Ct Colon Ography
-
Upload
daniel-situngkir -
Category
Documents
-
view
229 -
download
0
Transcript of Ct Colon Ography
-
8/12/2019 Ct Colon Ography
1/29
CT Colonography vs Colonoscopyfor the Detection of Advanced
Neoplasia David H. Kim, M.D., Perry J. Pickhardt, M.D., Andrew J. Taylor, M.D., Winifred K. Leung,
M.D., Thomas C. Winter, M.D., J. Louis Hinshaw, M.D., Deepak V. Gopal, M.D., Mark Reichelderfer, M.D., Richard H. Hsu, M.D., and Patrick R. Pfau, M.D.
NEJM Oct 4, 2007 Volume 357:1403-1412
-
8/12/2019 Ct Colon Ography
2/29
Background
-
8/12/2019 Ct Colon Ography
3/29
Ct Colonography
http://www.radiologyinfo.org/en/photocat/photos_pc.cfm?image=vcoloMovie.jpg&pg=ct_colo
http://www.radiologyinfo.org/en/photocat/photos_pc.cfm?image=vcoloMovie.jpg&pg=ct_colo -
8/12/2019 Ct Colon Ography
4/29
Colorectal cancer:
A major cause of cancer-relatedmortality in the US (55,000 deaths/yr)
Preventable by detection and removal ofits precursor:
advanced colonic adenoma
-
8/12/2019 Ct Colon Ography
5/29
Colonic adenoma progression
Small adenomas< 5mm dysplasia
Advance colonicadenomas>10mm Cancer
10 yrs
Most likelyHyperplastic
Usually do not progress to cancer
-
8/12/2019 Ct Colon Ography
6/29
Study Objective
-
8/12/2019 Ct Colon Ography
7/29
Optical colonoscopy (OC) is currently
the preferred screening and preventivestrategy of CRC by AGS
CT colonography (CTC) is a non-invasive promising alternative screeningmethod
Most trials examining CTC had failed toshow comparative sensitivity/specificityto OC.
-
8/12/2019 Ct Colon Ography
8/29
Methods
-
8/12/2019 Ct Colon Ography
9/29
Study design: Single center, nonrandomize clinical trial comparing CTCvs OC screening in a 25 month period
Study population: 6283 pt referred by primary care providers.
3120 CTC screening 3163 OC screening
-
8/12/2019 Ct Colon Ography
10/29
-
8/12/2019 Ct Colon Ography
11/29
Inclusion/Exclusion criteria Inclusion
Asymptomatic and average risk for
colorectal CA Exclusion
Prior polyp surveillance
History of bowel disorder (IBD, polyposis syndromes, hereditary non polyposis colorectal cancer syndrome)
-
8/12/2019 Ct Colon Ography
12/29
Screening Methods
Pt identified with advanced neoplasm(mass/polyps > 6mm) by CTC were given theoption of surveillance with CTC or removal ofthe polyp by OC.
In the OC group, All polyps/masses found wereremoved, regardless of size or significance.
All removed masses were evaluated for locationrelative to the splenic flexure, morphologiccharacteristics, and histology.
-
8/12/2019 Ct Colon Ography
13/29
Screening Methods
Lesions were divided into two categories: Polyps
Large: > 10mm Small: 6-9 mm Diminutive: 5mm or less
Invasive mass
-
8/12/2019 Ct Colon Ography
14/29
Statistics
A positive test was defined as detectionof polyps of any size in the OC groupand polyps of >6mm in the CTC group.
The two tests were compared usingstudents T -test and Chi squareanalyses
-
8/12/2019 Ct Colon Ography
15/29
Results
-
8/12/2019 Ct Colon Ography
16/29
-
8/12/2019 Ct Colon Ography
17/29
-
8/12/2019 Ct Colon Ography
18/29
-
8/12/2019 Ct Colon Ography
19/29
3120 Patients were enrolled inCTC screening
Routine follow-up in 5 yrs
2716 (87.1%) had negativefindings
404 (12.9%) had positivefindings
With 394 polyps (>6mm)
158 (5.1%) chose ongoingimaging surveillance
227 adenomas
246 (7.9%) underwent OC with polypectomy
With 193 polyps
123 Advanced neoplastic lesions
14 Cancers 153 non-neoplastic tumors
-
8/12/2019 Ct Colon Ography
20/29
-
8/12/2019 Ct Colon Ography
21/29
-
8/12/2019 Ct Colon Ography
22/29
More Information
-
8/12/2019 Ct Colon Ography
23/29
Summary of Results Both CTC and OC had comparative
diagnostic yield for both types of advanceneoplasia (p= 0.81)
CTC had an advantage of safety, norequirement for sedation, and detectingextra-colonic abnormalities
There were larger number of polypectomiesin the OC (2434) vs. in the CTC (561) whiletotal advance neoplasias were similar in both
(121/2434 vs 123/561)
-
8/12/2019 Ct Colon Ography
24/29
PPV for advance neoplasia
TP / TP+FP
CTC 123 / 561
OC 121 / 2434
-
8/12/2019 Ct Colon Ography
25/29
Discussion
-
8/12/2019 Ct Colon Ography
26/29
Study Strength
Large sample size, similar baselinecharacteristics
Relevant exclusion criteria
Detailed pathological characterization oftissues in addition to imaging to establishcomparative detection
Could have significant clinical andeconomical impact on current practice ofcolon CA screening
-
8/12/2019 Ct Colon Ography
27/29
Weakness Non blinded/non-randomized (selection
bias)
single Center Technical advancement may vary betweencenters for effective CTC screening
True negatives in pts with lesions < 5mm inthe CTC group is not determined
-
8/12/2019 Ct Colon Ography
28/29
Clinical Practice Relevance
Offers CTC as a non-invasive alternative toOC for comparative detection of colonicneoplasias
Eliminates the need for a large number ofunnecessary colonoscopies and
polypectomies
Due to variability in technical resourcesCTC may not yet be a potential replacementfor OC in many practice settings
-
8/12/2019 Ct Colon Ography
29/29
Thank you