Accuracy of CT colonography for detection of large adenomas and cancers

C. Daniel Johnson, Mei Hsiu Chen, Alicia Y. Toledano, Jay P. Heiken, Abraham Dachman, Mark D. Kuo, Christine O. Menias, Betina Siewert, Jugesh I. Cheema, Richard G. Obregon, Jeff L. Fidler, Peter Zimmerman, Karen M. Horton, Kevin Coakley, Revathy B. Iyer, Amy K. Hara, Robert A. Halvorsen, Giovanna Casola, Judy Yee, Benjamin A. HermanLawrence J. Burgart, Paul J. Limburg

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Computed tomographic (CT) colonography is a noninvasive option in screening for colorectal cancer. However, its accuracy as a screening tool in asymptomatic adults has not been well defined. METHODS: We recruited 2600 asymptomatic study participants, 50 years of age or older, at 15 study centers. CT colonographic images were acquired with the use of standard bowel preparation, stool and fluid tagging, mechanical insufflation, and multidetector-row CT scanners (with 16 or more rows). Radiologists trained in CT colonography reported all lesions measuring 5 mm or more in diameter. Optical colonoscopy and histologic review were performed according to established clinical protocols at each center and served as the reference standard. The primary end point was detection by CT colonography of histologically confirmed large adenomas and adenocarcinomas (10 mm in diameter or larger) that had been detected by colonoscopy; detection of smaller colorectal lesions (6 to 9 mm in diameter) was also evaluated. RESULTS: Complete data were available for 2531 participants (97%). For large adenomas and cancers, the mean (±SE) per-patient estimates of the sensitivity, specificity, positive and negative predictive values, and area under the receiver-operating-characteristic curve for CT colonography were 0.90±0.03, 0.86±0.02, 0.23±0.02, 0.99±<0.01, and 0.89±0.02, respectively. The sensitivity of 0.90 (i.e., 90%) indicates that CT colonography failed to detect a lesion measuring 10 mm or more in diameter in 10% of patients. The per-polyp sensitivity for large adenomas or cancers was 0.84±0.04. The per-patient sensitivity for detecting adenomas that were 6 mm or more in diameter was 0.78. CONCLUSIONS: In this study of asymptomatic adults, CT colonographic screening identified 90% of subjects with adenomas or cancers measuring 10 mm or more in diameter. These findings augment published data on the role of CT colonography in screening patients with an average risk of colorectal cancer. (ClinicalTrials.gov number, NCT00084929; American College of Radiology Imaging Network [ACRIN] number, 6664.)

Original languageEnglish (US)
Pages (from-to)1207-1217
Number of pages11
JournalNew England Journal of Medicine
Volume359
Issue number12
DOIs
StatePublished - Sep 18 2008
Externally publishedYes

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Computed Tomographic Colonography
Adenoma
Neoplasms
Colonoscopy
Colorectal Neoplasms
Insufflation
Clinical Protocols
Polyps
Radiology
ROC Curve
Adenocarcinoma
Sensitivity and Specificity

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Johnson, C. D., Chen, M. H., Toledano, A. Y., Heiken, J. P., Dachman, A., Kuo, M. D., ... Limburg, P. J. (2008). Accuracy of CT colonography for detection of large adenomas and cancers. New England Journal of Medicine, 359(12), 1207-1217. https://doi.org/10.1056/NEJMoa0800996

Accuracy of CT colonography for detection of large adenomas and cancers. / Johnson, C. Daniel; Chen, Mei Hsiu; Toledano, Alicia Y.; Heiken, Jay P.; Dachman, Abraham; Kuo, Mark D.; Menias, Christine O.; Siewert, Betina; Cheema, Jugesh I.; Obregon, Richard G.; Fidler, Jeff L.; Zimmerman, Peter; Horton, Karen M.; Coakley, Kevin; Iyer, Revathy B.; Hara, Amy K.; Halvorsen, Robert A.; Casola, Giovanna; Yee, Judy; Herman, Benjamin A.; Burgart, Lawrence J.; Limburg, Paul J.

In: New England Journal of Medicine, Vol. 359, No. 12, 18.09.2008, p. 1207-1217.

Research output: Contribution to journalArticle

Johnson, CD, Chen, MH, Toledano, AY, Heiken, JP, Dachman, A, Kuo, MD, Menias, CO, Siewert, B, Cheema, JI, Obregon, RG, Fidler, JL, Zimmerman, P, Horton, KM, Coakley, K, Iyer, RB, Hara, AK, Halvorsen, RA, Casola, G, Yee, J, Herman, BA, Burgart, LJ & Limburg, PJ 2008, 'Accuracy of CT colonography for detection of large adenomas and cancers', New England Journal of Medicine, vol. 359, no. 12, pp. 1207-1217. https://doi.org/10.1056/NEJMoa0800996
Johnson CD, Chen MH, Toledano AY, Heiken JP, Dachman A, Kuo MD et al. Accuracy of CT colonography for detection of large adenomas and cancers. New England Journal of Medicine. 2008 Sep 18;359(12):1207-1217. https://doi.org/10.1056/NEJMoa0800996
Johnson, C. Daniel ; Chen, Mei Hsiu ; Toledano, Alicia Y. ; Heiken, Jay P. ; Dachman, Abraham ; Kuo, Mark D. ; Menias, Christine O. ; Siewert, Betina ; Cheema, Jugesh I. ; Obregon, Richard G. ; Fidler, Jeff L. ; Zimmerman, Peter ; Horton, Karen M. ; Coakley, Kevin ; Iyer, Revathy B. ; Hara, Amy K. ; Halvorsen, Robert A. ; Casola, Giovanna ; Yee, Judy ; Herman, Benjamin A. ; Burgart, Lawrence J. ; Limburg, Paul J. / Accuracy of CT colonography for detection of large adenomas and cancers. In: New England Journal of Medicine. 2008 ; Vol. 359, No. 12. pp. 1207-1217.
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abstract = "BACKGROUND: Computed tomographic (CT) colonography is a noninvasive option in screening for colorectal cancer. However, its accuracy as a screening tool in asymptomatic adults has not been well defined. METHODS: We recruited 2600 asymptomatic study participants, 50 years of age or older, at 15 study centers. CT colonographic images were acquired with the use of standard bowel preparation, stool and fluid tagging, mechanical insufflation, and multidetector-row CT scanners (with 16 or more rows). Radiologists trained in CT colonography reported all lesions measuring 5 mm or more in diameter. Optical colonoscopy and histologic review were performed according to established clinical protocols at each center and served as the reference standard. The primary end point was detection by CT colonography of histologically confirmed large adenomas and adenocarcinomas (10 mm in diameter or larger) that had been detected by colonoscopy; detection of smaller colorectal lesions (6 to 9 mm in diameter) was also evaluated. RESULTS: Complete data were available for 2531 participants (97{\%}). For large adenomas and cancers, the mean (±SE) per-patient estimates of the sensitivity, specificity, positive and negative predictive values, and area under the receiver-operating-characteristic curve for CT colonography were 0.90±0.03, 0.86±0.02, 0.23±0.02, 0.99±<0.01, and 0.89±0.02, respectively. The sensitivity of 0.90 (i.e., 90{\%}) indicates that CT colonography failed to detect a lesion measuring 10 mm or more in diameter in 10{\%} of patients. The per-polyp sensitivity for large adenomas or cancers was 0.84±0.04. The per-patient sensitivity for detecting adenomas that were 6 mm or more in diameter was 0.78. CONCLUSIONS: In this study of asymptomatic adults, CT colonographic screening identified 90{\%} of subjects with adenomas or cancers measuring 10 mm or more in diameter. These findings augment published data on the role of CT colonography in screening patients with an average risk of colorectal cancer. (ClinicalTrials.gov number, NCT00084929; American College of Radiology Imaging Network [ACRIN] number, 6664.)",
author = "Johnson, {C. Daniel} and Chen, {Mei Hsiu} and Toledano, {Alicia Y.} and Heiken, {Jay P.} and Abraham Dachman and Kuo, {Mark D.} and Menias, {Christine O.} and Betina Siewert and Cheema, {Jugesh I.} and Obregon, {Richard G.} and Fidler, {Jeff L.} and Peter Zimmerman and Horton, {Karen M.} and Kevin Coakley and Iyer, {Revathy B.} and Hara, {Amy K.} and Halvorsen, {Robert A.} and Giovanna Casola and Judy Yee and Herman, {Benjamin A.} and Burgart, {Lawrence J.} and Limburg, {Paul J.}",
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TY - JOUR

T1 - Accuracy of CT colonography for detection of large adenomas and cancers

AU - Johnson, C. Daniel

AU - Chen, Mei Hsiu

AU - Toledano, Alicia Y.

AU - Heiken, Jay P.

AU - Dachman, Abraham

AU - Kuo, Mark D.

AU - Menias, Christine O.

AU - Siewert, Betina

AU - Cheema, Jugesh I.

AU - Obregon, Richard G.

AU - Fidler, Jeff L.

AU - Zimmerman, Peter

AU - Horton, Karen M.

AU - Coakley, Kevin

AU - Iyer, Revathy B.

AU - Hara, Amy K.

AU - Halvorsen, Robert A.

AU - Casola, Giovanna

AU - Yee, Judy

AU - Herman, Benjamin A.

AU - Burgart, Lawrence J.

AU - Limburg, Paul J.

PY - 2008/9/18

Y1 - 2008/9/18

N2 - BACKGROUND: Computed tomographic (CT) colonography is a noninvasive option in screening for colorectal cancer. However, its accuracy as a screening tool in asymptomatic adults has not been well defined. METHODS: We recruited 2600 asymptomatic study participants, 50 years of age or older, at 15 study centers. CT colonographic images were acquired with the use of standard bowel preparation, stool and fluid tagging, mechanical insufflation, and multidetector-row CT scanners (with 16 or more rows). Radiologists trained in CT colonography reported all lesions measuring 5 mm or more in diameter. Optical colonoscopy and histologic review were performed according to established clinical protocols at each center and served as the reference standard. The primary end point was detection by CT colonography of histologically confirmed large adenomas and adenocarcinomas (10 mm in diameter or larger) that had been detected by colonoscopy; detection of smaller colorectal lesions (6 to 9 mm in diameter) was also evaluated. RESULTS: Complete data were available for 2531 participants (97%). For large adenomas and cancers, the mean (±SE) per-patient estimates of the sensitivity, specificity, positive and negative predictive values, and area under the receiver-operating-characteristic curve for CT colonography were 0.90±0.03, 0.86±0.02, 0.23±0.02, 0.99±<0.01, and 0.89±0.02, respectively. The sensitivity of 0.90 (i.e., 90%) indicates that CT colonography failed to detect a lesion measuring 10 mm or more in diameter in 10% of patients. The per-polyp sensitivity for large adenomas or cancers was 0.84±0.04. The per-patient sensitivity for detecting adenomas that were 6 mm or more in diameter was 0.78. CONCLUSIONS: In this study of asymptomatic adults, CT colonographic screening identified 90% of subjects with adenomas or cancers measuring 10 mm or more in diameter. These findings augment published data on the role of CT colonography in screening patients with an average risk of colorectal cancer. (ClinicalTrials.gov number, NCT00084929; American College of Radiology Imaging Network [ACRIN] number, 6664.)

AB - BACKGROUND: Computed tomographic (CT) colonography is a noninvasive option in screening for colorectal cancer. However, its accuracy as a screening tool in asymptomatic adults has not been well defined. METHODS: We recruited 2600 asymptomatic study participants, 50 years of age or older, at 15 study centers. CT colonographic images were acquired with the use of standard bowel preparation, stool and fluid tagging, mechanical insufflation, and multidetector-row CT scanners (with 16 or more rows). Radiologists trained in CT colonography reported all lesions measuring 5 mm or more in diameter. Optical colonoscopy and histologic review were performed according to established clinical protocols at each center and served as the reference standard. The primary end point was detection by CT colonography of histologically confirmed large adenomas and adenocarcinomas (10 mm in diameter or larger) that had been detected by colonoscopy; detection of smaller colorectal lesions (6 to 9 mm in diameter) was also evaluated. RESULTS: Complete data were available for 2531 participants (97%). For large adenomas and cancers, the mean (±SE) per-patient estimates of the sensitivity, specificity, positive and negative predictive values, and area under the receiver-operating-characteristic curve for CT colonography were 0.90±0.03, 0.86±0.02, 0.23±0.02, 0.99±<0.01, and 0.89±0.02, respectively. The sensitivity of 0.90 (i.e., 90%) indicates that CT colonography failed to detect a lesion measuring 10 mm or more in diameter in 10% of patients. The per-polyp sensitivity for large adenomas or cancers was 0.84±0.04. The per-patient sensitivity for detecting adenomas that were 6 mm or more in diameter was 0.78. CONCLUSIONS: In this study of asymptomatic adults, CT colonographic screening identified 90% of subjects with adenomas or cancers measuring 10 mm or more in diameter. These findings augment published data on the role of CT colonography in screening patients with an average risk of colorectal cancer. (ClinicalTrials.gov number, NCT00084929; American College of Radiology Imaging Network [ACRIN] number, 6664.)

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