CT colonography for the detection of nonpolypoid adenomas

sensitivity assessed with restricted national CT colonography trial criteria

Jeff L. Fidler, Zheng Zhang, Benjamin A. Herman, Paul J. Limburg, J. G. Fletcher, Abraham Dachman, Jay P. Heiken, Mark D. Kuo, Christine O. Menias, Bettina Siewert, Jugesh I. Cheema, Richard G. Obregon, Peter Zimmerman, Karen M. Horton, Kevin Coakley, Revathy B. Iyer, Amy Hara, Robert A. Halvorsen, Giovanna Casola, Judy Yee & 2 others Lawrence J. Burgart, C. Daniel Johnson

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of this study was to determine the prevalence of nonpolypoid adenomas and the sensitivity of CT colonography (CTC) in their detection by use of the restricted criteria of height-to-width ratio <50% and height elevation ≤ 3 mm. MATERIALS AND METHODS. In the National CT Colonography Trial (American College of Radiology Imaging Network protocol 6664), a cohort of 2531 participants without symptoms underwent CTC and screening colonoscopy. The CTC examinations were interpreted with both 2D and 3D techniques. Nonpolypoid adenomatous polyps identified with CTC or colonoscopy were retrospectively reviewed to determine which polyps met the restricted criteria. The prevalence of nonpolypoid adenomas and the prospective sensitivity of CTC were determined. Descriptive statistics were used to report the prevalence, size, and histologic features. The sensitivities (with 95% CIs) for nonpolypoid and polypoid lesions were compared by twosided Z test for independent binomial proportions. RESULTS. The retrospective review confirmed 21 nonpolypoid adenomas, yielding a prevalence of 0.83% (21 of 2531 participants). Eight (38.1%) were advanced adenomas, many (50% [4/8]) only because of large size (≥ 10 mm). The overall per polyp sensitivity of CTC (combined 2D and 3D interpretation) for detecting nonpolypoid adenomas ≥ 5 mm (n = 21) was 0.76; ≥ 6 mm (n = 16), 0.75; and ≥ 10 mm (n = 5), 0.80. These values were not statistically different from the sensitivity of detecting polypoid adenomas (p> 0.37). CONCLUSION. In this large screening population, nonpolypoid adenomas had a very low prevalence (<1%), and advanced pathologic features were uncommon in polyps <10 mm in diameter. Most nonpolypoid adenomas are technically visible at CTC. The prospective sensitivity is similar to that for polypoid adenomas when the interpretation combines both 2D and 3D review.

Original languageEnglish (US)
Pages (from-to)W614-W622
JournalAmerican Journal of Roentgenology
Volume203
Issue number6
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Computed Tomographic Colonography
Adenoma
Polyps
Population

Keywords

  • Colon cancer
  • CT colonography
  • Nonpolypoid adenoma

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Fidler, J. L., Zhang, Z., Herman, B. A., Limburg, P. J., Fletcher, J. G., Dachman, A., ... Johnson, C. D. (2014). CT colonography for the detection of nonpolypoid adenomas: sensitivity assessed with restricted national CT colonography trial criteria. American Journal of Roentgenology, 203(6), W614-W622. https://doi.org/10.2214/AJR.13.12356

CT colonography for the detection of nonpolypoid adenomas : sensitivity assessed with restricted national CT colonography trial criteria. / Fidler, Jeff L.; Zhang, Zheng; Herman, Benjamin A.; Limburg, Paul J.; Fletcher, J. G.; Dachman, Abraham; Heiken, Jay P.; D. Kuo, Mark; Menias, Christine O.; Siewert, Bettina; Cheema, Jugesh I.; Obregon, Richard G.; Zimmerman, Peter; Horton, Karen M.; Coakley, Kevin; Iyer, Revathy B.; Hara, Amy; Halvorsen, Robert A.; Casola, Giovanna; Yee, Judy; Burgart, Lawrence J.; Johnson, C. Daniel.

In: American Journal of Roentgenology, Vol. 203, No. 6, 01.01.2014, p. W614-W622.

Research output: Contribution to journalArticle

Fidler, JL, Zhang, Z, Herman, BA, Limburg, PJ, Fletcher, JG, Dachman, A, Heiken, JP, D. Kuo, M, Menias, CO, Siewert, B, Cheema, JI, Obregon, RG, Zimmerman, P, Horton, KM, Coakley, K, Iyer, RB, Hara, A, Halvorsen, RA, Casola, G, Yee, J, Burgart, LJ & Johnson, CD 2014, 'CT colonography for the detection of nonpolypoid adenomas: sensitivity assessed with restricted national CT colonography trial criteria', American Journal of Roentgenology, vol. 203, no. 6, pp. W614-W622. https://doi.org/10.2214/AJR.13.12356
Fidler, Jeff L. ; Zhang, Zheng ; Herman, Benjamin A. ; Limburg, Paul J. ; Fletcher, J. G. ; Dachman, Abraham ; Heiken, Jay P. ; D. Kuo, Mark ; Menias, Christine O. ; Siewert, Bettina ; Cheema, Jugesh I. ; Obregon, Richard G. ; Zimmerman, Peter ; Horton, Karen M. ; Coakley, Kevin ; Iyer, Revathy B. ; Hara, Amy ; Halvorsen, Robert A. ; Casola, Giovanna ; Yee, Judy ; Burgart, Lawrence J. ; Johnson, C. Daniel. / CT colonography for the detection of nonpolypoid adenomas : sensitivity assessed with restricted national CT colonography trial criteria. In: American Journal of Roentgenology. 2014 ; Vol. 203, No. 6. pp. W614-W622.
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abstract = "OBJECTIVE. The purpose of this study was to determine the prevalence of nonpolypoid adenomas and the sensitivity of CT colonography (CTC) in their detection by use of the restricted criteria of height-to-width ratio <50{\%} and height elevation ≤ 3 mm. MATERIALS AND METHODS. In the National CT Colonography Trial (American College of Radiology Imaging Network protocol 6664), a cohort of 2531 participants without symptoms underwent CTC and screening colonoscopy. The CTC examinations were interpreted with both 2D and 3D techniques. Nonpolypoid adenomatous polyps identified with CTC or colonoscopy were retrospectively reviewed to determine which polyps met the restricted criteria. The prevalence of nonpolypoid adenomas and the prospective sensitivity of CTC were determined. Descriptive statistics were used to report the prevalence, size, and histologic features. The sensitivities (with 95{\%} CIs) for nonpolypoid and polypoid lesions were compared by twosided Z test for independent binomial proportions. RESULTS. The retrospective review confirmed 21 nonpolypoid adenomas, yielding a prevalence of 0.83{\%} (21 of 2531 participants). Eight (38.1{\%}) were advanced adenomas, many (50{\%} [4/8]) only because of large size (≥ 10 mm). The overall per polyp sensitivity of CTC (combined 2D and 3D interpretation) for detecting nonpolypoid adenomas ≥ 5 mm (n = 21) was 0.76; ≥ 6 mm (n = 16), 0.75; and ≥ 10 mm (n = 5), 0.80. These values were not statistically different from the sensitivity of detecting polypoid adenomas (p> 0.37). CONCLUSION. In this large screening population, nonpolypoid adenomas had a very low prevalence (<1{\%}), and advanced pathologic features were uncommon in polyps <10 mm in diameter. Most nonpolypoid adenomas are technically visible at CTC. The prospective sensitivity is similar to that for polypoid adenomas when the interpretation combines both 2D and 3D review.",
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T1 - CT colonography for the detection of nonpolypoid adenomas

T2 - sensitivity assessed with restricted national CT colonography trial criteria

AU - Fidler, Jeff L.

AU - Zhang, Zheng

AU - Herman, Benjamin A.

AU - Limburg, Paul J.

AU - Fletcher, J. G.

AU - Dachman, Abraham

AU - Heiken, Jay P.

AU - D. Kuo, Mark

AU - Menias, Christine O.

AU - Siewert, Bettina

AU - Cheema, Jugesh I.

AU - Obregon, Richard G.

AU - Zimmerman, Peter

AU - Horton, Karen M.

AU - Coakley, Kevin

AU - Iyer, Revathy B.

AU - Hara, Amy

AU - Halvorsen, Robert A.

AU - Casola, Giovanna

AU - Yee, Judy

AU - Burgart, Lawrence J.

AU - Johnson, C. Daniel

PY - 2014/1/1

Y1 - 2014/1/1

N2 - OBJECTIVE. The purpose of this study was to determine the prevalence of nonpolypoid adenomas and the sensitivity of CT colonography (CTC) in their detection by use of the restricted criteria of height-to-width ratio <50% and height elevation ≤ 3 mm. MATERIALS AND METHODS. In the National CT Colonography Trial (American College of Radiology Imaging Network protocol 6664), a cohort of 2531 participants without symptoms underwent CTC and screening colonoscopy. The CTC examinations were interpreted with both 2D and 3D techniques. Nonpolypoid adenomatous polyps identified with CTC or colonoscopy were retrospectively reviewed to determine which polyps met the restricted criteria. The prevalence of nonpolypoid adenomas and the prospective sensitivity of CTC were determined. Descriptive statistics were used to report the prevalence, size, and histologic features. The sensitivities (with 95% CIs) for nonpolypoid and polypoid lesions were compared by twosided Z test for independent binomial proportions. RESULTS. The retrospective review confirmed 21 nonpolypoid adenomas, yielding a prevalence of 0.83% (21 of 2531 participants). Eight (38.1%) were advanced adenomas, many (50% [4/8]) only because of large size (≥ 10 mm). The overall per polyp sensitivity of CTC (combined 2D and 3D interpretation) for detecting nonpolypoid adenomas ≥ 5 mm (n = 21) was 0.76; ≥ 6 mm (n = 16), 0.75; and ≥ 10 mm (n = 5), 0.80. These values were not statistically different from the sensitivity of detecting polypoid adenomas (p> 0.37). CONCLUSION. In this large screening population, nonpolypoid adenomas had a very low prevalence (<1%), and advanced pathologic features were uncommon in polyps <10 mm in diameter. Most nonpolypoid adenomas are technically visible at CTC. The prospective sensitivity is similar to that for polypoid adenomas when the interpretation combines both 2D and 3D review.

AB - OBJECTIVE. The purpose of this study was to determine the prevalence of nonpolypoid adenomas and the sensitivity of CT colonography (CTC) in their detection by use of the restricted criteria of height-to-width ratio <50% and height elevation ≤ 3 mm. MATERIALS AND METHODS. In the National CT Colonography Trial (American College of Radiology Imaging Network protocol 6664), a cohort of 2531 participants without symptoms underwent CTC and screening colonoscopy. The CTC examinations were interpreted with both 2D and 3D techniques. Nonpolypoid adenomatous polyps identified with CTC or colonoscopy were retrospectively reviewed to determine which polyps met the restricted criteria. The prevalence of nonpolypoid adenomas and the prospective sensitivity of CTC were determined. Descriptive statistics were used to report the prevalence, size, and histologic features. The sensitivities (with 95% CIs) for nonpolypoid and polypoid lesions were compared by twosided Z test for independent binomial proportions. RESULTS. The retrospective review confirmed 21 nonpolypoid adenomas, yielding a prevalence of 0.83% (21 of 2531 participants). Eight (38.1%) were advanced adenomas, many (50% [4/8]) only because of large size (≥ 10 mm). The overall per polyp sensitivity of CTC (combined 2D and 3D interpretation) for detecting nonpolypoid adenomas ≥ 5 mm (n = 21) was 0.76; ≥ 6 mm (n = 16), 0.75; and ≥ 10 mm (n = 5), 0.80. These values were not statistically different from the sensitivity of detecting polypoid adenomas (p> 0.37). CONCLUSION. In this large screening population, nonpolypoid adenomas had a very low prevalence (<1%), and advanced pathologic features were uncommon in polyps <10 mm in diameter. Most nonpolypoid adenomas are technically visible at CTC. The prospective sensitivity is similar to that for polypoid adenomas when the interpretation combines both 2D and 3D review.

KW - Colon cancer

KW - CT colonography

KW - Nonpolypoid adenoma

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