Computed tomography colonography vs colonoscopy for colorectal cancer surveillance after surgery Journal Article
| Authors: | Weinberg, D. S.; Pickhardt, P. J.; Bruining, D. H.; Edwards, K.; Fletcher, J. G.; Gollub, M. J.; Keenan, E. M.; Kupfer, S. S.; Li, T.; Lubner, S. J.; Markowitz, A. J.; Ross, E. A. |
| Article Title: | Computed tomography colonography vs colonoscopy for colorectal cancer surveillance after surgery |
| Abstract: | Background & Aims: Recommendations for surveillance after curative surgery for colorectal cancer (CRC) include a 1-year post-resection abdominal-pelvic computed tomography (CT) scan and optical colonoscopy (OC). CT colonography (CTC), when used in CRC screening, effectively identifies colorectal polyps ≥10 mm and cancers. We performed a prospective study to determine whether CTC, concurrent with CT, could substitute for OC in CRC surveillance. Methods: Our study enrolled 231 patients with resected stage 0–III CRC, identified at 5 tertiary care academic centers. Approximately 1 year after surgery, participants underwent outpatient CTC plus CT, followed by same-day OC. CTC results were revealed after endoscopic visualization of sequential colonic segments, which were re-examined for discordant findings. The primary outcome was performance of CTC in the detection of colorectal adenomas and cancers using endoscopy as the reference standard. Results: Of the 231 participants, 116 (50.2%) had polyps of any size or histology identified by OC, and 15.6% had conventional adenomas and/or serrated polyps ≥6 mm. No intra-luminal cancers were detected. CTC detected patients with polyps of ≥6 mm with 44.0% sensitivity (95% CI, 30.2–57.8) and 93.4% specificity (95% CI, 89.7–97.0). CTC detected polyps ≥10 mm with 76.9% sensitivity (95% CI, 54.0–99.8) and 89.0% specificity (95% CI, 84.8–93.1). Similar values were found when only adenomatous polyps were considered. The negative predictive value of CTC for adenomas ≥6 mm was 90.7% (95% CI, 86.7–94.5) and for adenomas ≥10 mm the negative predictive value was 98.6% (95% CI, 97.0–100). Conclusions: In a CRC surveillance population 1 year following resection, CTC was inferior to OC for detecting patients with polyps ≥6 mm. Clinical Trials.gov Registration Number: NCT02143115. © 2018 AGA Institute |
| Keywords: | colorectal cancer; colonoscopy; ct colonography; surveillance |
| Journal Title: | Gastroenterology |
| Volume: | 154 |
| Issue: | 4 |
| ISSN: | 0016-5085 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2018-03-01 |
| Start Page: | 927 |
| End Page: | 934.e4 |
| Language: | English |
| DOI: | 10.1053/j.gastro.2017.11.025 |
| PROVIDER: | scopus |
| PMCID: | PMC5847443 |
| PUBMED: | 29174927 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 2 April 2018 -- Source: Scopus |
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