1. Diagnostic accuracy of computed tomographic colonography for the detection of advanced neoplasia in individuals at increased risk of colorectal cancer
- Author
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Giovanni Simonetti, Didier Bielen, Giovanni Gandini, Silvia Venturini, G. Galatola, Patrizia Della Monica, Andrea Grasso, Giuseppe Angelelli, Claudia Borghi, Carlo Bartolozzi, Cesare Hassan, Maria Carla Cassinis, Luca Boni, Carlo Senore, Daniele Regge, Teresa Gallo, Maria Cristina Martina, Brunella Barbaro, Paolo Bruzzi, Luigina Bonelli, C. Laudi, Massimo Galia, Andrea Laghi, Emanuele Neri, R. Asnaghi, Regge, D, Laudi, C, Galatola, G, Della Monica, P, Bonelli, L, Angelelli, G, Asnaghi, R, Barbaro, B, Bartolozzi, C, Bielen, D, Boni, L, Borghi, C, Bruzzi, P, Cassinis, MC, Galia, M, Gallo, TM, Grasso, A, Hassan, C, Laghi, A, Martina, MC, Neri, E, Senore, C, Simonetti, G, Venturini, S, and Gandini, G
- Subjects
Male ,occult blood test ,Colorectal cancer ,Colonoscopy ,cancer risk ,prediction and forecasting ,Gastroenterology ,Risk Factors ,cancer diagnosis ,Positive predicative value ,advanced cancer ,Medicine ,Family history ,comparative study ,colorectal adenoma ,family history ,education.field_of_study ,medicine.diagnostic_test ,article ,clinical trial ,General Medicine ,Middle Aged ,priority journal ,risk factor ,Predictive value of tests ,diagnostic accuracy ,Female ,diagnostic value ,Colorectal Neoplasms ,Colonography, Computed Tomographic ,radiography ,Computed Tomographic ,Adult ,medicine.medical_specialty ,Settore MED/12 - GASTROENTEROLOGIA ,Population ,colorectal cancer ,Sensitivity and Specificity ,Predictive Value of Tests ,Internal medicine ,adult ,aged ,cancer classification ,colonoscopy ,computed tomographic colonography ,controlled clinical trial ,controlled study ,cross-sectional study ,female ,human ,major clinical study ,male ,multicenter study ,predictive validity ,colorectal tumor ,middle aged ,sensitivity and specificity ,Aged ,Cross-Sectional Studies ,Humans ,education ,business.industry ,Fecal occult blood ,Sigmoidoscopy ,Colonography ,medicine.disease ,CT colonography, colorectal cancer, screening ,Settore MED/36 - Diagnostica Per Immagini E Radioterapia ,business - Abstract
CONTEXT: Computed tomographic (CT) colonography has been recognized as an alternative for colorectal cancer (CRC) screening in average-risk individuals, but less information is available on its performance in individuals at increased risk of CRC. OBJECTIVE: To assess the accuracy of CT colonography in detecting advanced colorectal neoplasia in asymptomatic individuals at increased risk of CRC using unblinded colonoscopy as the reference standard. DESIGN, SETTING, AND PARTICIPANTS: This was a multicenter, cross-sectional study. Individuals at increased risk of CRC due to either family history of advanced neoplasia in first-degree relatives, personal history of colorectal adenomas, or positive results from fecal occult blood tests (FOBTs) were recruited in 11 Italian centers and 1 Belgian center between December 2004 and May 2007. Each participant underwent CT colonography followed by colonoscopy on the same day. MAIN OUTCOME MEASURES: Sensitivity and specificity of CT colonography in detecting individuals with advanced neoplasia (ie, advanced adenoma or CRC) 6 mm or larger. RESULTS: Of 1103 participants, 937 were included in the final analysis: 373 cases in the family-history group, 343 in the group with personal history of adenomas, and 221 in the FOBT-positive group. Overall, CT colonography identified 151 of 177 participants with advanced neoplasia 6 mm or larger (sensitivity, 85.3%; 95% confidence interval [CI], 79.0%-90.0%) and correctly classified results as negative for 667 of 760 participants without such lesions (specificity, 87.8%; 95% CI, 85.2%-90.0%). The positive and negative predictive values were 61.9% (95% CI, 55.4%-68.0%) and 96.3% (95% CI, 94.6%-97.5%), respectively; after group stratification, a significantly lower negative predictive value was found for the FOBT-positive group (84.9%; 95% CI, 76.2%-91.3%; P < .001). CONCLUSIONS: In a group of persons at increased risk for CRC, CT colonography compared with colonoscopy resulted in a negative predictive value of 96.3% overall. When limited to FOBT-positive persons, the negative predictive value was 84.9%.
- Published
- 2009