Article Text

other Versions

PDF
Using CT colonography as a triage technique after a positive Faecal Occult Blood Test in colorectal cancer screening
  1. Marjolein Henrieke Liedenbaum (m.h.liedenbaum{at}amc.uva.nl)
  1. Academic Medical Centre, Netherlands
    1. Anne Floortje van Rijn (a.f.vanrijn{at}amc.uva.nl)
    1. Academic Medical Centre, Netherlands
      1. Ayso H de Vries (ayso.devries{at}amc.uva.nl)
      1. Academic Medical Centre, Netherlands
        1. Helena M Dekker (h.dekker{at}rad.umcn.nl)
        1. Radboud University Nijmegen Medical Centre, Netherlands
          1. Maarten Thomeer (m.thomeer{at}erasmusmc.nl)
          1. Erasmus Medical Centre Rotterdam, Netherlands
            1. Corine J van Marrewijk (c.vanmarrewijk{at}antrg.umcn.nl)
            1. Radboud University Nijmegen Medical Centre, Netherlands
              1. Lieke Hol (l.hol.1{at}erasmusmc.nl)
              1. Erasmus Medical Centre Rotterdam, Netherlands
                1. Marcel G Dijkgraaf (m.g.dijkgraaf{at}amc.uva.nl)
                1. Academic Medical Centre, Netherlands
                  1. Paul Fockens (p.fockens{at}amc.uva.nl)
                  1. Academic Medical Centre, Netherlands
                    1. Patrick M Bossuyt (p.m.bossuyt{at}amc.uva.nl)
                    1. Academic Medical Centre, Netherlands
                      1. Evelien Dekker (e.dekker{at}amc.uva.nl)
                      1. Academic Medical Centre, Netherlands
                        1. Jaap Stoker (j.stoker{at}amc.uva.nl)
                        1. Academic Medical Centre, Netherlands

                          Abstract

                          Objective: To evaluate the effectiveness of CT colonography (CTC) as a triage technique in Faecal Occult Blood Test (FOBT) positive screening participants.

                          Methods: Consecutive guiac (G-FOBT) and immunochemical (I-FOBT) FOBT positives scheduled for colonoscopy underwent CTC with iodine tagging bowel preparation. Each CTC was read independently by two experienced observers. Per patient sensitivity, specificity and positive and negative predictive values (PPV and NPV) were calculated based on double reading with different CTC cut-off lesion sizes using segmental unblinded colonoscopy as the reference standard. Patient acceptance was evaluated with questionnaires.

                          Results: 302 FOBT positives were included (54 G-FOBT and 248 I-FOBT). 22 FOBT positives (7%) had a colorectal carcinoma and 211 (70%) had a lesion ≥6mm. Participants considered colonoscopy more burdensome than CTC (p<0.05). Using a 6mm CTC size cut-off, per patient sensitivity for CTC was 91% (95% CI: 85% to 91%) and specificity was 69% (95% CI: 60% to 89%) for the detection of colonoscopy lesions ≥6mm. PPV of CTC was 87% (95% CI: 80% to 93%) and NPV 77% (95%CI: 69% to 85%). Using CTC as a triage technique in 100 FOBT positives would mean that colonoscopy could be prevented in 28 patients while missing ≥10mm lesions in 2 patients.

                          Conclusion: CTC with limited bowel preparation has reasonable predictive values in a FOBT positive population and a higher patient acceptation than colonoscopy. But due to the high prevalence of clinically relevant lesions in FOBT positives, CTC is unlikely to be an efficient triage technique in a first round FOBT population screening programme.

                          Statistics from Altmetric.com

                          Request permissions

                          If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

                          Linked Articles

                          • Digest
                            Robin Spiller Severine Vermeire