Computed Tomographic Colonography (Virtual Colonoscopy)

A Multicenter Comparison with Standard Colonoscopy for Detection of Colorectal Neoplasia

Peter B. Cotton, Valerie L. Durkalski, Benoit C. Pineau, Yuko Y. Palesch, Patrick D. Mauldin, Brenda Hoffman, David J. Vining, William C. Small, John Affronti, Douglas Rex, Kenyon K. Kopecky, Susan Ackerman, J. Steven Burdick, Cecelia Brewington, Mary A. Turner, Alvin Zfass, Andrew R. Wright, Revathy B. Iyer, Patrick Lynch, Michael V. Sivak & 1 others Harold Butler

Research output: Contribution to journalArticle

561 Citations (Scopus)

Abstract

Context: Conventional colonoscopy is the best available method for detection of colorectal cancer; however, it is invasive and not without risk. Computed tomographic colonography (CTC), also known as virtual colonoscopy, has been reported to be reasonably accurate in the diagnosis of colorectal neoplasia in studies performed at expert centers. Objective: To assess the accuracy of CTC in a large number of participants across multiple centers. Design, Setting, and Participants: A nonrandomized, evaluator-blinded, noninferiority study design of 615 participants aged 50 years or older who were referred for routine, clinically indicated colonoscopy in 9 major hospital centers between April 17, 2000, and October 3, 2001. The CTC was performed by using multislice scanners immediately before standard colonoscopy; findings at colonoscopy were reported before and after segmental unblinding to the CTC results. Main Outcome Measures: The sensitivity and specificity of CTC and conventional colonoscopy in detecting participants with lesions sized at least 6 mm. Secondary outcomes included detection of all lesions, detection of advanced lesions, possible technical confounders, participant preferences, and evidence for increasing accuracy with experience. Results: A total of 827 lesions were detected in 308 of 600 participants who underwent both procedures; 104 participants had lesions sized at least 6 mm. The sensitivity of CTC for detecting participants with 1 or more lesions sized at least 6 mm was 39.0% (95% confidence interval [CI], 29.6%-48.4%) and for lesions sized at least 10 mm, it was 55.0% (95% CI, 39.9%-70.0%). These results were significantly lower than those for conventional colonoscopy, with sensitivities of 99.0% (95% CI, 97.1%->99.9%) and 100%, respectively. A total of 496 participants were without any lesion sized at least 6 mm. The specificity of CTC and conventional colonoscopy for detecting participants without any lesion sized at least 6 mm was 90.5% (95% CI, 87.9%-93.1%) and 100%, respectively, and without lesions sized at least 10 mm, 96.0% (95% CI, 94.3%-97.6%) and 100%, respectively. Computed tomographic colonography missed 2 of 8 cancers. The accuracy of CTC varied considerably between centers and did not improve as the study progressed. Participants expressed no clear preference for either technique. Conclusions: Computed tomographic colonography by these methods is not yet ready for widespread clinical application. Techniques and training need to be improved.

Original languageEnglish
Pages (from-to)1713-1719
Number of pages7
JournalJournal of the American Medical Association
Volume291
Issue number14
DOIs
StatePublished - Apr 14 2004

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Computed Tomographic Colonography
Colonoscopy
Neoplasms
Confidence Intervals
Colorectal Neoplasms
Teaching

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Computed Tomographic Colonography (Virtual Colonoscopy) : A Multicenter Comparison with Standard Colonoscopy for Detection of Colorectal Neoplasia. / Cotton, Peter B.; Durkalski, Valerie L.; Pineau, Benoit C.; Palesch, Yuko Y.; Mauldin, Patrick D.; Hoffman, Brenda; Vining, David J.; Small, William C.; Affronti, John; Rex, Douglas; Kopecky, Kenyon K.; Ackerman, Susan; Burdick, J. Steven; Brewington, Cecelia; Turner, Mary A.; Zfass, Alvin; Wright, Andrew R.; Iyer, Revathy B.; Lynch, Patrick; Sivak, Michael V.; Butler, Harold.

In: Journal of the American Medical Association, Vol. 291, No. 14, 14.04.2004, p. 1713-1719.

Research output: Contribution to journalArticle

Cotton, PB, Durkalski, VL, Pineau, BC, Palesch, YY, Mauldin, PD, Hoffman, B, Vining, DJ, Small, WC, Affronti, J, Rex, D, Kopecky, KK, Ackerman, S, Burdick, JS, Brewington, C, Turner, MA, Zfass, A, Wright, AR, Iyer, RB, Lynch, P, Sivak, MV & Butler, H 2004, 'Computed Tomographic Colonography (Virtual Colonoscopy): A Multicenter Comparison with Standard Colonoscopy for Detection of Colorectal Neoplasia', Journal of the American Medical Association, vol. 291, no. 14, pp. 1713-1719. https://doi.org/10.1001/jama.291.14.1713
Cotton, Peter B. ; Durkalski, Valerie L. ; Pineau, Benoit C. ; Palesch, Yuko Y. ; Mauldin, Patrick D. ; Hoffman, Brenda ; Vining, David J. ; Small, William C. ; Affronti, John ; Rex, Douglas ; Kopecky, Kenyon K. ; Ackerman, Susan ; Burdick, J. Steven ; Brewington, Cecelia ; Turner, Mary A. ; Zfass, Alvin ; Wright, Andrew R. ; Iyer, Revathy B. ; Lynch, Patrick ; Sivak, Michael V. ; Butler, Harold. / Computed Tomographic Colonography (Virtual Colonoscopy) : A Multicenter Comparison with Standard Colonoscopy for Detection of Colorectal Neoplasia. In: Journal of the American Medical Association. 2004 ; Vol. 291, No. 14. pp. 1713-1719.
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abstract = "Context: Conventional colonoscopy is the best available method for detection of colorectal cancer; however, it is invasive and not without risk. Computed tomographic colonography (CTC), also known as virtual colonoscopy, has been reported to be reasonably accurate in the diagnosis of colorectal neoplasia in studies performed at expert centers. Objective: To assess the accuracy of CTC in a large number of participants across multiple centers. Design, Setting, and Participants: A nonrandomized, evaluator-blinded, noninferiority study design of 615 participants aged 50 years or older who were referred for routine, clinically indicated colonoscopy in 9 major hospital centers between April 17, 2000, and October 3, 2001. The CTC was performed by using multislice scanners immediately before standard colonoscopy; findings at colonoscopy were reported before and after segmental unblinding to the CTC results. Main Outcome Measures: The sensitivity and specificity of CTC and conventional colonoscopy in detecting participants with lesions sized at least 6 mm. Secondary outcomes included detection of all lesions, detection of advanced lesions, possible technical confounders, participant preferences, and evidence for increasing accuracy with experience. Results: A total of 827 lesions were detected in 308 of 600 participants who underwent both procedures; 104 participants had lesions sized at least 6 mm. The sensitivity of CTC for detecting participants with 1 or more lesions sized at least 6 mm was 39.0{\%} (95{\%} confidence interval [CI], 29.6{\%}-48.4{\%}) and for lesions sized at least 10 mm, it was 55.0{\%} (95{\%} CI, 39.9{\%}-70.0{\%}). These results were significantly lower than those for conventional colonoscopy, with sensitivities of 99.0{\%} (95{\%} CI, 97.1{\%}->99.9{\%}) and 100{\%}, respectively. A total of 496 participants were without any lesion sized at least 6 mm. The specificity of CTC and conventional colonoscopy for detecting participants without any lesion sized at least 6 mm was 90.5{\%} (95{\%} CI, 87.9{\%}-93.1{\%}) and 100{\%}, respectively, and without lesions sized at least 10 mm, 96.0{\%} (95{\%} CI, 94.3{\%}-97.6{\%}) and 100{\%}, respectively. Computed tomographic colonography missed 2 of 8 cancers. The accuracy of CTC varied considerably between centers and did not improve as the study progressed. Participants expressed no clear preference for either technique. Conclusions: Computed tomographic colonography by these methods is not yet ready for widespread clinical application. Techniques and training need to be improved.",
author = "Cotton, {Peter B.} and Durkalski, {Valerie L.} and Pineau, {Benoit C.} and Palesch, {Yuko Y.} and Mauldin, {Patrick D.} and Brenda Hoffman and Vining, {David J.} and Small, {William C.} and John Affronti and Douglas Rex and Kopecky, {Kenyon K.} and Susan Ackerman and Burdick, {J. Steven} and Cecelia Brewington and Turner, {Mary A.} and Alvin Zfass and Wright, {Andrew R.} and Iyer, {Revathy B.} and Patrick Lynch and Sivak, {Michael V.} and Harold Butler",
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TY - JOUR

T1 - Computed Tomographic Colonography (Virtual Colonoscopy)

T2 - A Multicenter Comparison with Standard Colonoscopy for Detection of Colorectal Neoplasia

AU - Cotton, Peter B.

AU - Durkalski, Valerie L.

AU - Pineau, Benoit C.

AU - Palesch, Yuko Y.

AU - Mauldin, Patrick D.

AU - Hoffman, Brenda

AU - Vining, David J.

AU - Small, William C.

AU - Affronti, John

AU - Rex, Douglas

AU - Kopecky, Kenyon K.

AU - Ackerman, Susan

AU - Burdick, J. Steven

AU - Brewington, Cecelia

AU - Turner, Mary A.

AU - Zfass, Alvin

AU - Wright, Andrew R.

AU - Iyer, Revathy B.

AU - Lynch, Patrick

AU - Sivak, Michael V.

AU - Butler, Harold

PY - 2004/4/14

Y1 - 2004/4/14

N2 - Context: Conventional colonoscopy is the best available method for detection of colorectal cancer; however, it is invasive and not without risk. Computed tomographic colonography (CTC), also known as virtual colonoscopy, has been reported to be reasonably accurate in the diagnosis of colorectal neoplasia in studies performed at expert centers. Objective: To assess the accuracy of CTC in a large number of participants across multiple centers. Design, Setting, and Participants: A nonrandomized, evaluator-blinded, noninferiority study design of 615 participants aged 50 years or older who were referred for routine, clinically indicated colonoscopy in 9 major hospital centers between April 17, 2000, and October 3, 2001. The CTC was performed by using multislice scanners immediately before standard colonoscopy; findings at colonoscopy were reported before and after segmental unblinding to the CTC results. Main Outcome Measures: The sensitivity and specificity of CTC and conventional colonoscopy in detecting participants with lesions sized at least 6 mm. Secondary outcomes included detection of all lesions, detection of advanced lesions, possible technical confounders, participant preferences, and evidence for increasing accuracy with experience. Results: A total of 827 lesions were detected in 308 of 600 participants who underwent both procedures; 104 participants had lesions sized at least 6 mm. The sensitivity of CTC for detecting participants with 1 or more lesions sized at least 6 mm was 39.0% (95% confidence interval [CI], 29.6%-48.4%) and for lesions sized at least 10 mm, it was 55.0% (95% CI, 39.9%-70.0%). These results were significantly lower than those for conventional colonoscopy, with sensitivities of 99.0% (95% CI, 97.1%->99.9%) and 100%, respectively. A total of 496 participants were without any lesion sized at least 6 mm. The specificity of CTC and conventional colonoscopy for detecting participants without any lesion sized at least 6 mm was 90.5% (95% CI, 87.9%-93.1%) and 100%, respectively, and without lesions sized at least 10 mm, 96.0% (95% CI, 94.3%-97.6%) and 100%, respectively. Computed tomographic colonography missed 2 of 8 cancers. The accuracy of CTC varied considerably between centers and did not improve as the study progressed. Participants expressed no clear preference for either technique. Conclusions: Computed tomographic colonography by these methods is not yet ready for widespread clinical application. Techniques and training need to be improved.

AB - Context: Conventional colonoscopy is the best available method for detection of colorectal cancer; however, it is invasive and not without risk. Computed tomographic colonography (CTC), also known as virtual colonoscopy, has been reported to be reasonably accurate in the diagnosis of colorectal neoplasia in studies performed at expert centers. Objective: To assess the accuracy of CTC in a large number of participants across multiple centers. Design, Setting, and Participants: A nonrandomized, evaluator-blinded, noninferiority study design of 615 participants aged 50 years or older who were referred for routine, clinically indicated colonoscopy in 9 major hospital centers between April 17, 2000, and October 3, 2001. The CTC was performed by using multislice scanners immediately before standard colonoscopy; findings at colonoscopy were reported before and after segmental unblinding to the CTC results. Main Outcome Measures: The sensitivity and specificity of CTC and conventional colonoscopy in detecting participants with lesions sized at least 6 mm. Secondary outcomes included detection of all lesions, detection of advanced lesions, possible technical confounders, participant preferences, and evidence for increasing accuracy with experience. Results: A total of 827 lesions were detected in 308 of 600 participants who underwent both procedures; 104 participants had lesions sized at least 6 mm. The sensitivity of CTC for detecting participants with 1 or more lesions sized at least 6 mm was 39.0% (95% confidence interval [CI], 29.6%-48.4%) and for lesions sized at least 10 mm, it was 55.0% (95% CI, 39.9%-70.0%). These results were significantly lower than those for conventional colonoscopy, with sensitivities of 99.0% (95% CI, 97.1%->99.9%) and 100%, respectively. A total of 496 participants were without any lesion sized at least 6 mm. The specificity of CTC and conventional colonoscopy for detecting participants without any lesion sized at least 6 mm was 90.5% (95% CI, 87.9%-93.1%) and 100%, respectively, and without lesions sized at least 10 mm, 96.0% (95% CI, 94.3%-97.6%) and 100%, respectively. Computed tomographic colonography missed 2 of 8 cancers. The accuracy of CTC varied considerably between centers and did not improve as the study progressed. Participants expressed no clear preference for either technique. Conclusions: Computed tomographic colonography by these methods is not yet ready for widespread clinical application. Techniques and training need to be improved.

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