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Diagnostic Accuracy of Computed Tomographic Colonography for the Detection of Advanced Neoplasia in Individuals at Increased Risk of Colorectal Cancer
Daniele Regge, MD;
Cristiana Laudi, MD;
Giovanni Galatola, MD;
Patrizia Della Monica, PhD;
Luigina Bonelli, MD;
Giuseppe Angelelli, MD;
Roberto Asnaghi, MD;
Brunella Barbaro, MD;
Carlo Bartolozzi, MD;
Didier Bielen, MD;
Luca Boni, MD;
Claudia Borghi, MD;
Paolo Bruzzi, MD;
Maria Carla Cassinis, MD;
Massimo Galia, MD;
Teresa Maria Gallo, MD;
Andrea Grasso, MD;
Cesare Hassan, MD;
Andrea Laghi, MD;
Maria Cristina Martina, MD;
Emanuele Neri, MD;
Carlo Senore, MD;
Giovanni Simonetti, MD;
Silvia Venturini, MD;
Giovanni Gandini, MD
JAMA. 2009;301(23):2453-2461.
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%.
Author Affiliations: Radiology Unit (Drs Regge, Della Monica, and Gallo) and Gastroenterology Unit (Drs Laudi and Galatola), Institute for Cancer Research and Treatment, Candiolo, Turin, Italy; Epidemiology Unit (Drs Bonelli, Boni, and Bruzzi) and Radiology Unit (Dr Grasso), National Institute for Cancer Research, Genoa, Italy; Radiology Department, University of Bari, Policlinico Hospital, Bari, Italy (Dr Angelelli); Radiology Unit, Salvatore Maugeri IRCCS Foundation, Veruno, Novara, Italy (Dr Asnaghi); Radiology Department, University Cattolica, Policlinico Agostino Gemelli, Rome, Italy (Dr Barbaro); Radiology Department, University of Pisa, Pisa, Italy (Drs Bartolozzi and Neri); Radiology Department, University of Leuven, UZ Gasthuisberg, Leuven, Belgium (Dr Bielen); Radiology Unit, Valduce Hospital, Como, Italy (Dr Borghi); Radiology Department, University of Turin, San Giovanni Battista Hospital, Turin (Drs Cassinis, Martina, and Gandini); Radiology Department, University of Palermo, Policlinico Paolo Giaccone, Palermo, Italy (Dr Galia); Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome (Dr Hassan); Radiology Department, University La Sapienza, Polo Didattico Pontino ICOT, Rome (Dr Laghi); CPO Piemonte, ASO San Giovanni Battista, Turin (Dr Senore); Radiology Department, Tor Vergata University, Rome (Dr Simonetti); and Radiology Unit, National Cancer Institute, Aviano, Pordenone, Italy (Dr Venturini).
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