Computed Tomography Colonography vs Colonoscopy for Colorectal Cancer Surveillance After Surgery

David S. Weinberg, Perry J. Pickhardt, David H. Bruining, Kristin Edwards, Joel G. Fletcher, Marc J. Gollub, Eileen M. Keenan, Sonia S. Kupfer, Tianyu Li, Sam J. Lubner, Arnold J. Markowitz, Eric A. Ross

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Background & Aims: Recommendations for surveillance after curative surgery for colorectal cancer (CRC) include a 1-year post-resection abdominal-pelvic computed tomography (CT) scan and optical colonoscopy (OC). CT colonography (CTC), when used in CRC screening, effectively identifies colorectal polyps ≥10 mm and cancers. We performed a prospective study to determine whether CTC, concurrent with CT, could substitute for OC in CRC surveillance. Methods: Our study enrolled 231 patients with resected stage 0–III CRC, identified at 5 tertiary care academic centers. Approximately 1 year after surgery, participants underwent outpatient CTC plus CT, followed by same-day OC. CTC results were revealed after endoscopic visualization of sequential colonic segments, which were re-examined for discordant findings. The primary outcome was performance of CTC in the detection of colorectal adenomas and cancers using endoscopy as the reference standard. Results: Of the 231 participants, 116 (50.2%) had polyps of any size or histology identified by OC, and 15.6% had conventional adenomas and/or serrated polyps ≥6 mm. No intra-luminal cancers were detected. CTC detected patients with polyps of ≥6 mm with 44.0% sensitivity (95% CI, 30.2–57.8) and 93.4% specificity (95% CI, 89.7–97.0). CTC detected polyps ≥10 mm with 76.9% sensitivity (95% CI, 54.0–99.8) and 89.0% specificity (95% CI, 84.8–93.1). Similar values were found when only adenomatous polyps were considered. The negative predictive value of CTC for adenomas ≥6 mm was 90.7% (95% CI, 86.7–94.5) and for adenomas ≥10 mm the negative predictive value was 98.6% (95% CI, 97.0–100). Conclusions: In a CRC surveillance population 1 year following resection, CTC was inferior to OC for detecting patients with polyps ≥6 mm. Clinical Trials.gov Registration Number: NCT02143115.

Original languageEnglish (US)
Pages (from-to)927-934.e4
JournalGastroenterology
Volume154
Issue number4
DOIs
StatePublished - Mar 2018

Keywords

  • CT Colonography
  • Colonoscopy
  • Colorectal Cancer
  • Surveillance

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Weinberg, D. S., Pickhardt, P. J., Bruining, D. H., Edwards, K., Fletcher, J. G., Gollub, M. J., Keenan, E. M., Kupfer, S. S., Li, T., Lubner, S. J., Markowitz, A. J., & Ross, E. A. (2018). Computed Tomography Colonography vs Colonoscopy for Colorectal Cancer Surveillance After Surgery. Gastroenterology, 154(4), 927-934.e4. https://doi.org/10.1053/j.gastro.2017.11.025