CT colonography without cathartic preparation: positive predictive value and patient experience in clinical practice

Zueco, C. Zueco; Sampedro, Carolina Sobrido; Corroto, Juan D.; Fernández, Paula Rodríguez; Fontanillo, Manuela Fontanillo

doi:10.1007/s00330-011-2367-0

Cited by 26 publications

(16 citation statements)

References 40 publications

(69 reference statements)

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“…Low specificities may partly reflect the high prevalence of abnormality in the gFOBt/FIT positive population, potentially leading radiologists to report equivocal findings as positive (to maximise sensitivity). Furthermore, the minimum level of radiologist experience (50 to 100 cases) was substantially lower than the studies reporting high PPV (minimum 300 cases) [33,34]. Additionally, faecal tagging was not used in the study with the lowest specificity [29], which reported that most of the false-positives were due to faecal residue.…”

Section: Discussionmentioning

confidence: 63%

See 1 more Smart Citation

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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Section: Discussionmentioning

confidence: 63%

“…Specificity and PPV were less good, with the latter ranging from 62 to 88%, somewhat lower than the 92-93% reported when CTC is used for asymptomatic screenees [33,34]. The pooled estimate of specificity was 75.4%, although heterogeneity was high.…”

Section: Discussionmentioning

confidence: 77%

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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“…What can be assessed are the true-positive versus false-positive studies, allowing for determination of positive predictive value (PPV), which serves as an important quality measure in clinical practice. 7,8 In our experience, the PPV for lesions ≥ 6 mm should be generally be above 90% at CTC in routine clinical practice. 7 The true-positive results from CTC also be used to compare against the expected prevalence of disease (eg, for advanced neoplasia).…”

Section: Clinical Trial Versus Clinical Practice Settingmentioning

confidence: 74%

Missed lesions at CT colonography: lessons learned

Pickhardt

2012

Abdom Imaging

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Misinterpretation at CT colonography (CTC) can result in either a colorectal lesion being missed (false negative) or a false-positive diagnosis. This review will largely focus on potential missed lesions – and ways to avoid such misses. The general causes of false-negative interpretation at CTC can be broadly characterized and grouped into discrete categories related to suboptimal study technique, specific lesion characteristics, anatomic location, and imaging artifacts. Overlapping causes further increase the likelihood of missing a clinically relevant lesion. In the end, if the technical factors of bowel preparation, colonic distention, and robust CTC software are adequately addressed on a consistent basis, and the reader is aware of all the potential pitfalls at CTC, important lesions will seldom be missed.

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“…One useful feature at CTC that likely improves detection of flat lesions is the tendency for oral contrast to adhere to their surface. As noted above, the PPV for flat lesions detected at CTC is considerably lower [14,15], which likely reflects a combination of over-calling (i.e., CTC false positives) and lesions missed at optical colonoscopy (i.e., colonoscopic false negatives). Carpet lesions, also referred to as ‘laterally spreading tumors’, are large (≥ 3 cm) flat lesions that are most often found in the cecum and rectum.…”

Section: Other Computed Tomography Colonography Performance Datamentioning

confidence: 99%

“…Recent noteworthy advances in CTC technique include new data on noncathartic bowel preparations [15,21 ▪▪ ,23 ▪▪ ] and computer-aided detection (CAD) [24,25]. Potential benefits of noncathartic or laxative-free CTC include improved patient acceptance and adherence, but these must be weighed against the potential disadvantages, which include the inability for same-day polypectomy and reduced accuracy.…”

Section: Technical Advancesmentioning

confidence: 99%

Computed tomography colonography

Pickhardt

2013

Current Opinion in Gastroenterology

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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.

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CT colonography without cathartic preparation: positive predictive value and patient experience in clinical practice

Abstract: • Computed tomographic colonography (CTC) without cathartic preparation is well accepted by patients • Cathartic-free faecal tagging CTC yields high positive predictive values • CTC without cathartic preparation could improve uptake of colorectal cancer screening.

Cited by 26 publications

References 40 publications

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

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

Missed lesions at CT colonography: lessons learned

Computed tomography colonography

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