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Hadjittofi C, Sharma V, Bhatt D, Rifai T, Williams S, Shaikh I. Computed tomographic colonography for symptomatic patients: the diminutive polyp dilemma. ANZ J Surg 2022; 93:939-944. [PMID: 36350028 DOI: 10.1111/ans.18152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Computed tomographic colonography (CTC) is sensitive to polyp detection but is considered inaccurate for measuring diminutive polyps (<6 mm), with divergence between CTC and either colonoscopic or histopathological polyp measurements. Reporting diminutive polyps remains debatable. This study aims to compare outcomes of symptomatic patients with diminutive versus borderline polyps on CTC and to thereby examine the potential implication of reporting diminutive polyps. METHODS A single-centre retrospective study of symptomatic patients who underwent CTC from October 2016 through September 2018 was performed. After excluding CTC demonstrating cancer, no polyps, or polyps >6 mm, cases were categorized as either 'diminutive' (largest polyp <6 mm), or 'borderline' (largest polyp = 6 mm). The outcome measures were progression to endoscopy, surgery, procedure-related morbidity, dysplasia and malignancy. RESULTS A total of 308 cases (211 diminutive and 97 borderline) were analysed. The groups were similar (P > 0.05) in mean age (73 vs. 74 years), female proportion (57% vs. 49%), endoscopy-related morbidity (6% vs. 7%) and CTC-related morbidity (0 vs. 1%). Most patients (64%) underwent endoscopy, which was more common in the borderline vs. the diminutive group (76% vs. 59%; P = 0.003). Dysplasia was more common in the borderline vs. the diminutive group (69% vs. 48%; P = 0.003). No malignancies were diagnosed, and no patients proceeded to surgery. CONCLUSION Reporting diminutive polyps on CTC for symptomatic patients frequently leads to endoscopy, which often reveals dysplasia but rarely malignancy. This raises the question of how referring clinicians can best counsel and manage symptomatic patients with diminutive polyps on CTC, by considering the balance between utilitarianism and deontology.
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Affiliation(s)
- Christopher Hadjittofi
- Department of General Surgery Norfolk & Norwich University Hospitals NHS Foundation Trust Norwich UK
| | - Vivek Sharma
- Department of General Surgery University Hospitals Leicester Leicester UK
| | - Dhaara Bhatt
- Department of General Surgery Norfolk & Norwich University Hospitals NHS Foundation Trust Norwich UK
| | - Tamam Rifai
- Department of General Surgery Norfolk & Norwich University Hospitals NHS Foundation Trust Norwich UK
| | - Stuart Williams
- Department of General Surgery Norfolk & Norwich University Hospitals NHS Foundation Trust Norwich UK
| | - Irshad Shaikh
- Department of General Surgery Norfolk & Norwich University Hospitals NHS Foundation Trust Norwich UK
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2
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Rutter MD, East J, Rees CJ, Cripps N, Docherty J, Dolwani S, Kaye PV, Monahan KJ, Novelli MR, Plumb A, Saunders BP, Thomas-Gibson S, Tolan DJM, Whyte S, Bonnington S, Scope A, Wong R, Hibbert B, Marsh J, Moores B, Cross A, Sharp L. British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines. Gut 2020; 69:201-223. [PMID: 31776230 PMCID: PMC6984062 DOI: 10.1136/gutjnl-2019-319858] [Citation(s) in RCA: 194] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 12/11/2022]
Abstract
These consensus guidelines were jointly commissioned by the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE). They provide an evidence-based framework for the use of surveillance colonoscopy and non-colonoscopic colorectal imaging in people aged 18 years and over. They are the first guidelines that take into account the introduction of national bowel cancer screening. For the first time, they also incorporate surveillance of patients following resection of either adenomatous or serrated polyps and also post-colorectal cancer resection. They are primarily aimed at healthcare professionals, and aim to address:Which patients should commence surveillance post-polypectomy and post-cancer resection?What is the appropriate surveillance interval?When can surveillance be stopped? two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument provided a methodological framework for the guidelines. The BSG's guideline development process was used, which is National Institute for Health and Care Excellence (NICE) compliant.two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps The key recommendations are that the high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise either:two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps This cohort should undergo a one-off surveillance colonoscopy at 3 years. Post-CRC resection patients should undergo a 1 year clearance colonoscopy, then a surveillance colonoscopy after 3 more years.
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Affiliation(s)
- Matthew D Rutter
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - James East
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Colin J Rees
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
- Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK
| | - Neil Cripps
- Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | | | - Sunil Dolwani
- Gastroenterology, Cardiff and Vale NHS Trust, Cardiff, UK
| | - Philip V Kaye
- Histopathology, Nottingham University Hospitals, Nottingham, UK
| | - Kevin J Monahan
- Family History of Bowel Cancer Clinic, West Middlesex University Hospital, London, UK
- Imperial College, London, UK
| | | | | | | | | | - Damian J M Tolan
- Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sophie Whyte
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Alison Scope
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ruth Wong
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | | | | | - Amanda Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine of Imperial College, Imperial College London, London, UK
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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3
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Interobserver Variation of Colonic Polyp Measurement at Computed Tomography Colonography. Can Assoc Radiol J 2019; 70:44-51. [PMID: 30691562 DOI: 10.1016/j.carj.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/14/2018] [Accepted: 09/20/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The concept of "advanced polyps" is well accepted and is defined as polyps ≥10 mm and/or those having a villous component and/or demonstrating areas of dysplasia. Of these parameters, computed tomography colonography (CTC) can only document size. The accepted management of CTC-detected "advanced polyps" is to recommend excision if feasible, whereas the management of "intermediate" (6-9 mm) polyps is more controversial, and interval surveillance may be acceptable. Therefore, distinction between 6-9 mm and ≥10 mm is important. METHODS Datasets containing 26 polyps originally reported as between 8-12 mm in diameter were reviewed independently by 4 CTC-accredited radiologists. Observers tabulated the largest measurement for each polyp on axial, coronal, sagittal, and endoluminal views at lung-window settings. These measurements were also compared to those determined by the computer-aided detection (CAD) software. RESULTS The interobserver reliability intra-class correlation coefficient (ICC) for sagittal projection was 0.80 ("excellent" category of Hosmer and Lemeshow [2004]), 0.71 for axial ("acceptable"), 0.69 for coronal, and 0.41 for endoluminal ("unacceptable"). The largest of sagittal/axial/coronal measurement gave the best reliability with the smallest variance (ICC = 0.80; 95% CI 0.67-0.89). For 8 of 26 polyps, at least one radiologist's measurement placed the polyp in a different category compared to a colleague. For the majority of the polyps, the CAD significantly overestimated the readings compared to the largest of the manual measurements with an average difference of 1.6 mm (P < .0001 for sagittal/axial/coronal). This resulted in 33% of polyps falling into a different category-10% were lower and 23% were higher (P < .034). CONCLUSION It is apparent that around the cutoff point of 10 mm between "advanced" and "intermediate" polyps, interobserver performance is variable.
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Labianca R, Merelli B. Screening and Diagnosis for Colorectal Cancer: Present and Future. TUMORI JOURNAL 2018. [DOI: 10.1177/548.6506] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Barbara Merelli
- Unit of Medical Oncology, Ospedali Riuniti di Bergamo, Italy
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Tsai FC, Strum WB. Prevalence of advanced adenomas in small and diminutive colon polyps using direct measurement of size. Dig Dis Sci 2011; 56:2384-8. [PMID: 21318587 DOI: 10.1007/s10620-011-1598-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 01/27/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS Most studies reporting polyp size use visual estimates. Determining the prevalence of advanced histology based on direct measurement of polyp size may help guide the management of polyps found at optical colonoscopy (OC) and CT colonography (CTC). METHODS We designed a large, prospective study to assess the prevalence of advanced adenomas based on direct measurement of polyp size by a certified pathologists' assistant as reported in the pathology report. Patients between 40 and 89 years of age who presented for screening colonoscopy were included in our study. Advanced adenomas were defined as ≥10 mm or ≥25% villous features, high grade dysplasia or cancer. Polyps were divided by size into three groups: diminutive (≤5 mm), small (6-9 mm) and large (≥10 mm). If more than one adenoma was present, the most advanced was used for analysis. RESULTS We evaluated 6,905 consecutive patients referred for colonoscopy between January 2005 and December 2006. Of the 4,967 who met the inclusion criteria, the mean age was 58.8 and consisted of 59% women. Overall, 930 (18.7%) had an adenoma; 248 (5%) were advanced adenomas including 8 (0.16%) cancers. Of 89 polyps≥10 mm, 76 (85%) had advanced histology; of 247 polyps 6-9 mm, 67 (27%) were advanced; of 1,025 polyps ≤5 mm, 105 (10%) were advanced. Thus, 172 of 248 (69%) patients with advanced adenomas had small or diminutive adenomas. CONCLUSIONS Our data indicate the majority (69%) of advanced adenomas are <10 mm. Even among polyps≤5 mm, there was an appreciable prevalence of advanced adenomas (10%). These findings may help guide the management of sub-centimeter colon polyps found by OC or CTC.
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Affiliation(s)
- Franklin C Tsai
- Division of Gastroenterology, Scripps Clinic and the Scripps Clinic Research Institute, Torrey Pines, 10666 North Torrey Pines Road, La Jolla, CA 92037, USA.
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Barancin C, Pickhardt PJ, Kim DH, Spier B, Lindstrom M, Reichelderfer M, Gopal D, Pfau P. Prospective blinded comparison of polyp size on computed tomography colonography and endoscopic colonoscopy. Clin Gastroenterol Hepatol 2011; 9:443-5. [PMID: 21277389 DOI: 10.1016/j.cgh.2011.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 01/11/2011] [Accepted: 01/20/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The size of polyps found on computed tomography colonography (CTC) has been suggested as the major determinant of patient management. We compared polyp size as seen on CTC with endoscopic visualization, in vivo probe measurement, and ex vivo size before and after fixation. METHODS Polyps measured on CTC sent for endoscopic removal were evaluated for polyp size in a blinded fashion by endoscopic estimation, in vivo probe measurement, and after removal. RESULTS Fifty-six polyps were included in the study. There was no significant difference between CTC polyp size, real-time colonoscopy size estimation, or probe measurement. The size of polyp measured immediately ex vivo and after pathology fixation was significantly smaller. Management would be altered in 6 of 56 polyps (10.7%) on the basis of differences between size of the polyp on endoscopy and CTC. CONCLUSIONS (1) CTC polyp size measurement is not significantly different from colonoscopy in vivo visual estimation and linear probe measurement. (2) Differences in size of polyps as measured on CTC and endoscopy will affect patient management in 10% of cases.
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Affiliation(s)
- Courtney Barancin
- Section of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin 53792, USA
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Summers RM. Polyp size measurement at CT colonography: what do we know and what do we need to know? Radiology 2010; 255:707-20. [PMID: 20501711 DOI: 10.1148/radiol.10090877] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Polyp size is a critical biomarker for clinical management. Larger polyps have a greater likelihood of being or of becoming an adenocarcinoma. To balance the referral rate for polypectomy against the risk of leaving potential cancers in situ, sizes of 6 and 10 mm are increasingly being discussed as critical thresholds for clinical decision making (immediate polypectomy versus polyp surveillance) and have been incorporated into the consensus CT Colonography Reporting and Data System (C-RADS). Polyp size measurement at optical colonoscopy, pathologic examination, and computed tomographic (CT) colonography has been studied extensively but the reported precision, accuracy, and relative sizes have been highly variable. Sizes measured at CT colonography tend to lie between those measured at optical colonoscopy and pathologic evaluation. The size measurements are subject to a variety of sources of error associated with image acquisition, display, and interpretation, such as partial volume averaging, two- versus three-dimensional displays, and observer variability. This review summarizes current best practices for polyp size measurement, describes the role of automated size measurement software, discusses how to manage the measurement uncertainties, and identifies areas requiring further research.
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Affiliation(s)
- Ronald M Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bldg 10, Room 1C368X, MSC 1182, Bethesda, MD 20892-1182, USA.
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Abstract
Computed tomographic colonography (CTC) is a promising emerging technology for imaging of the colon. This concise review discusses the currently available data on CTC technique, test characteristics, acceptance, safety, cost-effectiveness, follow-up strategy, and extracolonic findings. In summary, CTC technique is still evolving, and further research is needed to clarify the role of automated colonic insufflation, smooth-muscle relaxants, intravenous and oral contrast, software rendering, and patient positioning. Currently, full bowel preparation is still required to achieve optimal results. The sensitivity for detecting large polyps (> 1 cm) can be as high as 85%, with specificity of up to 97%. These test characteristics are almost comparable to those of conventional colonoscopy. Patient acceptance of CTC is generally higher than that for colonoscopy, especially in patients who have never undergone either procedure. CTC is generally safe, although uncommon instances of colonic perforation have been documented. In terms of cost-effectiveness, most decision analyses have concluded that CTC would only be cost-effective if it were considerably cheaper than conventional colonoscopy. The proper follow-up strategy for small polyps or incidental extracolonic findings discovered during CTC is still under debate. At present, the exact clinical role of virtual colonoscopy still awaits determination. Even though widespread CTC screening is not available today, in the future there may eventually be a role for this technology. Technological advances in this area will undoubtedly continue, with multi-detector row CT scanners allowing thinner collimation and higher resolution images. Stool-tagging techniques are likely to evolve and may eventually allow for low-preparation CTC. Perceptual and fatigue-related reading errors can potentially be minimized with the help of computer-aided detection software. Further research will define the exact role of this promising technology in our diagnostic armamentarium.
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Rudzińska M, Rudziński J, Leksowski K. Computed tomography colonography - reasons for different and false results. Pol J Radiol 2010; 75:38-41. [PMID: 22802789 PMCID: PMC3389881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 11/23/2009] [Indexed: 11/22/2022] Open
Abstract
Computed tomography colonography (CT colonography) is one of the latest radiological methods of colorectal diagnostic imaging. Many studies confirmed a high efficacy of CT colonography in diagnosing colorectal polyps and tumors. However, this imaging method is not devoid of false diagnoses. Our paper presented the main causes of false results, causes of heterogeneity of the results among centres, as well as ways of avoiding them.
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Affiliation(s)
- Małgorzata Rudzińska
- Clinical Institute of Medical Radiology, Military Teaching Hospital No. 10 with a Polyclinic in Bydgoszcz, Bydgoszcz, Poland,Author’s address: Małgorzata Rudzińska, Clinical Department of Gastroenterology, Military Teaching Hospital No. 10 with a Polyclinic in Bydgoszcz, Powstańców Warszawy 5 Str., 85-915 Bydgoszcz, Poland, e-mail:
| | - Janusz Rudziński
- Clinical Department of Gastroenterology, Military Teaching Hospital No. 10 with a Polyclinic in Bydgoszcz, Bydgoszcz, Poland
| | - Krzysztof Leksowski
- Department of General, Thoracic and Vascular Surgery, Military Teaching Hospital No. 10 with a Polyclinic in Bydgoszcz, Bydgoszcz, Poland, Institute of Public Health of the Department of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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Liedenbaum MH, van Rijn AF, de Vries AH, Dekker HM, Thomeer M, van Marrewijk CJ, Hol L, Dijkgraaf MGW, Fockens P, Bossuyt PMM, Dekker E, Stoker J. Using CT colonography as a triage technique after a positive faecal occult blood test in colorectal cancer screening. Gut 2009; 58:1242-9. [PMID: 19625276 PMCID: PMC2719082 DOI: 10.1136/gut.2009.176867] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effectiveness of CT colonography (CTC) as a triage technique in faecal occult blood test (FOBT)-positive screening participants. METHODS Consecutive guaiac (G-FOBT) and immunochemical (I-FOBT) FOBT-positive patients 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. The acceptability of the technique to patients was evaluated with questionnaires. RESULTS 302 FOBT-positive patients were included (54 G-FOBT and 248 I-FOBT). 22 FOBT-positive patients (7%) had a colorectal carcinoma and 211 (70%) had a lesion >or=6 mm. Participants considered colonoscopy more burdensome than CTC (p<0.05). Using a 6 mm 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 >or=6 mm. The 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-positive patients would mean that colonoscopy could be prevented in 28 patients while missing >or=10 mm lesions in 2 patients. CONCLUSION CTC with limited bowel preparation has reasonable predictive values in an FOBT-positive population and a higher acceptability to patients than colonoscopy. However, due to the high prevalence of clinically relevant lesions in FOBT-positive patients, CTC is unlikely to be an efficient triage technique in a first round FOBT population screening programme.
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Affiliation(s)
- M H Liedenbaum
- Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands.
| | - A F van Rijn
- Academic Medical Centre Amsterdam, The Netherlands
| | - A H de Vries
- Academic Medical Centre Amsterdam, The Netherlands
| | - H M Dekker
- Radboud University Nijmegen Medical Centre, The Netherlands
| | - M Thomeer
- Erasmus Medical Centre Rotterdam, The Netherlands
| | | | - L Hol
- Erasmus Medical Centre Rotterdam, The Netherlands
| | | | - P Fockens
- Academic Medical Centre Amsterdam, The Netherlands
| | | | - E Dekker
- Academic Medical Centre Amsterdam, The Netherlands
| | - J Stoker
- Academic Medical Centre Amsterdam, The Netherlands
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11
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Rockey DC, Chen MH, Herman BA, Johnson CD, Toledano A, Dachman AH, Hara AK, Fidler JL, Menias CO, Coakley KJ, Kuo M, Horton KM, Cheema J, Iyer R, Siewert B, Yee J, Obregon R, Zimmerman P, Halvorsen R, Casola G, Morrin M. Computed tomographic colonography: current perspectives and future directions. Gastroenterology 2009; 137:7-14. [PMID: 19450595 DOI: 10.1053/j.gastro.2009.05.036] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Computed tomographic (CT) colonography, also known as virtual colonoscopy or CT colography, is capable of detecting colon polyps and cancers. It is emerging rapidly and has gained great momentum over the past several years, to the point where it has been proposed to be a viable primary colon cancer screening option. Despite the current publicity, many issues concerning CT colonography remain. As of 2009, the following topics are of paramount importance: (1) accuracy, including both sensitivity and specificity, (2) bowel preparation, (3) safety, (4) extracolonic findings, (5) patient acceptability, (6) training and standardization, and (7) implementation of CT colonography. Although much about CT colonography has already been learned, more remains to be learned in the future.
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Affiliation(s)
- Don C Rockey
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8887, USA.
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12
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Liedenbaum MH, de Vries AH, Halligan S, Bossuyt PMM, Dachman AH, Dekker E, Florie J, Gryspeerdt SS, Jensch S, Johnson CD, Laghi A, Taylor SA, Stoker J. CT colonography polyp matching: differences between experienced readers. Eur Radiol 2009; 19:1723-30. [PMID: 19224220 PMCID: PMC2691532 DOI: 10.1007/s00330-009-1328-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Revised: 12/23/2008] [Accepted: 01/06/2009] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to investigate if experienced readers differ when matching polyps shown by both CT colonography (CTC) and optical colonoscopy (OC) and to explore the reasons for discrepancy. Twenty-eight CTC cases with corresponding OC were presented to eight experienced CTC readers. Cases represented a broad spectrum of findings, not completely fulfilling typical matching criteria. In 21 cases there was a single polyp on CTC and OC; in seven there were multiple polyps. Agreement between readers for matching was analyzed. For the 21 single-polyp cases, the number of correct matches per reader varied from 13 to 19. Almost complete agreement between readers was observed in 15 cases (71%), but substantial discrepancy was found for the remaining six (29%) probably due to large perceived differences in polyp size between CT and OC. Readers were able to match between 27 (71%) and 35 (92%) of the 38 CTC detected polyps in the seven cases with multiple polyps. Experienced CTC readers agree to a considerable extent when matching polyps between CTC and subsequent OC, but non-negligible disagreement exists.
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Affiliation(s)
- Marjolein H Liedenbaum
- Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, Netherlands.
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Abstract
PURPOSE OF REVIEW Computed tomographic colonography is a new and noninvasive method to evaluate the colon. The goal of this review is to discuss the latest data and define outstanding issues related to computed tomographic colonography. RECENT FINDINGS Computed tomographic colonography is gaining momentum as a potential primary colon cancer screening method in the USA. Although not as accurate as colonoscopy, the accuracy of computed tomographic colonography for detection of large lesions appears to be in the 80-90% range. The field is rapidly evolving, not only in terms of technology but also in a variety of other practical areas. SUMMARY Current data suggest that computed tomographic colonography is a viable colon cancer screening modality in the USA. However, it is not ready for widespread implementation, largely because of lack of standards for training and reading and the fact that the number of skilled readers is limited.
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Roy HK, Gomes A, Turzhitsky V, Goldberg MJ, Rogers J, Ruderman S, L YK, Kromine A, Brand RE, Jameel M, Vakil P, Hasabou N, Backman V. Spectroscopic microvascular blood detection from the endoscopically normal colonic mucosa: biomarker for neoplasia risk. Gastroenterology 2008; 135:1069-78. [PMID: 18722372 PMCID: PMC3405534 DOI: 10.1053/j.gastro.2008.06.046] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Revised: 06/11/2008] [Accepted: 06/19/2008] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS We previously used a novel biomedical optics technology, 4-dimensional elastically scattered light fingerprinting, to show that in experimental colon carcinogenesis the predysplastic epithelial microvascular blood content is increased markedly. To assess the potential clinical translatability of this putative field effect marker, we characterized the early increase in blood supply (EIBS) in human beings in vivo. METHODS We developed a novel, endoscopically compatible, polarization-gated, spectroscopic probe that was capable of measuring oxygenated and deoxygenated (Dhb) hemoglobin specifically in the mucosal microcirculation through polarization gating. Microvascular blood content was measured in 222 patients from the endoscopically normal cecum, midtransverse colon, and rectum. If a polyp was present, readings were taken from the polyp tissue along with the normal mucosa 10-cm and 30-cm proximal and distal to the lesion. RESULTS Tissue phantom studies showed that the probe had outstanding accuracy for hemoglobin determination (r(2) = 0.99). Augmentation of microvasculature blood content was most pronounced within the most superficial ( approximately 100 microm) layer and dissipated in deeper layers (ie, submucosa). EIBS was detectable within 30 cm from the lesion and the magnitude mirrored adenoma proximity. This occurred for both oxygenated hemoglobin and DHb, with the effect size being slightly greater for DHb. EIBS correlated with adenoma size and was not engendered by nonneoplastic (hyperplastic) polyps. CONCLUSIONS We show, herein, that in vivo microvascular blood content can be measured and provides an accurate marker of field carcinogenesis. This technological/biological advance has numerous potential applications in colorectal cancer screening such as improved polyp detection and risk stratification.
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Affiliation(s)
- Hemant K. Roy
- Dept of Internal Medicine, Evanston-Northwestern Healthcare, Evanston IL
| | - Andrew Gomes
- Biomedical Engineering Department, Northwestern University, Evanston IL
| | | | - Michael J Goldberg
- Dept of Internal Medicine, Evanston-Northwestern Healthcare, Evanston IL
| | - Jeremy Rogers
- Biomedical Engineering Department, Northwestern University, Evanston IL
| | - Sarah Ruderman
- Biomedical Engineering Department, Northwestern University, Evanston IL
| | - Young Kim L
- Dept of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh PA
| | - Alex Kromine
- Biomedical Engineering Department, Northwestern University, Evanston IL
| | - Randall E. Brand
- Dept of Biomedical Engineering, Purdue University, West Lafayette IN
| | - Mohammed Jameel
- Dept of Internal Medicine, Evanston-Northwestern Healthcare, Evanston IL
| | - Parmede Vakil
- Biomedical Engineering Department, Northwestern University, Evanston IL
| | - Nahla Hasabou
- Dept of Internal Medicine, Evanston-Northwestern Healthcare, Evanston IL
| | - Vadim Backman
- Biomedical Engineering Department, Northwestern University, Evanston IL
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15
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Buchner AM, Wallace MB. Future expectations in digestive endoscopy: competition with other novel imaging techniques. Best Pract Res Clin Gastroenterol 2008; 22:971-87. [PMID: 18790442 DOI: 10.1016/j.bpg.2008.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Digestive endoscopy has been evolving from primary diagnostic to extensive therapeutic modalities in the management of gastrointestinal diseases. The present endoscopic imaging includes (A) standard endoscopy alone and /or with adjunct technologies such as point enhancement, e.g. confocal endomicroscopy and field enhancement technologies such as chromoendoscopy, NBI and FICE and (B) endoscopic ultrasound. Other novel imaging technologies including virtual colonoscopy or CT/MR colonography, CT or MRI enterography and capsule endoscopy have also been developed. This article reviews the diagnostic and therapeutic role of digestive endoscopy and future directions of digestive endoscopy are discussed. Digestive endoscopy is also compared with emerging novel imaging techniques in gastrointestinal diseases such as capsule endoscopy and CT colonography. The fact that digestive endoscopy has become a multidisciplinary specialty combining advances in all fields (radiology, bioengineering, surgery and gastroenterology) is highlighted.
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Affiliation(s)
- Anna M Buchner
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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16
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Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Bond J, Dash C, Giardiello FM, Glick S, Johnson D, Johnson CD, Levin TR, Pickhardt PJ, Rex DK, Smith RA, Thorson A, Winawer SJ. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 2008; 134:1570-95. [PMID: 18384785 DOI: 10.1053/j.gastro.2008.02.002] [Citation(s) in RCA: 1419] [Impact Index Per Article: 88.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer. CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized. In 2006 to 2007, the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average-risk adults. In this update of each organization's guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy. When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that primarily is effective at early cancer detection and a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps. It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening.
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Affiliation(s)
- Bernard Levin
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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