Diagnostic accuracy of computed tomographic colonography for the detection of advanced neoplasia in individuals at increased risk of colorectal cancer.

Massimo Galia, Andrea Laghi, Silvia Venturini, Emanuele Neri, Roberto Asnaghi, Cesare Hassan, Daniele Regge, Patrizia Della Monica, Claudia Borghi, Emanuele Neri, Cristiana Laudi, Didier Bielen, Carlo Senore, Maria Carla Cassinis, Maria Cristina Martina, Teresa Maria Gallo, Brunella Barbaro, Luigina Bonelli, Giovanni Galatola, Luca BoniPaolo Bruzzi, Giuseppe Angelelli, Carlo Bartolozzi, Giovanni Gandini, Giovanni Simonetti, Andrea Grasso

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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%.
Original languageEnglish
Number of pages9
JournalJAMA
Volume2009-06-17
Publication statusPublished - 2009

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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    Galia, M., Laghi, A., Venturini, S., Neri, E., Asnaghi, R., Hassan, C., Regge, D., Della Monica, P., Borghi, C., Neri, E., Laudi, C., Bielen, D., Senore, C., Cassinis, M. C., Martina, M. C., Gallo, T. M., Barbaro, B., Bonelli, L., Galatola, G., ... Grasso, A. (2009). Diagnostic accuracy of computed tomographic colonography for the detection of advanced neoplasia in individuals at increased risk of colorectal cancer. JAMA, 2009-06-17.