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Computed tomographic colonography compared with colonoscopy in patients at increased risk for colorectal cancer.

Abstract：

BACKGROUND & AIMS:To date, computed tomographic (CT) colonography has been compared with an imperfect test, colonoscopy, and has been mainly assessed in patients with positive screening test results or symptoms. Therefore, the available data may not apply to screening of patients with a personal or family history of colorectal polyps or cancer (increased risk). We prospectively investigated the ability of CT colonography to identify individuals with large (>or=10 mm) colorectal polyps in consecutive patients at increased risk for colorectal cancer. METHODS:A total of 249 consecutive patients at increased risk for colorectal cancer underwent CT colonography before colonoscopy. Two reviewers interpreted CT colonography examinations independently. Sensitivity, specificity, and predictive values were determined after meticulous matching of CT colonography with colonoscopy. Unexplained large false-positive findings were verified with a second-look colonoscopy. RESULTS:In total, 31 patients (12%) had 48 large polyps at colonoscopy. This included 8 patients with 8 large polyps that were overlooked initially and detected at the second-look colonoscopy. In 6 of 8 patients, the missed polyp was the only large lesion. With CT colonography, 84% of patients (26/31) with large polyp(s) were identified, paired for a specificity of 92% (200-201/218). Positive and negative predictive values were 59%-60% (26/43-44) and 98% (200-201/205-206), respectively. CT colonography detected 75%-77% (36-37/48) of large polyps, with 9 of the missed lesions being flat. CONCLUSIONS:CT colonography and colonoscopy have a similar ability to identify individuals with large polyps in patients at increased risk for colorectal cancer. The large proportion of missed flat lesions warrants further study.

journal_name

Gastroenterology

journal_title

Gastroenterology

authors

Van Gelder RE,Nio CY,Florie J,Bartelsman JF,Snel P,De Jager SW,Van Deventer SJ,Laméris JS,Bossuyt PM,Stoker J

doi

10.1053/j.gastro.2004.03.055

keywords:

subject

Has Abstract

pub_date

2004-07-01 00:00:00

pages

41-8

issue

eissn

0016-5085

issn

1528-0012

pii

S0016508504005141

journal_volume

127

pub_type

杂志文章

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Computed tomographic colonography compared with colonoscopy in patients at increased risk for colorectal cancer.