Using CT colonography as a triage technique after a positive faecal occult blood test in colorectal cancer screening
Identifieur interne : 001053 ( Main/Exploration ); précédent : 001052; suivant : 001054Using CT colonography as a triage technique after a positive faecal occult blood test in colorectal cancer screening
Auteurs : M H Liedenbaum [Pays-Bas] ; A F Van Rijn [Pays-Bas] ; A H De Vries [Pays-Bas] ; H M Dekker [Pays-Bas] ; M. Thomeer [Pays-Bas] ; C J Van Marrewijk [Pays-Bas] ; L. Hol [Pays-Bas] ; M G W. Dijkgraaf [Pays-Bas] ; P. Fockens [Pays-Bas] ; P M M. Bossuyt [Pays-Bas] ; E. Dekker [Pays-Bas] ; J. Stoker [Pays-Bas]Source :
- Gut [ 0017-5749 ] ; 2009.
Abstract
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.
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.
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 ⩾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 ⩾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 ⩾10 mm lesions in 2 patients.
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.
Url:
DOI: 10.1136/gut.2009.176867
PubMed: 19625276
PubMed Central: 2719082
Affiliations:
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Hol</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Erasmus Medical Centre Rotterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Erasmus Medical Centre Rotterdam</wicri:regionArea></affiliation></author><author><name sortKey="Dijkgraaf, M G W" sort="Dijkgraaf, M G W" uniqKey="Dijkgraaf M" first="M G W" last="Dijkgraaf">M G W. Dijkgraaf</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Academic Medical Centre Amsterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Academic Medical Centre Amsterdam</wicri:regionArea></affiliation></author><author><name sortKey="Fockens, P" sort="Fockens, P" uniqKey="Fockens P" first="P" last="Fockens">P. Fockens</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Academic Medical Centre Amsterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Academic Medical Centre Amsterdam</wicri:regionArea></affiliation></author><author><name sortKey="Bossuyt, P M M" sort="Bossuyt, P M M" uniqKey="Bossuyt P" first="P M M" last="Bossuyt">P M M. Bossuyt</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Academic Medical Centre Amsterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Academic Medical Centre Amsterdam</wicri:regionArea></affiliation></author><author><name sortKey="Dekker, E" sort="Dekker, E" uniqKey="Dekker E" first="E" last="Dekker">E. Dekker</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Academic Medical Centre Amsterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Academic Medical Centre Amsterdam</wicri:regionArea></affiliation></author><author><name sortKey="Stoker, J" sort="Stoker, J" uniqKey="Stoker J" first="J" last="Stoker">J. Stoker</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Academic Medical Centre Amsterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Academic Medical Centre Amsterdam</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">19625276</idno><idno type="pmc">2719082</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719082</idno><idno type="RBID">PMC:2719082</idno><idno type="doi">10.1136/gut.2009.176867</idno><date when="2009">2009</date><idno type="wicri:Area/Pmc/Corpus">000369</idno><idno type="wicri:Area/Pmc/Curation">000369</idno><idno type="wicri:Area/Pmc/Checkpoint">000404</idno><idno type="wicri:Area/Ncbi/Merge">000055</idno><idno type="wicri:Area/Ncbi/Curation">000055</idno><idno type="wicri:Area/Ncbi/Checkpoint">000055</idno><idno type="wicri:doubleKey">0017-5749:2009:Liedenbaum M:using:ct:colonography</idno><idno type="wicri:Area/Main/Merge">001055</idno><idno type="wicri:Area/Main/Curation">001053</idno><idno type="wicri:Area/Main/Exploration">001053</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Using CT colonography as a triage technique after a positive faecal occult blood test in colorectal cancer screening</title><author><name sortKey="Liedenbaum, M H" sort="Liedenbaum, M H" uniqKey="Liedenbaum M" first="M H" last="Liedenbaum">M H Liedenbaum</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Academic Medical Centre Amsterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Academic Medical Centre Amsterdam</wicri:regionArea></affiliation></author><author><name sortKey="Van Rijn, A F" sort="Van Rijn, A F" uniqKey="Van Rijn A" first="A F" last="Van Rijn">A F Van Rijn</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Academic Medical Centre Amsterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Academic Medical Centre Amsterdam</wicri:regionArea></affiliation></author><author><name sortKey="De Vries, A H" sort="De Vries, A H" uniqKey="De Vries A" first="A H" last="De Vries">A H De Vries</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Academic Medical Centre Amsterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Academic Medical Centre Amsterdam</wicri:regionArea></affiliation></author><author><name sortKey="Dekker, H M" sort="Dekker, H M" uniqKey="Dekker H" first="H M" last="Dekker">H M Dekker</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Radboud University Nijmegen Medical Centre, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Radboud University Nijmegen Medical Centre</wicri:regionArea></affiliation></author><author><name sortKey="Thomeer, M" sort="Thomeer, M" uniqKey="Thomeer M" first="M" last="Thomeer">M. Thomeer</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Erasmus Medical Centre Rotterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Erasmus Medical Centre Rotterdam</wicri:regionArea></affiliation></author><author><name sortKey="Van Marrewijk, C J" sort="Van Marrewijk, C J" uniqKey="Van Marrewijk C" first="C J" last="Van Marrewijk">C J Van Marrewijk</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Erasmus Medical Centre Rotterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Erasmus Medical Centre Rotterdam</wicri:regionArea></affiliation></author><author><name sortKey="Hol, L" sort="Hol, L" uniqKey="Hol L" first="L" last="Hol">L. Hol</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Erasmus Medical Centre Rotterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Erasmus Medical Centre Rotterdam</wicri:regionArea></affiliation></author><author><name sortKey="Dijkgraaf, M G W" sort="Dijkgraaf, M G W" uniqKey="Dijkgraaf M" first="M G W" last="Dijkgraaf">M G W. Dijkgraaf</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Academic Medical Centre Amsterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Academic Medical Centre Amsterdam</wicri:regionArea></affiliation></author><author><name sortKey="Fockens, P" sort="Fockens, P" uniqKey="Fockens P" first="P" last="Fockens">P. Fockens</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Academic Medical Centre Amsterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Academic Medical Centre Amsterdam</wicri:regionArea></affiliation></author><author><name sortKey="Bossuyt, P M M" sort="Bossuyt, P M M" uniqKey="Bossuyt P" first="P M M" last="Bossuyt">P M M. Bossuyt</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Academic Medical Centre Amsterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Academic Medical Centre Amsterdam</wicri:regionArea></affiliation></author><author><name sortKey="Dekker, E" sort="Dekker, E" uniqKey="Dekker E" first="E" last="Dekker">E. Dekker</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Academic Medical Centre Amsterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Academic Medical Centre Amsterdam</wicri:regionArea></affiliation></author><author><name sortKey="Stoker, J" sort="Stoker, J" uniqKey="Stoker J" first="J" last="Stoker">J. Stoker</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Academic Medical Centre Amsterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Academic Medical Centre Amsterdam</wicri:regionArea></affiliation></author></analytic><series><title level="j">Gut</title><idno type="ISSN">0017-5749</idno><idno type="eISSN">1468-3288</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective:</title><p>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.</p></sec><sec><title>Methods:</title><p>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.</p></sec><sec><title>Results:</title><p>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 ⩾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 ⩾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 ⩾10 mm lesions in 2 patients.</p></sec><sec><title>Conclusion:</title><p>CTC with limited bowel preparation has reasonable predictive values in an FOBT-positive population and a higher acceptability to patients than colonoscopy. 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Plank</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Pays-Bas</li></country></list><tree><country name="Pays-Bas"><noRegion><name sortKey="Liedenbaum, M H" sort="Liedenbaum, M H" uniqKey="Liedenbaum M" first="M H" last="Liedenbaum">M H Liedenbaum</name></noRegion><name sortKey="Bossuyt, P M M" sort="Bossuyt, P M M" uniqKey="Bossuyt P" first="P M M" last="Bossuyt">P M M. Bossuyt</name><name sortKey="De Vries, A H" sort="De Vries, A H" uniqKey="De Vries A" first="A H" last="De Vries">A H De Vries</name><name sortKey="Dekker, E" sort="Dekker, E" uniqKey="Dekker E" first="E" last="Dekker">E. Dekker</name><name sortKey="Dekker, H M" sort="Dekker, H M" uniqKey="Dekker H" first="H M" last="Dekker">H M Dekker</name><name sortKey="Dijkgraaf, M G W" sort="Dijkgraaf, M G W" uniqKey="Dijkgraaf M" first="M G W" last="Dijkgraaf">M G W. Dijkgraaf</name><name sortKey="Fockens, P" sort="Fockens, P" uniqKey="Fockens P" first="P" last="Fockens">P. Fockens</name><name sortKey="Hol, L" sort="Hol, L" uniqKey="Hol L" first="L" last="Hol">L. Hol</name><name sortKey="Stoker, J" sort="Stoker, J" uniqKey="Stoker J" first="J" last="Stoker">J. Stoker</name><name sortKey="Thomeer, M" sort="Thomeer, M" uniqKey="Thomeer M" first="M" last="Thomeer">M. Thomeer</name><name sortKey="Van Marrewijk, C J" sort="Van Marrewijk, C J" uniqKey="Van Marrewijk C" first="C J" last="Van Marrewijk">C J Van Marrewijk</name><name sortKey="Van Rijn, A F" sort="Van Rijn, A F" uniqKey="Van Rijn A" first="A F" last="Van Rijn">A F Van Rijn</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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