Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: Prospective comparison

D. C. Rockey, E. Paulson, D. Niedzwiecki, W. Davis, H. B. Bosworth, L. Sanders, Judy Yee, J. Henderson, P. Hatten, S. Burdick, A. Sanyal, D. T. Rubin, M. Sterling, G. Akerkar, M. S. Bhutani, K. Binmoeller, J. Garvie, E. J. Bini, K. McQuaid, W. L. FosterW. M. Thompson, A. Dachman, R. Halvorsen

Research output: Contribution to journalArticle

466 Citations (Scopus)

Abstract

Background The usefulness of currently available colon imaging tests, including air contrast barium enema (ACBE), computed tomographic colonography (CTC), and colonoscopy, to detect colon polyps and cancers is uncertain. We aimed to assess the sensitivity of these three imaging tests. Methods Patients with faecal occult blood, haematochezia, iron-deficiency anaemia, or a family history of colon cancer underwent three separate colon-imaging studies - ACBE, followed 7-14 days later by CTC and colonoscopy on the same day. The primary outcome was detection of colonic polyps and cancers. Outcomes were assessed by building an aggregate view of the colon, taking into account results of all three tests. Findings 614 patients completed all three imaging tests. When analysed on a per-patient basis, for lesions 10 mm or larger in size (n=63), the sensitivity of ACBE was 48% (95% CI 35-61), CTC 59% (46-71, p=0·1083 for CTC vs ACBE), and colonoscopy 98% (91-100, p<0·0001 for colonoscopy vs CTC). For lesions 6-9 mm in size (n=116), sensitivity was 35% for ACBE (27-45), 51% for CTC (41-60, p=0·0080 for CTC vs ACBE), and 99% for colonoscopy (95-100, p<0·0001 for colonoscopy vs CTC). For lesions of 10 mm or larger in size, the specificity was greater for colonoscopy (0·996) than for either ACBE (0·90) or CTC (0·96) and declined for ACBE and CTC when smaller lesions were considered. Interpretation Colonoscopy was more sensitive than other tests, as currently undertaken, for detection of colonic polyps and cancers. These data have important implications for diagnostic use of colon imaging tests.

Original languageEnglish (US)
Pages (from-to)305-311
Number of pages7
JournalLancet
Volume365
Issue number9456
DOIs
StatePublished - Jan 22 2005
Externally publishedYes

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Computed Tomographic Colonography
Colonoscopy
Air
Colonic Neoplasms
Colon
Colonic Polyps
Barium Enema
Occult Blood
Contrast Sensitivity
Gastrointestinal Hemorrhage
Iron-Deficiency Anemias
Polyps

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Rockey, D. C., Paulson, E., Niedzwiecki, D., Davis, W., Bosworth, H. B., Sanders, L., ... Halvorsen, R. (2005). Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: Prospective comparison. Lancet, 365(9456), 305-311. https://doi.org/10.1016/S0140-6736(05)17784-8

Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy : Prospective comparison. / Rockey, D. C.; Paulson, E.; Niedzwiecki, D.; Davis, W.; Bosworth, H. B.; Sanders, L.; Yee, Judy; Henderson, J.; Hatten, P.; Burdick, S.; Sanyal, A.; Rubin, D. T.; Sterling, M.; Akerkar, G.; Bhutani, M. S.; Binmoeller, K.; Garvie, J.; Bini, E. J.; McQuaid, K.; Foster, W. L.; Thompson, W. M.; Dachman, A.; Halvorsen, R.

In: Lancet, Vol. 365, No. 9456, 22.01.2005, p. 305-311.

Research output: Contribution to journalArticle

Rockey, DC, Paulson, E, Niedzwiecki, D, Davis, W, Bosworth, HB, Sanders, L, Yee, J, Henderson, J, Hatten, P, Burdick, S, Sanyal, A, Rubin, DT, Sterling, M, Akerkar, G, Bhutani, MS, Binmoeller, K, Garvie, J, Bini, EJ, McQuaid, K, Foster, WL, Thompson, WM, Dachman, A & Halvorsen, R 2005, 'Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: Prospective comparison', Lancet, vol. 365, no. 9456, pp. 305-311. https://doi.org/10.1016/S0140-6736(05)17784-8
Rockey DC, Paulson E, Niedzwiecki D, Davis W, Bosworth HB, Sanders L et al. Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: Prospective comparison. Lancet. 2005 Jan 22;365(9456):305-311. https://doi.org/10.1016/S0140-6736(05)17784-8
Rockey, D. C. ; Paulson, E. ; Niedzwiecki, D. ; Davis, W. ; Bosworth, H. B. ; Sanders, L. ; Yee, Judy ; Henderson, J. ; Hatten, P. ; Burdick, S. ; Sanyal, A. ; Rubin, D. T. ; Sterling, M. ; Akerkar, G. ; Bhutani, M. S. ; Binmoeller, K. ; Garvie, J. ; Bini, E. J. ; McQuaid, K. ; Foster, W. L. ; Thompson, W. M. ; Dachman, A. ; Halvorsen, R. / Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy : Prospective comparison. In: Lancet. 2005 ; Vol. 365, No. 9456. pp. 305-311.
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T1 - Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy

T2 - Prospective comparison

AU - Rockey, D. C.

AU - Paulson, E.

AU - Niedzwiecki, D.

AU - Davis, W.

AU - Bosworth, H. B.

AU - Sanders, L.

AU - Yee, Judy

AU - Henderson, J.

AU - Hatten, P.

AU - Burdick, S.

AU - Sanyal, A.

AU - Rubin, D. T.

AU - Sterling, M.

AU - Akerkar, G.

AU - Bhutani, M. S.

AU - Binmoeller, K.

AU - Garvie, J.

AU - Bini, E. J.

AU - McQuaid, K.

AU - Foster, W. L.

AU - Thompson, W. M.

AU - Dachman, A.

AU - Halvorsen, R.

PY - 2005/1/22

Y1 - 2005/1/22

N2 - Background The usefulness of currently available colon imaging tests, including air contrast barium enema (ACBE), computed tomographic colonography (CTC), and colonoscopy, to detect colon polyps and cancers is uncertain. We aimed to assess the sensitivity of these three imaging tests. Methods Patients with faecal occult blood, haematochezia, iron-deficiency anaemia, or a family history of colon cancer underwent three separate colon-imaging studies - ACBE, followed 7-14 days later by CTC and colonoscopy on the same day. The primary outcome was detection of colonic polyps and cancers. Outcomes were assessed by building an aggregate view of the colon, taking into account results of all three tests. Findings 614 patients completed all three imaging tests. When analysed on a per-patient basis, for lesions 10 mm or larger in size (n=63), the sensitivity of ACBE was 48% (95% CI 35-61), CTC 59% (46-71, p=0·1083 for CTC vs ACBE), and colonoscopy 98% (91-100, p<0·0001 for colonoscopy vs CTC). For lesions 6-9 mm in size (n=116), sensitivity was 35% for ACBE (27-45), 51% for CTC (41-60, p=0·0080 for CTC vs ACBE), and 99% for colonoscopy (95-100, p<0·0001 for colonoscopy vs CTC). For lesions of 10 mm or larger in size, the specificity was greater for colonoscopy (0·996) than for either ACBE (0·90) or CTC (0·96) and declined for ACBE and CTC when smaller lesions were considered. Interpretation Colonoscopy was more sensitive than other tests, as currently undertaken, for detection of colonic polyps and cancers. These data have important implications for diagnostic use of colon imaging tests.

AB - Background The usefulness of currently available colon imaging tests, including air contrast barium enema (ACBE), computed tomographic colonography (CTC), and colonoscopy, to detect colon polyps and cancers is uncertain. We aimed to assess the sensitivity of these three imaging tests. Methods Patients with faecal occult blood, haematochezia, iron-deficiency anaemia, or a family history of colon cancer underwent three separate colon-imaging studies - ACBE, followed 7-14 days later by CTC and colonoscopy on the same day. The primary outcome was detection of colonic polyps and cancers. Outcomes were assessed by building an aggregate view of the colon, taking into account results of all three tests. Findings 614 patients completed all three imaging tests. When analysed on a per-patient basis, for lesions 10 mm or larger in size (n=63), the sensitivity of ACBE was 48% (95% CI 35-61), CTC 59% (46-71, p=0·1083 for CTC vs ACBE), and colonoscopy 98% (91-100, p<0·0001 for colonoscopy vs CTC). For lesions 6-9 mm in size (n=116), sensitivity was 35% for ACBE (27-45), 51% for CTC (41-60, p=0·0080 for CTC vs ACBE), and 99% for colonoscopy (95-100, p<0·0001 for colonoscopy vs CTC). For lesions of 10 mm or larger in size, the specificity was greater for colonoscopy (0·996) than for either ACBE (0·90) or CTC (0·96) and declined for ACBE and CTC when smaller lesions were considered. Interpretation Colonoscopy was more sensitive than other tests, as currently undertaken, for detection of colonic polyps and cancers. These data have important implications for diagnostic use of colon imaging tests.

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