 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||
19 April 2005 | Volume 142 Issue 8 | Pages 635-650
Background: Computed tomographic (CT) colonography, also called virtual colonoscopy, is an evolving technology under evaluation as a new method of screening for colorectal cancer. However, its performance as a test has varied widely across studies, and the reasons for these discrepancies are poorly defined.
Purpose: To systematically review the test performance of CT colonography compared to colonoscopy or surgery and to assess variables that may affect test performance.
Data Sources: The PubMed, MEDLINE, and EMBASE databases and the Cochrane Controlled Trials Register were searched for English-language articles published between January 1975 and February 2005.
Study Selection: Prospective studies of adults undergoing CT colonography after full bowel preparation, with colonoscopy or surgery as the gold standard, were selected. Studies had to have used state-of-the-art technology, including at least a single-detector CT scanner with supine and prone positioning, insufflation of the colon with air or carbon dioxide, collimation smaller than 5 mm, and both 2-dimensional and 3-dimensional views during scan interpretation. The evaluators of the colonogram had to be unaware of the findings from use of the gold standard test.
Data on sensitivity and specificity overall and for detection of polyps less than 6 mm, 6 to 9 mm, and greater than 9 mm in size were abstracted. Sensitivities and specificities weighted by sample size were calculated, and heterogeneity was explored by using stratified analyses and meta-regression.
Data Synthesis: 33 studies provided data on 6393 patients. The sensitivity of CT colonography was heterogeneous but improved as polyp size increased (48% [95% CI, 25% to 70%] for detection of polyps <6 mm, 70% [CI, 55% to 84%] for polyps 6 to 9 mm, and 85% [CI, 79% to 91%] for polyps >9 mm). Characteristics of the CT colonography scanner, including width of collimation, type of detector, and mode of imaging, explained some of this heterogeneity. In contrast, specificity was homogenous (92% [CI, 89% to 96%] for detection of polyps <6 mm, 93% [CI, 91% to 95%] for polyps 6 to 9 mm, and 97% [CI, 96% to 97%] for polyps >9 mm).
Limitations: The studies differed widely, and the extractable variables explained only a small amount of the heterogeneity. In addition, only a few studies examined the newest CT colonography technology.
Conclusions: Computed tomographic colonography is highly specific, but the range of reported sensitivities is wide. Patient or scanner characteristics do not fully account for this variability, but collimation, type of scanner, and mode of imaging explain some of the discrepancy. This heterogeneity raises concerns about consistency of performance and about technical variability. These issues must be resolved before CT colonography can be advocated for generalized screening for colorectal cancer.
Author and Article Information
From Walter Reed Army Medical Center and Uniformed Services University, Washington, DC.
Disclaimer: The opinions and assertions contained herein are the private views of the authors and are not be to be construed as reflecting the views of the Department of the Army or the Department of Defense.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Brian P. Mulhall, MD, MPH, Gastroenterology Service, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Building 2, 7F18, Washington, DC 20307; e-mail, brian.mulhall{at}na.amedd.army.mil.
Current Author Addresses: Dr. Mulhall: Gastroenterology Service, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Building 2, 7F18, Washington, DC 20307.
Dr. Veerappan: Department of Medicine, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Building 2, 7F18, Washington, DC 20307.
Dr. Jackson: Medicine-EDP, 4301 Jones Bridge Road, Bethesda, MD 20814. REVIEW
Meta-Analysis: Computed Tomographic Colonography
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  E. P. Whitlock, J. S. Lin, E. Liles, T. L. Beil, and R. Fu Screening for Colorectal Cancer: A Targeted, Updated Systematic Review for the U.S. Preventive Services Task Force Ann Intern Med, October 6, 2008; (2008) 0000605-200811040-00245. [Abstract] [Full Text]
|
|
|
|
 |
|
 D. Hock, R. Ouhadi, R. Materne, A.-S. Aouchria, I. Mancini, T. Broussaud, P. Magotteaux, and A. Nchimi Virtual Dissection CT Colonography: Evaluation of Learning Curves and Reading Times with and without Computer-aided Detection Radiology, September 1, 2008; 248(3): 860 - 868. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. An, K. H. Lee, Y. H. Kim, S. H. Park, H. Y. Kim, S. H. Kim, and N. Kim Screening CT Colonography in an Asymptomatic Average-Risk Asian Population: A 2-Year Experience in a Single Institution Am. J. Roentgenol., September 1, 2008; 191(3): W100 - W106. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J J Y Sung, J Y W Lau, G P Young, Y Sano, H M Chiu, J S Byeon, K G Yeoh, K L Goh, J Sollano, R Rerknimitr, et al. Asia Pacific consensus recommendations for colorectal cancer screening Gut, August 1, 2008; 57(8): 1166 - 1176. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. H. Kim, J. M. Lee, C.-I. Shin, H. C. Kim, J.-G. Lee, J. H. Kim, J. Y. Choi, H. W. Eun, J. K. Han, J. Y. Lee, et al. Effects of Spatial Resolution and Tube Current on Computer-aided Detection of Polyps on CT Colonographic Images: Phantom Study Radiology, August 1, 2008; 248(2): 492 - 503. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. W. Iqbal, D. C. Cullinane, H. J. Schiller, M. D. Sawyer, S. P. Zietlow, and D. R. Farley Surgical Management and Outcomes of 165 Colonoscopic Perforations From a Single Institution Arch Surg, July 1, 2008; 143(7): 701 - 707. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Levin, D. A. Lieberman, B. McFarland, R. A. Smith, D. Brooks, K. S. Andrews, C. Dash, F. M. Giardiello, S. Glick, T. R. Levin, et al. 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 CA Cancer J Clin, May 1, 2008; 58(3): 130 - 160. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Hassan, P. Pickhardt, A. Laghi, D. Kim, A. Zullo, F. Iafrate, L. Di Giulio, and S. Morini Computed Tomographic Colonography to Screen for Colorectal Cancer, Extracolonic Cancer, and Aortic Aneurysm: Model Simulation With Cost-effectiveness Analysis Arch Intern Med, April 14, 2008; 168(7): 696 - 705. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Pickhardt, C. Hassan, A. Laghi, D. H. Kim, A. Zullo, F. Iafrate, and S. Morini Is There Sufficient MDCT Capacity to Provide Colorectal Cancer Screening with CT Colonography for the U.S. Population? Am. J. Roentgenol., April 1, 2008; 190(4): 1044 - 1049. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. D. Johnson, A. Manduca, J. G. Fletcher, R. L. MacCarty, M. J. Carston, W. S. Harmsen, and J. N. Mandrekar Noncathartic CT Colonography with Stool Tagging: Performance With and Without Electronic Stool Subtraction Am. J. Roentgenol., February 1, 2008; 190(2): 361 - 366. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Sosna, T. Sella, O. Sy, P. T. Lavin, R. Eliahou, S. Fraifeld, and E. Libson Critical Analysis of the Performance of Double-Contrast Barium Enema for Detecting Colorectal Polyps >= 6 mm in the Era of CT Colonography Am. J. Roentgenol., February 1, 2008; 190(2): 374 - 385. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Pickhardt, C. Hassan, A. Laghi, A. Zullo, D. H. Kim, F. Iafrate, and S. Morini Small and Diminutive Polyps Detected at Screening CT Colonography: A Decision Analysis for Referral to Colonoscopy Am. J. Roentgenol., January 1, 2008; 190(1): 136 - 144. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Burton, G Brown, N Bees, A Norman, O Biedrzycki, A Arnaout, A M Abulafi, and R I Swift Accuracy of CT prediction of poor prognostic features in colonic cancer Br. J. Radiol., January 1, 2008; 81(961): 10 - 19. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Burling, J. E East, and S. A Taylor Investigating rectal bleeding BMJ, December 15, 2007; 335(7632): 1260 - 1262. [Full Text] [PDF]
|
|
|
|
|
|
K. K. Deshpande, R. M. Summers, R. L. Van Uitert, M. Franaszek, L. Brown, A. J. Dwyer, J. G. Fletcher, J. R. Choi, and P. J. Pickhardt Quality Assessment for CT Colonography: Validation of Automated Measurement of Colonic Distention and Residual Fluid Am. J. Roentgenol., December 1, 2007; 189(6): 1457 - 1463. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. B Ballinger and C. Anggiansah Colorectal cancer BMJ, October 6, 2007; 335(7622): 715 - 718. [Full Text] [PDF]
|
|
|
|
|
|
M. E. Baker, L. Bogoni, N. A. Obuchowski, C. Dass, R. M. Kendzierski, E. M. Remer, D. M. Einstein, P. Cathier, A. Jerebko, S. Lakare, et al. Computer-aided Detection of Colorectal Polyps: Can It Improve Sensitivity of Less-Experienced Readers? Preliminary Findings Radiology, October 1, 2007; 245(1): 140 - 149. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. D. Johnson, J. G. Fletcher, R. L. MacCarty, J. N. Mandrekar, W. S. Harmsen, P. J. Limburg, and L. A. Wilson Effect of Slice Thickness and Primary 2D Versus 3D Virtual Dissection on Colorectal Lesion Detection at CT Colonography in 452 Asymptomatic Adults Am. J. Roentgenol., September 1, 2007; 189(3): 672 - 680. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. H. Kim, J. M. Lee, H. W. Eun, M. W. Lee, J. K. Han, J. Y. Lee, and B. I. Choi Two- versus Three-dimensional Colon Evaluation with Recently Developed Virtual Dissection Software for CT Colonography Radiology, September 1, 2007; 244(3): 852 - 864. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. K. Choi, S. H. Park, D. Y. Kim, and H. K. Ha Malignant Rectal Polyp Overlooked on CT Colonography Because of Retention Balloon: Opposing Crescent Appearance as Sign of Compressed Polyp Am. J. Roentgenol., July 1, 2007; 189(1): W1 - W3. [Full Text] [PDF]
|
|
|
|
|
|
S. Halligan and D. G. Altman Evidence-based Practice in Radiology: Steps 3 and 4--Appraise and Apply Systematic Reviews and Meta-Analyses Radiology, April 1, 2007; 243(1): 13 - 27. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. S. WERDERMAN CT Colonography Radiol. Technol., March 1, 2007; 78(4): 309CT - 324CT. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Veit-Haibach, C. A. Kuehle, T. Beyer, H. Stergar, H. Kuehl, J. Schmidt, G. Borsch, G. Dahmen, J. Barkhausen, A. Bockisch, et al. Diagnostic Accuracy of Colorectal Cancer Staging With Whole-Body PET/CT Colonography JAMA, December 6, 2006; 296(21): 2590 - 2600. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J Solomon, S. J Lord, and S. Walleser Review: computed tomographic colonography is accurate for medium and large colorectal polyps and cancer Evid. Based Med., October 1, 2006; 11(5): 153 - 153. [Full Text] [PDF]
|
|
|
|
 |
|
 Population screening for colorectal cancer DTB, September 1, 2006; 44(9): 65 - 68. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. T. Ferrucci Double-contrast barium enema: use in practice and implications for CT colonography. Am. J. Roentgenol., July 1, 2006; 187(1): 170 - 173. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. C. Taylor A 71-Year-Old Woman Contemplating a Screening Colonoscopy JAMA, March 8, 2006; 295(10): 1161 - 1167. [Full Text] [PDF]
|
|
|
|
|
|
ADDITIONAL ARTICLES ABSTRACTED IN ACP JOURNAL CLUB Evid. Based Med., December 1, 2005; 10(6): 188 - 188. [Full Text] [PDF]
|
|
|
|
|
|
JournalScan Gut, July 1, 2005; 54(7): 1044 - 1044. [Full Text] [PDF]
|
|
|
|
|
|
A. Tonks What's new in the other general journals BMJ, April 30, 2005; 330(7498): 989 - 990. [Full Text] [PDF]
|
|
|
|
|
|
T. F. Imperiale Can Computed Tomographic Colonography Become a "Good" Screening Test? Ann Intern Med, April 19, 2005; 142(8): 669 - 670. [Full Text] [PDF]
|
|
Read all Rapid Responses
Article
