Extracolonic Findings on CT Colonography Increases Yield of Colorectal Cancer Screening

Veerappan, Ganesh R.; Ally, Mazer; Choi, Jeewook; Pak, Jennifer S.; Maydonovitch, Corinne; Wong, Roy K.H.

doi:10.2214/ajr.09.3779

Cited by 69 publications

(50 citation statements)

References 26 publications

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“…In common with researchers working in an asymptomatic setting, we found that the highest categories (E3, E4) were least frequently reported: a US screening study of 2277 patients found that 46% had at least one extracolonic finding, but this was rated as E3 or E4 in only 250 patients (11%). 43 The combined rate for E3 and E4 detections in our study was higher (21%), likely reflecting the symptomatic nature and greater age of our cohort.…”

Section: Extracolonic Findingsmentioning

confidence: 51%

“…In addition, the largest studies have been performed in asymptomatic individuals being screened for CRC. 42,43 Until now there has been no prospective, randomised study examining the consequences of detecting extracolonic lesions in symptomatic patients having CTC. We collected data on the frequency and nature of extracolonic pathology detected at CTC, subsequent investigations and resource use and ultimate clinical outcome.…”

Section: Introductionmentioning

confidence: 99%

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Computed tomographic colonography compared with colonoscopy or barium enema for diagnosis of colorectal cancer in older symptomatic patients: two multicentre randomised trials with economic evaluation (the SIGGAR trials)

Halligan

Dadswell

Wooldrage

et al. 2015

Health Technol Assess

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BackgroundComputed tomographic colonography (CTC) is a relatively new diagnostic test that may be superior to existing alternatives to investigate the large bowel.ObjectivesTo compare the diagnostic efficacy, acceptability, safety and cost-effectiveness of CTC with barium enema (BE) or colonoscopy.DesignParallel randomised trials: BE compared with CTC and colonoscopy compared with CTC (randomisation 2 : 1, respectively).SettingA total of 21 NHS hospitals.ParticipantsPatients aged ≥ 55 years with symptoms suggestive of colorectal cancer (CRC).InterventionsCTC, BE and colonoscopy.Main outcome measuresFor the trial of CTC compared with BE, the primary outcome was the detection rate of CRC and large polyps (≥ 10 mm), with the proportion of patients referred for additional colonic investigation as a secondary outcome. For the trial of CTC compared with colonoscopy, the primary outcome was the proportion of patients referred for additional colonic investigation, with the detection rate of CRC and large polyps as a secondary outcome. Secondary outcomes for both trials were miss rates for cancer (via registry data), all-cause mortality, serious adverse events, patient acceptability, extracolonic pathology and cost-effectiveness.ResultsA total of 8484 patients were registered and 5384 were randomised and analysed (BE trial: 2527 BE, 1277 CTC; colonoscopy trial: 1047 colonoscopy, 533 CTC). Detection rates in the BE trial were 7.3% (93/1277) for CTC, compared with 5.6% (141/2527) for BE (p = 0.0390). The difference was due to better detection of large polyps by CTC (3.6% vs. 2.2%;p = 0.0098), with no significant difference for cancer (3.7% vs. 3.4%;p = 0.66). Significantly more patients having CTC underwent additional investigation (23.5% vs. 18.3%;p = 0.0003). At the 3-year follow-up, the miss rate for CRC was 6.7% for CTC (three missed cancers) and 14.1% for BE (12 missed cancers). Significantly more patients randomised to CTC than to colonoscopy underwent additional investigation (30% vs. 8.2%;p < 0.0001). There was no significant difference in detection rates for cancer or large polyps (10.7% for CTC vs. 11.4% for colonoscopy;p = 0.69), with no difference when cancers (p = 0.94) and large polyps (p = 0.53) were analysed separately. At the 3-year follow-up, the miss rate for cancer was nil for colonoscopy and 3.4% for CTC (one missed cancer). Adverse events were uncommon for all procedures. In 1042 of 1748 (59.6%) CTC examinations, at least one extracolonic finding was reported, and this proportion increased with age (p < 0.0001). A total of 149 patients (8.5%) were subsequently investigated, and extracolonic neoplasia was diagnosed in 79 patients (4.5%) and malignancy in 29 (1.7%). In the short term, CTC was significantly more acceptable to patients than BE or colonoscopy. Total costs for CTC and colonoscopy were finely balanced, but CTC was associated with higher health-care costs than BE. The cost per large polyp or cancer detected was £4235 (95% confidence interval £395 to £9656).ConclusionsCTC is superior to BE for detection of cancers and large polyps in symptomatic patients. CTC and colonoscopy detect a similar proportion of large polyps and cancers and their costs are also similar. CTC precipitates significantly more additional investigations than either BE or colonoscopy, and evidence-based referral criteria are needed. Further work is recommended to clarify the extent to which patients initially referred for colonoscopy or BE undergo subsequent abdominopelvic imaging, for example by computed tomography, which will have a significant impact on health economic estimates.Trial registrationCurrent Controlled Trials ISRCTN95152621.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 54. See the NIHR Journals Library website for further project information. Funding was also provided by the UK Department of Health, which stipulated a randomised controlled design but had no involvement in the collection, analysis or interpretation of data, in writing the report, or in the decision to submit for publication. This was also the case for manufacturers who donated equipment for the study (Bracco UK Ltd, High Wycombe, UK; Viatronix Inc., Stony Brook, NY, USA; Medicsight plc, London, UK; Barco Ltd, Bracknell, UK).

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Section: Extracolonic Findingsmentioning

confidence: 51%

Section: Introductionmentioning

confidence: 99%

Computed tomographic colonography compared with colonoscopy or barium enema for diagnosis of colorectal cancer in older symptomatic patients: two multicentre randomised trials with economic evaluation (the SIGGAR trials)

Halligan

Dadswell

Wooldrage

et al. 2015

Health Technol Assess

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“…55 Because CT colonography produces CT images not only of the colon but also of the upper and lower abdomen, there is a chance that incidental extracolonic findings will be detected. The results of 11 CT colonography studies, where lesions outside the colon were mentioned, 37,40,44,47,[56][57][58][59][60][61][62][63] show that the rate of detection of extracolonic lesions in CT colonography ranges from 18 to 98% and that the incidence of lesions with 'high' clinical significance ranged from 2% to 35%. The incidence of clinically significant extracolonic lesions in the asymptomatic, average-risk population is approximately 4.5%.…”

Section: ) Ct Colonographymentioning

confidence: 99%

Korean Guidelines for Colorectal Cancer Screening and Polyp Detection

Lee

Hong

Kim

et al. 2012

J Korean Soc Radiol

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According to the statistical yearbook of the Ministry of Health and Welfare, crude colorectal cancer incidence rates in Korea in 2008 were 54.7 and 36.9 per 100,000 among males and females, respectively. Colorectal cancer is thus the second most common cancer in males and the fourth most common Clin Endosc 2012;45:25-43 Copyright © 2012 The Korean Society of Gastrointestinal Endoscopy 25 cancer in females. 1 The mortality rates (the number of deaths per 100,000 people, %) of colorectal cancer in 2008 were 15.4% among males and 12.1% among females. Colorectal cancer is thus the fourth most common cause of cancer death among Korean males and the second most common cause of cancer death among Korean females. The age-standardized mortality rates of colorectal cancer continue to increase, unlike those of other common cancers, including lung cancer, liver cancer and stomach cancer, whose mortality rates have decreased in recent years. Increases in the incidence of colorectal cancer may be partly due to Westernization of many Koreans' lifestyles. Greater public awareness of colorectal cancer and the addition of colorectal cancer in 2004 to the national cancer screening program are likely also responsible in part for the increased incidence rates. Participation rates in the national colorectal screening program increased from ap Now colorectal cancer is the second most common cancer in males and the fourth most common cancer in females in Korea. Since most of colorectal cancers occur after the prolonged transformation of adenomas into carcinomas, early detection and removal of colorectal adenomas are one of the most effective methods to prevent colorectal cancer. Considering the increasing incidence of colorectal cancer and polyps in Korea, it is very important to establish Korean guideline for colorectal cancer screening and polyp detection. The guideline was developed by the Korean Multi-Society Take Force and we tried to establish the guideline by evidence-based methods. Parts of the statements were draw by systematic reviews and meta-analyses. Herein we discussed epidemiology of colorectal cancers and adenomas in Korea and optimal methods for screening of colorectal cancer and detection of adenomas including fecal occult blood tests, radiologic tests, and endoscopic examinations.

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“…The majority of findings will ultimately prove to be of little or no clinical significance. 12,13 However, in approximately 10% of cases, significant pathology may be identified, such as early cancers of the kidney and ovary as well as abdominal or pelvic lymphadenopathy in underlying lymphoma. Abdominal aortic aneurysms >5 cm in transverse diameter may be detected incidentally.…”

Section: Introductionmentioning

confidence: 99%

“…Abdominal aortic aneurysms >5 cm in transverse diameter may be detected incidentally. 12,13 Visualisation of such pathology is not possible with OC or DCBE. CTC is less invasive, with minimal complications.…”

Section: Introductionmentioning

confidence: 99%

An approach for performing a successful computed tomography colonography examination

Bortz¹

2014

S. Afr. j. radiol.

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Computed tomography colonography (CTC) is a minimally invasive, fast, safe and accurate screening examination for colorectal cancer. It also allows evaluation of structures outside the colon. A successful CTC examination requires good bowel preparation, adequate patient hydration, tagging agents, the use of automated carbon dioxide insufflation, and correct positioning for two view and additional view scans. Knowledge of polyp morphology and measurement of polyps are important when interpreting 2D or 3D scans.

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Extracolonic Findings on CT Colonography Increases Yield of Colorectal Cancer Screening

Abstract: CTC increased the odds of identifying high-risk lesions by 78%. CTC should be considered as an alternative to optical colonoscopy for colorectal cancer screening or as a onetime procedure to identify significant treatable intracolonic and extracolonic lesions.

Cited by 69 publications

References 26 publications

Computed tomographic colonography compared with colonoscopy or barium enema for diagnosis of colorectal cancer in older symptomatic patients: two multicentre randomised trials with economic evaluation (the SIGGAR trials)

Computed tomographic colonography compared with colonoscopy or barium enema for diagnosis of colorectal cancer in older symptomatic patients: two multicentre randomised trials with economic evaluation (the SIGGAR trials)

Korean Guidelines for Colorectal Cancer Screening and Polyp Detection

An approach for performing a successful computed tomography colonography examination

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