The performance of routine computed tomography for the detection of colorectal cancer

Colvin, Hugh; Lukram, Ajit; Sohail, Iram; Chung, Kwon; Jehangir, Ernest; Berry, Jon; Babu, Harathi Parasur; Hinson, F. L.

doi:10.1308/003588413x13629960049072

Cited by 13 publications

(12 citation statements)

References 12 publications

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“…Research examining the sensitivity of routine CT in detecting CRC is limited. A study with a similar retrospective design evaluated patients having undergone CT prior to colonoscopy due to different clinical symptoms [9]. Of their 96 patients, only 2 cases had confirmed malignancy at colonoscopy, making it difficult to correlate results secondary to their small positive sample size.…”

Section: Discussionmentioning

confidence: 99%

“…Four additional suspicious lesions by CT were proven negative by colonoscopy. As a result, their reported sensitivity was 100% concluding suspicion of malignancy raised by CT usually warrants further investigation [9]. A recently published article with a retrospective design and larger sample size of 717 calculated an overall sensitivity of 74.5% of routine CT detecting CRC and correlated an improved sensitivity with an increase in lesion size [11].…”

Section: Discussionmentioning

confidence: 99%

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The Accuracy of Colorectal Cancer Detection by Computed Tomography in the Unprepared Large Bowel in a Community-Based Hospital

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Accuracy of Colorectal Cancer Detection by Computed Tomography in the Unprepared Large Bowel in a Community-Based Hospital

et al. 2018

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“…Incremental true positives and incremental false positives were derived from the incremental diagnostic yield under the assumption that cases and non-cases were equally likely to convert. Sensitivity and specificity of CT mini-prep were estimated from local radiologists' estimates (sensitivity 75–80 per cent) and available data in literature (sensitivity 100 per cent, specificity 87–95.7 per cent) 20 , 21 . However, for the base case, estimates from real-time COVID-adapted pathway data were used.…”

Section: Methodsmentioning

confidence: 99%

Risk of missing colorectal cancer with a COVID-adapted diagnostic pathway using quantitative faecal immunochemical testing

et al. 2021

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Background COVID-19 has brought an unprecedented challenge to healthcare services. The authors’ COVID-adapted pathway for suspected bowel cancer combines two quantitative faecal immunochemical tests (qFITs) with a standard CT scan with oral preparation (CT mini-prep). The aim of this study was to estimate the degree of risk mitigation and residual risk of undiagnosed colorectal cancer. Method Decision-tree models were developed using a combination of data from the COVID-adapted pathway (April–May 2020), a local audit of qFIT for symptomatic patients performed since 2018, relevant data (prevalence of colorectal cancer and sensitivity and specificity of diagnostic tools) obtained from literature and a local cancer data set, and expert opinion for any missing data. The considered diagnostic scenarios included: single qFIT; two qFITs; single qFIT and CT mini-prep; two qFITs and CT mini-prep (enriched pathway). These were compared to the standard diagnostic pathway (colonoscopy or CT virtual colonoscopy (CTVC)). Results The COVID-adapted pathway included 422 patients, whereas the audit of qFIT included more than 5000 patients. The risk of missing a colorectal cancer, if present, was estimated as high as 20.2 per cent with use of a single qFIT as a triage test. Using both a second qFIT and a CT mini-prep as add-on tests reduced the risk of missed cancer to 6.49 per cent. The trade-off was an increased rate of colonoscopy or CTVC, from 287 for a single qFIT to 418 for the double qFIT and CT mini-prep combination, per 1000 patients. Conclusion Triage using qFIT alone could lead to a high rate of missed cancers. This may be reduced using CT mini-prep as an add-on test for triage to colonoscopy or CTVC.

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“…Patients were informed that CT was a more accessible intervention during the pandemic, but was not as accurate at diagnosing CRC as LGI endoscopy. [9][10][11]…”

Section: Patient Cohortmentioning

confidence: 99%

Prioritisation of lower gastrointestinal endoscopy during the COVID-19 pandemic: outcomes of a novel triage pathway

Archer

Aziz

Kurien

et al. 2021

Frontline Gastroenterol

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ObjectiveThe 2-week-wait (2ww) referral pathway is used in England to fast-track patients with suspected colorectal cancer (CRC). A two-stage triage pathway was used to prioritise lower gastrointestinal (LGI) endoscopy for suspected CRC during the COVID-19 pandemic.MethodAll patients referred for an LGI endoscopy via a 2ww referral pathway between March 2020 and July 2020 were assessed. The first stage triaged patients to high, standard or low risk of CRC based on symptoms and faecal immunochemical test (FIT), and offered CT scans to those at high risk. The second stage, endoscopy prioritisation (EP), incorporated the CT results, FIT and symptoms to triage into four groups, EP1–EP4; with EP1 being the most urgent and EP4 the least. The primary outcome measure was CRC detection.Results514 patients were included. The risk of CRC was triaged as high in 190/514 patients (37%), standard in 274/514 patients (53%) and low in 50/514 (10%) patients. 422/514 patients (82%) underwent endoscopy with triage to EP1 in 52/422 (12%), EP2 in 105/422 (25%), EP3 in 210/422 (50%) and EP4 in 55/422 (13%). CRC was detected in 23 patients (5.4%). CRC was significantly more frequent in the EP1 group (23.1%, relative risk (RR)=16.2) and EP2 group (6.7%, RR=4.7) compared with EP3 group (1.4%). All CRC lesions were identified by CT imaging when performed prior to LGI endoscopy.ConclusionThis triage pathway designated 83% of patients with CRC to either EP1 or EP2. During a period of limited endoscopy provision, this pathway effectively prioritises endoscopy for those at greatest risk of CRC.

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The performance of routine computed tomography for the detection of colorectal cancer

Cited by 13 publications

References 12 publications

The Accuracy of Colorectal Cancer Detection by Computed Tomography in the Unprepared Large Bowel in a Community-Based Hospital

The Accuracy of Colorectal Cancer Detection by Computed Tomography in the Unprepared Large Bowel in a Community-Based Hospital

Risk of missing colorectal cancer with a COVID-adapted diagnostic pathway using quantitative faecal immunochemical testing

Prioritisation of lower gastrointestinal endoscopy during the COVID-19 pandemic: outcomes of a novel triage pathway

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