Diagnostic Accuracy of Computed Tomographic Colonography for the Detection of Advanced Neoplasia in Individuals at Increased Risk of Colorectal Cancer

Topics: Type I and type II errors, Colonoscopy, Colorectal cancer Pages: 12 (2479 words) Published: October 10, 2013
ORIGINAL CONTRIBUTION

Diagnostic Accuracy of Computed
Tomographic Colonography for the Detection
of Advanced Neoplasia in Individuals
at Increased Risk of Colorectal Cancer
Daniele Regge, MD
Cristiana Laudi, MD
Giovanni Galatola, MD
Patrizia Della Monica, PhD
Luigina Bonelli, MD
Giuseppe Angelelli, MD
Roberto Asnaghi, MD
Brunella Barbaro, MD
Carlo Bartolozzi, MD
Didier Bielen, MD
Luca Boni, MD
Claudia Borghi, MD
Paolo Bruzzi, MD
Maria Carla Cassinis, MD
Massimo Galia, MD
Teresa Maria Gallo, MD
Andrea Grasso, MD
Cesare Hassan, MD
Andrea Laghi, MD
Maria Cristina Martina, MD
Emanuele Neri, MD
Carlo Senore, MD
Giovanni Simonetti, MD
Silvia Venturini, MD
Giovanni Gandini, MD

C

OLORECTAL CANCER (CRC)
accounts for approximately
210 000 deaths each year in
Europe. 1 The majority of
CRCs arise within adenomatous polyps,2 and polypectomy is associated with a reduction in CRC incidence and

For editorial comment see p 2498.

Context Computed tomographic (CT) colonography has been recognized as an alternative for colorectal cancer (CRC) screening in average-risk individuals, but less information is available on its performance in individuals at increased risk of CRC. Objective To assess the accuracy of CT colonography in detecting advanced colorectal neoplasia in asymptomatic individuals at increased risk of CRC using unblinded colonoscopy as the reference standard.

Design, Setting, and Participants This was a multicenter, cross-sectional study. Individuals at increased risk of CRC due to either family history of advanced neoplasia in first-degree relatives, personal history of colorectal adenomas, or positive results from fecal occult blood tests (FOBTs) were recruited in 11 Italian centers and 1 Belgian center between December 2004 and May 2007. Each participant underwent CT colonography followed by colonoscopy on the same day.

Main Outcome Measures Sensitivity and specificity of CT colonography in detecting individuals with advanced neoplasia (ie, advanced adenoma or CRC) 6 mm or larger.
Results Of 1103 participants, 937 were included in the final analysis: 373 cases in the family-history group, 343 in the group with personal history of adenomas, and 221 in the FOBT-positive group. Overall, CT colonography identified 151 of 177 participants with advanced neoplasia 6 mm or larger (sensitivity, 85.3%; 95% confidence interval [CI], 79.0%-90.0%) and correctly classified results as negative for 667 of 760 participants without such lesions (specificity, 87.8%; 95% CI, 85.2%-90.0%). The positive and negative predictive values were 61.9% (95% CI, 55.4%-68.0%) and 96.3% (95% CI, 94.6%-97.5%), respectively; after group stratification, a significantly lower negative predictive value was found for the FOBT-positive group (84.9%; 95% CI, 76.2%-91.3%; PϽ.001).

Conclusions In a group of persons at increased risk for CRC, CT colonography compared with colonoscopy resulted in a negative predictive value of 96.3% overall. When limited to FOBT-positive persons, the negative predictive value was 84.9%. www.jama.com

JAMA. 2009;301(23):2453-2461

mortality.3 The target lesions in mass
screening programs are advanced adenomas, which harbor the greatest cancer risk, and early stage CRC,4 but
adherence to screening procedures remains suboptimal.5,6
Computed tomographic (CT) colonography has been shown to be sufficiently accurate in detecting colorectal neoplasia.7,8 Less invasive and better tolerated than colonoscopy,9,10 CT colo-

©2009 American Medical Association. All rights reserved.

nography is now considered a valid alternative for CRC screening in the general population.11 Individuals with first-degree family
history of advanced colorectal neoplasia, those who have had resection of coAuthor Affiliations are listed at the end of this article. Corresponding Author: Cristiana Laudi, MD, Gastroenterology Unit, Institute for Cancer Research and Treatment, Strada Provinciale 142, km 3.95, 10060...
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