutive polyps is relevant to "resect and discard" and CT colonography reporting recommendations.We evaluated a prospectively collected colonoscopy polyp database to identify polyps < 10 mm and those with cancer or advanced histology (high-grade dysplasia or villous elements)Of 32,790 colonoscopies, 15,558 colonoscopies detected 42,630 polyps < 10 mm in size. A total of 4,790 lesions were excluded as they were not conventional adenomas or serrated class lesions.There were 23,524 conventional adenomas < 10 mm of which 22,952 were tubular adenomas.There were 14,316 serrated class lesions of which 13,589 were hyperplastic polyps and the remainder were sessile serrated polyps. Of all conventional adenomas, 96 had high-grade dysplasia including 0.3% of adenomas ≤ 5 mm in size and 0.8% of adenomas 6-9 mm in size. Of all conventional adenomas, 2.1% of those ≤ 5 mm in size and 5.6% of those 6-9 mm in size were advanced. Among 36,107 polyps ≤ 5 mm in size and 6,523 polyps 6-9 mm in size, there were no cancers.These results support the safety of resect and discard as well as current CT colonography reporting recommendations for small and diminutive polyps.

show abstract

supporting

confidence: 93%

supporting

confidence: 79%

See 1 more Smart Citation

Risk of cancer in small and diminutive colorectal polyps

Ponugoti

Cummings

Rex

2017

Digestive and Liver Disease

118

View full text Add to dashboard Cite

show abstract

“…This study was part of the original IRBapproved project and consent form that led to publication of Ref. 4 and the patient population is the same.…”

Section: Patient Populationmentioning

confidence: 99%

Computed Tomographic Virtual Colonoscopy Computer-Aided Polyp Detection in a Screening Population

et al. 2005

Self Cite

View full text Add to dashboard Cite

show abstract

“…Th e National Naval Medical Center in Bethesda, MD, has been instrumental in developing CTC as an eff ective screening tool (2) . Although all clinical CTC studies at this center continue to be interpreted by radiologists, a group of seven gastroenterologists and fellows participated in a retrospective reader study using a subset of CTC cases from the original Department of Defense (DoD) screening trial, the results of which are published in this issue of the American Journal of Gastroenterology (1) .…”

mentioning

confidence: 99%

CTC Interpretation by Gastroenterologists

Pickhardt

2009

American Journal of Gastroenterology

Self Cite

View full text Add to dashboard Cite

As shown by Young et al.(1) in this issue of the Americn Journal of Gastroenterology , adequate diagnostic performance in the interpretation of computed tomographic colonography (CTC) would appear to be achievable for a subset of gastroenterologists with a specifi c interest in colorectal screening. Although it is likely that some gastroenterologists will aspire to interpret CTC in clinical practice, there are a number of issues and circumstances that should fi rst be considered, as they may dampen this enthusiasm somewhat. In the end, quality assurance measures will help ensure adequate performance levels for CTC interpretation, whether read by radiologists or nonradiologists. This editorial commentary will review the relevant issues surrounding CTC interpretation by gastroenterologists. Am J Gastroenterol 2009; 104:2932 -2934 doi: 10.1038/ajg.2009 With proper technique and a robust 3D soft ware platform, some non-radiologists will demonstrate good performance results for computed tomographic colonography (CTC) interpretation in retrospective reader studies (1) . To be clear from the start, I have no fundamental objections to gastroenterologists reading CTC, and welcome any medical professional who is willing and able to provide reasonably accurate interpretations that are free of any secondary gain (e.g., from referral to colonoscopy). However, before gastroenterologists ponder the notion of abandoning their scopes to become, in eff ect, practicing radiologists, there are a number of confounding factors to consider that will likely dampen any initial enthusiasm.Th e National Naval Medical Center in Bethesda, MD, has been instrumental in developing CTC as an eff ective screening tool (2) . Although all clinical CTC studies at this center continue to be interpreted by radiologists, a group of seven gastroenterologists and fellows participated in a retrospective reader study using a subset of CTC cases from the original Department of Defense (DoD) screening trial, the results of which are published in this issue of the American Journal of Gastroenterology (1) . Using a robust CTC soft ware system highly capable of primary 3D evaluation (Viatronix V3D Colon), the reported results were mixed but generally showed good sensitivity for polyp detection, coupled with generally suboptimal specifi city for excluding polyps.I believe some caution is warranted before any comparisons with radiologist performance from the original trial are applied. For one, the current study appears to be considerably underpowered to exclude relevant diff erences (unfortunately, the actual data points are all missing -only the resulting percentages are reported). Furthermore, the polyp prevalence for lesions of relevant size was substantially enhanced for this retrospective study over the screening baseline, which will generally improve lesion detection even if the readers are unaware of the exact prevalence. In addition, formal CTC training was not available for the radiologists before commencing the prospective DoD screening tria...

show abstract

Computed Tomographic Virtual Colonoscopy to Screen for Colorectal Neoplasia in Asymptomatic Adults

Abstract: CT virtual colonoscopy with the use of a three-dimensional approach is an accurate screening method for the detection of colorectal neoplasia in asymptomatic average-risk adults and compares favorably with optical colonoscopy in terms of the detection of clinically relevant lesions.

Cited by 1,814 publications

References 28 publications

Risk of cancer in small and diminutive colorectal polyps

Risk of cancer in small and diminutive colorectal polyps

Computed Tomographic Virtual Colonoscopy Computer-Aided Polyp Detection in a Screening Population

CTC Interpretation by Gastroenterologists

Contact Info

Product

Resources

About