CT-Colonography vs. Colonoscopy for Detection of High-Risk Sessile Serrated Polyps

J. E. G. IJspeert; C. J. Tutein Nolthenius; E. J. Kuipers; M. E. van Leerdam; C. Y. Nio; M. G. J. Thomeer; K. Biermann; M. J. van de Vijver; E. Dekker; J. Stoker

doi:10.1038/ajg.2016.58

CT-Colonography vs. Colonoscopy for Detection of High-Risk Sessile Serrated Polyps

J. E. G. IJspeert
, C. J. Tutein Nolthenius
, E. J. Kuipers
, M. E. van Leerdam
, C. Y. Nio
, M. G. J. Thomeer
, K. Biermann
, M. J. van de Vijver
, E. Dekker
, J. Stoker

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Sessile serrated polyps (SSPs) are suggested to be the precursors of 15-30% of all colorectal cancers (CRCs). Therefore, CRC screening modalities should also be designed to detect high-risk SSPs. We compared computed tomography colonography (CTC) with colonoscopy-based screening for the detection of high-risk SSPs in average-risk individuals. Data from a randomized controlled trial that compared CTC with colonoscopy for population screening were used for the analysis. Individuals diagnosed at CTC with a lesion ≥10 mm in size were referred for colonoscopy. Individuals with only 6-9 mm lesions were offered surveillance CTC. This surveillance CTC was followed by a colonoscopy when a lesion ≥6 mm was detected. Yield of both was accumulated to mimic current American College of Radiology CTC referral strategy (referral of individuals with any lesion ≥6 mm). Per participant detection of ≥1 high-risk (dysplastic and/or ≥10 mm) SSP was compared with colonoscopy using multiple logistic regression analysis. In total, 8,844 individuals were invited to participate (in 2:1 allocation), of which 1,276 colonoscopy and 982 CTC invitees participated in the study. In the colonoscopy arm, 4.3% of individuals were diagnosed with ≥1 high-risk SSP, compared with 0.8% in the CTC arm (odds ratio (OR) 5.5; 95% confidence interval (CI) 2.6-11.6; P <0.001). In total, 3.1% of individuals in the colonoscopy arm were diagnosed with high-risk SSPs as most advanced lesion, compared with 0.4% in the CTC arm (OR 7.7; 95% CI 2.7-21.6; P <0.001). The current CTC strategy showed a marked lower detection for especially flat high-risk SSPs (17 vs. 0), high-risk SSP located in the proximal colon (32 vs. 1), and SSPs with dysplasia (30 vs. 1). In a randomized controlled setting, the detection rate of high-risk SSPs was significantly higher with colonoscopy than CTC. These results might have implications for CTC as a CRC modality for opportunistic screening in average-risk adults

Original language	English
Pages (from-to)	516-522
Journal	American journal of gastroenterology
Volume	111
Issue number	4
DOIs	https://doi.org/10.1038/ajg.2016.58
Publication status	Published - 2016

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@article{45a7f2d2dd374b82a8b711e1b638c05f,

title = "CT-Colonography vs. Colonoscopy for Detection of High-Risk Sessile Serrated Polyps",

abstract = "Sessile serrated polyps (SSPs) are suggested to be the precursors of 15-30\% of all colorectal cancers (CRCs). Therefore, CRC screening modalities should also be designed to detect high-risk SSPs. We compared computed tomography colonography (CTC) with colonoscopy-based screening for the detection of high-risk SSPs in average-risk individuals. Data from a randomized controlled trial that compared CTC with colonoscopy for population screening were used for the analysis. Individuals diagnosed at CTC with a lesion ≥10 mm in size were referred for colonoscopy. Individuals with only 6-9 mm lesions were offered surveillance CTC. This surveillance CTC was followed by a colonoscopy when a lesion ≥6 mm was detected. Yield of both was accumulated to mimic current American College of Radiology CTC referral strategy (referral of individuals with any lesion ≥6 mm). Per participant detection of ≥1 high-risk (dysplastic and/or ≥10 mm) SSP was compared with colonoscopy using multiple logistic regression analysis. In total, 8,844 individuals were invited to participate (in 2:1 allocation), of which 1,276 colonoscopy and 982 CTC invitees participated in the study. In the colonoscopy arm, 4.3\% of individuals were diagnosed with ≥1 high-risk SSP, compared with 0.8\% in the CTC arm (odds ratio (OR) 5.5; 95\% confidence interval (CI) 2.6-11.6; P <0.001). In total, 3.1\% of individuals in the colonoscopy arm were diagnosed with high-risk SSPs as most advanced lesion, compared with 0.4\% in the CTC arm (OR 7.7; 95\% CI 2.7-21.6; P <0.001). The current CTC strategy showed a marked lower detection for especially flat high-risk SSPs (17 vs. 0), high-risk SSP located in the proximal colon (32 vs. 1), and SSPs with dysplasia (30 vs. 1). In a randomized controlled setting, the detection rate of high-risk SSPs was significantly higher with colonoscopy than CTC. These results might have implications for CTC as a CRC modality for opportunistic screening in average-risk adults",

author = "IJspeert, \{J. E. G.\} and \{Tutein Nolthenius\}, \{C. J.\} and Kuipers, \{E. J.\} and \{van Leerdam\}, \{M. E.\} and Nio, \{C. Y.\} and Thomeer, \{M. G. J.\} and K. Biermann and \{van de Vijver\}, \{M. J.\} and E. Dekker and J. Stoker",

year = "2016",

doi = "10.1038/ajg.2016.58",

language = "English",

volume = "111",

pages = "516--522",

journal = "American journal of gastroenterology",

issn = "0002-9270",

publisher = "Springer Nature",

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TY - JOUR

T1 - CT-Colonography vs. Colonoscopy for Detection of High-Risk Sessile Serrated Polyps

AU - IJspeert, J. E. G.

AU - Tutein Nolthenius, C. J.

AU - Kuipers, E. J.

AU - van Leerdam, M. E.

AU - Nio, C. Y.

AU - Thomeer, M. G. J.

AU - Biermann, K.

AU - van de Vijver, M. J.

AU - Dekker, E.

AU - Stoker, J.

PY - 2016

Y1 - 2016

N2 - Sessile serrated polyps (SSPs) are suggested to be the precursors of 15-30% of all colorectal cancers (CRCs). Therefore, CRC screening modalities should also be designed to detect high-risk SSPs. We compared computed tomography colonography (CTC) with colonoscopy-based screening for the detection of high-risk SSPs in average-risk individuals. Data from a randomized controlled trial that compared CTC with colonoscopy for population screening were used for the analysis. Individuals diagnosed at CTC with a lesion ≥10 mm in size were referred for colonoscopy. Individuals with only 6-9 mm lesions were offered surveillance CTC. This surveillance CTC was followed by a colonoscopy when a lesion ≥6 mm was detected. Yield of both was accumulated to mimic current American College of Radiology CTC referral strategy (referral of individuals with any lesion ≥6 mm). Per participant detection of ≥1 high-risk (dysplastic and/or ≥10 mm) SSP was compared with colonoscopy using multiple logistic regression analysis. In total, 8,844 individuals were invited to participate (in 2:1 allocation), of which 1,276 colonoscopy and 982 CTC invitees participated in the study. In the colonoscopy arm, 4.3% of individuals were diagnosed with ≥1 high-risk SSP, compared with 0.8% in the CTC arm (odds ratio (OR) 5.5; 95% confidence interval (CI) 2.6-11.6; P <0.001). In total, 3.1% of individuals in the colonoscopy arm were diagnosed with high-risk SSPs as most advanced lesion, compared with 0.4% in the CTC arm (OR 7.7; 95% CI 2.7-21.6; P <0.001). The current CTC strategy showed a marked lower detection for especially flat high-risk SSPs (17 vs. 0), high-risk SSP located in the proximal colon (32 vs. 1), and SSPs with dysplasia (30 vs. 1). In a randomized controlled setting, the detection rate of high-risk SSPs was significantly higher with colonoscopy than CTC. These results might have implications for CTC as a CRC modality for opportunistic screening in average-risk adults

AB - Sessile serrated polyps (SSPs) are suggested to be the precursors of 15-30% of all colorectal cancers (CRCs). Therefore, CRC screening modalities should also be designed to detect high-risk SSPs. We compared computed tomography colonography (CTC) with colonoscopy-based screening for the detection of high-risk SSPs in average-risk individuals. Data from a randomized controlled trial that compared CTC with colonoscopy for population screening were used for the analysis. Individuals diagnosed at CTC with a lesion ≥10 mm in size were referred for colonoscopy. Individuals with only 6-9 mm lesions were offered surveillance CTC. This surveillance CTC was followed by a colonoscopy when a lesion ≥6 mm was detected. Yield of both was accumulated to mimic current American College of Radiology CTC referral strategy (referral of individuals with any lesion ≥6 mm). Per participant detection of ≥1 high-risk (dysplastic and/or ≥10 mm) SSP was compared with colonoscopy using multiple logistic regression analysis. In total, 8,844 individuals were invited to participate (in 2:1 allocation), of which 1,276 colonoscopy and 982 CTC invitees participated in the study. In the colonoscopy arm, 4.3% of individuals were diagnosed with ≥1 high-risk SSP, compared with 0.8% in the CTC arm (odds ratio (OR) 5.5; 95% confidence interval (CI) 2.6-11.6; P <0.001). In total, 3.1% of individuals in the colonoscopy arm were diagnosed with high-risk SSPs as most advanced lesion, compared with 0.4% in the CTC arm (OR 7.7; 95% CI 2.7-21.6; P <0.001). The current CTC strategy showed a marked lower detection for especially flat high-risk SSPs (17 vs. 0), high-risk SSP located in the proximal colon (32 vs. 1), and SSPs with dysplasia (30 vs. 1). In a randomized controlled setting, the detection rate of high-risk SSPs was significantly higher with colonoscopy than CTC. These results might have implications for CTC as a CRC modality for opportunistic screening in average-risk adults

U2 - 10.1038/ajg.2016.58

DO - 10.1038/ajg.2016.58

M3 - Article

C2 - 27021193

SN - 0002-9270

VL - 111

SP - 516

EP - 522

JO - American journal of gastroenterology

JF - American journal of gastroenterology

IS - 4

ER -

CT-Colonography vs. Colonoscopy for Detection of High-Risk Sessile Serrated Polyps

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