Using CT colonography as a triage technique after a positive faecal occult blood test in colorectal cancer screening
Identifieur interne : 000055 ( Ncbi/Merge ); précédent : 000054; suivant : 000056Using 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
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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></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. 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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Winawer, S" uniqKey="Winawer S">S Winawer</name></author><author><name sortKey="Fletcher, R" uniqKey="Fletcher R">R Fletcher</name></author><author><name sortKey="Rex, D" uniqKey="Rex D">D Rex</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bond, Jh" uniqKey="Bond J">JH Bond</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hardcastle, Jd" uniqKey="Hardcastle J">JD Hardcastle</name></author><author><name sortKey="Chamberlain, Jo" uniqKey="Chamberlain J">JO Chamberlain</name></author><author><name sortKey="Robinson, Mh" uniqKey="Robinson M">MH 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Gut</journal-id><journal-id journal-id-type="publisher-id">gut</journal-id><journal-id journal-id-type="hwp">gutjnl</journal-id><journal-title-group><journal-title>Gut</journal-title></journal-title-group><issn pub-type="ppub">0017-5749</issn><issn pub-type="epub">1468-3288</issn><publisher><publisher-name>BMJ Group</publisher-name><publisher-loc>BMA House, Tavistock Square, London, WC1H 9JR</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">19625276</article-id><article-id pub-id-type="pmc">2719082</article-id><article-id pub-id-type="publisher-id">gt176867</article-id><article-id pub-id-type="doi">10.1136/gut.2009.176867</article-id><article-categories><subj-group subj-group-type="heading"><subject>Colorectal Cancer</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>1506</subject></subj-group></article-categories><title-group><article-title>Using CT colonography as a triage technique after a positive faecal occult blood test in colorectal cancer screening</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Liedenbaum</surname><given-names>M H</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>van Rijn</surname><given-names>A F</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>de Vries</surname><given-names>A H</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Dekker</surname><given-names>H M</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Thomeer</surname><given-names>M</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>van Marrewijk</surname><given-names>C J</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Hol</surname><given-names>L</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Dijkgraaf</surname><given-names>M G W</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Fockens</surname><given-names>P</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Bossuyt</surname><given-names>P M M</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Dekker</surname><given-names>E</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Stoker</surname><given-names>J</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Academic Medical Centre Amsterdam, The Netherlands</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Radboud University Nijmegen Medical Centre, The Netherlands</addr-line></aff><aff id="aff3"><label>3</label><addr-line>Erasmus Medical Centre Rotterdam, The Netherlands</addr-line></aff><author-notes><corresp>Correspondence to: Mrs M H Liedenbaum, Department of Radiology, G1-226, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; <email>M.H.Liedenbaum@amc.uva.nl</email></corresp></author-notes><pub-date pub-type="collection"><year>2009</year></pub-date><pub-date pub-type="ppub"><month>9</month><year>2009</year></pub-date><pub-date pub-type="epub"><day>4</day><month>8</month><year>2009</year></pub-date><pub-date pub-type="pmc-release"><day>4</day><month>8</month><year>2009</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
<volume>58</volume><issue>9</issue><fpage>1242</fpage><lpage>1249</lpage><history><date date-type="rev-recd"><day>31</day><month>3</month><year>2009</year></date><date date-type="accepted"><day>1</day><month>4</month><year>2009</year></date></history><permissions><copyright-statement>© Liedenbaum et al 2009</copyright-statement><copyright-year>2009</copyright-year><license license-type="openaccess" xlink:href="http://creativecommons.org/licenses/by/2.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><self-uri xlink:title="pdf" xlink:type="simple" xlink:href="GUT-58-09-1242.pdf"></self-uri><abstract><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. 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.</p></sec></abstract></article-meta></front></pmc><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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