Post-imaging colorectal cancer or interval cancer rates after CT colonography: a systematic review and meta-analysis

Obaro, Anu E; Plumb, Andrew; Fanshawe, Thomas R; Torres, Ulysses S.; Baldwin-Cleland, Rachel; Taylor, Stuart A.; Halligan, Steve; Burling, David

doi:10.1016/s2468-1253(18)30032-3

Cited by 35 publications

(21 citation statements)

References 53 publications

(141 reference statements)

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“…63 These data translate to a low interval cancer incidence of 0.6 per 1000 person-years of follow-up, particularly encouraging given that only 7% of the interval cancers retrospectively reviewed in this study were truly occult. 62 These data support current CTC management strategies of not reporting diminutive polyps and the option of CTC follow-up for small polyps. Since most missed cancers at CTC were visible in retrospect, formal training and accreditation is warranted to ensure consistent high-quality practice (inter)nationally.…”

Section: Referral Thresholds and Diminutive Polypssupporting

confidence: 69%

“…Ultimately, the most important quality indicator of CTC management is the rate of interval cancer after negative CTC. A recent systematic review has shown this rate to be 4.4% in the published literature, 62 which compares favourably with colonoscopy (published rates 3-9%). 63 These data translate to a low interval cancer incidence of 0.6 per 1000 person-years of follow-up, particularly encouraging given that only 7% of the interval cancers retrospectively reviewed in this study were truly occult.…”

Section: Referral Thresholds and Diminutive Polypsmentioning

confidence: 91%

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Colon cancer screening with CT colonography: logistics, cost-effectiveness, efficiency and progress

Obaro

Burling

Plumb

2018

BJR

Self Cite

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Colorectal cancer (CRC) incidence and mortality can be significantly reduced by population screening. Several different screening methods are currently in use, and this review focuses specifically on the imaging technique computed tomographic colonography (CTC). The challenges and logistics of CTC screening, as well as the importance of test accuracy, uptake, quality assurance and cost-effectiveness will be discussed. With comparable advanced adenoma detection rates to colonoscopy (the most commonly used whole-colon investigation), CTC is a less-invasive alternative, requiring less laxative, and with the potential benefit that it permits assessment of extra colonic structures. Three large-scale European trials have contributed valuable evidence supporting the use of CTC in population screening, and highlight the importance of selecting appropriate clinical management pathways based on initial CTC findings. Future research into CTC-screening will likely focus on radiologist training and CTC quality assurance, with identification of evidence-based key performance indicators that are associated with clinically-relevant outcomes such as the incidence of post-test interval cancers (CRC occurring after a presumed negative CTC). In comparison to other CRC screening techniques, CTC offers a safe and accurate option that is particularly useful when colonoscopy is contraindicated. Forthcoming cost-effectiveness analyses which evaluate referral thresholds, the impact of extra-colonic findings and real-world uptake will provide useful information regarding the feasibility of future CTC population screening.

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Section: Referral Thresholds and Diminutive Polypssupporting

confidence: 69%

Section: Referral Thresholds and Diminutive Polypsmentioning

confidence: 91%

Colon cancer screening with CT colonography: logistics, cost-effectiveness, efficiency and progress

Obaro

Burling

Plumb

2018

BJR

Self Cite

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“…Two new European randomized trials [17,18] and an evaluation of follow-up [19] have shown detection rates for advanced neoplasia being similar to those of optical colonoscopy in asymptomatic individuals invited for screening. A systematic review has shown the rate of interval cancers after a negative CTC (4.5 %) compares favorably with that following optical colonoscopy (3 % -9 %) [20]. In a Japanese multicenter trial, including 1177 patients, sensitivities and specificities of over 90 % were achieved for detection of colorectal neoplasia > 9 mm by CTC [21].…”

Section: Radiological Imaging For the Diagnosis Of Colorectal Neoplasiamentioning

confidence: 99%

Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline – Update 2020

et al. 2020

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Main recommendations 1 ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia.Strong recommendation, high quality evidence.ESGE/ESGAR do not recommend barium enema in this setting.Strong recommendation, high quality evidence. 2 ESGE/ESGAR recommend CTC, preferably the same or next day, if colonoscopy is incomplete. The timing depends on an interdisciplinary decision including endoscopic and radiological factors.Strong recommendation, low quality evidence.ESGE/ESGAR suggests that, in centers with expertise in and availability of colon capsule endoscopy (CCE), CCE preferably the same or the next day may be considered if colonoscopy is incomplete.Weak recommendation, low quality evidence. 3 When colonoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with alarm symptoms.Strong recommendation, high quality evidence.Because of lack of direct evidence, ESGE/ESGAR do not recommend CCE in this situation.Very low quality evidence.ESGE/ESGAR recommend CTC as an acceptable alternative to colonoscopy for patients with non-alarm symptoms.Strong recommendation, high quality evidence.In centers with availability, ESGE/ESGAR suggests that CCE may be considered in patients with non-alarm symptoms.Weak recommendation, low quality evidence. 4 Where there is no organized fecal immunochemical test (FIT)-based population colorectal screening program, ESGE/ESGAR recommend CTC as an option for colorectal cancer screening, providing the screenee is adequately informed about test characteristics, benefits, and risks, and depending on local service- and patient-related factors.Strong recommendation, high quality evidence.ESGE/ESGAR do not suggest CCE as a first-line screening test for colorectal cancer.Weak recommendation, low quality evidence. 5 ESGE/ESGAR recommend CTC in the case of a positive fecal occult blood test (FOBT) or FIT with incomplete or unfeasible colonoscopy, within organized population screening programs.Strong recommendation, moderate quality evidence.ESGE/ESGAR also suggest the use of CCE in this setting based on availability.Weak recommendation, moderate quality evidence. 6 ESGE/ESGAR suggest CTC with intravenous contrast medium injection for surveillance after curative-intent resection of colorectal cancer only in patients in whom colonoscopy is contraindicated or unfeasibleWeak recommendation, low quality evidence.There is insufficient evidence to recommend CCE in this setting.Very low quality evidence. 7 ESGE/ESGAR suggest CTC in patients with high risk polyps undergoing surveillance after polypectomy only when colonoscopy is unfeasible.Weak recommendation, low quality evidence.There is insufficient evidence to recommend CCE in post-polypectomy surveillance.Very low quality evidence. 8 ESGE/ESGAR recommend against CTC in patients with acute colonic inflammation and in those who have recently undergone colorectal surgery, pending a multidisciplinary evaluation.Strong recommendation, low quality evidence. 9 ESGE/ESGAR recommend referral for endoscopic polypectomy in patients with at least one polyp ≥ 6 mm detected at CTC or CCE.Follow-up CTC may be clinically considered for 6 – 9-mm CTC-detected lesions if patients do not undergo polypectomy because of patient choice, comorbidity, and/or low risk profile for advanced neoplasia.Strong recommendation, moderate quality evidence.

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“…The literature is relatively clear regarding detection of established CRC: two meta-analyses have shown that CTC is approximately 96% sensitive for CRC [21,22], not significantly different from colonoscopy, which was 95% sensitive in one of these analyses [22]. Furthermore, a recent further systematic review has shown that identification of (initially undetected) CRC in the 3-year period following CTC is rare, only occurring in 4.4% of cases [23]. Since adenomas typically take many years or even decades to transition to carcinoma [24], these are likely to be due to missed CRC at the index CTC examination, entirely consistent with approximately 95% sensitivity for cancer.…”

Section: Diagnostic Accuracymentioning

confidence: 99%

Computed tomographic colonography for diagnosis of early cancer and polyps?

et al. 2019

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Post-imaging colorectal cancer or interval cancer rates after CT colonography: a systematic review and meta-analysis

Abstract: St Mark's Hospital Foundation and the UK National Institute for Health Research via the UCL/UCLH Biomedical Research Centre.

Cited by 35 publications

References 53 publications

Colon cancer screening with CT colonography: logistics, cost-effectiveness, efficiency and progress

Colon cancer screening with CT colonography: logistics, cost-effectiveness, efficiency and progress

Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline – Update 2020

Computed tomographic colonography for diagnosis of early cancer and polyps?

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