CT-Colonography vs. Colonoscopy for Detection of High-Risk Sessile Serrated Polyps.

Autor:	IJspeert JE; Academic Medical Center, Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, The Netherlands., Tutein Nolthenius CJ; Academic Medical Center, Department of Radiology, University of Amsterdam, Amsterdam, The Netherlands., Kuipers EJ; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands., van Leerdam ME; Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Nio CY; Academic Medical Center, Department of Radiology, University of Amsterdam, Amsterdam, The Netherlands., Thomeer MG; Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands., Biermann K; Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands., van de Vijver MJ; Academic Medical Center, Department of Pathology, University of Amsterdam, Amsterdam, The Netherlands., Dekker E; Academic Medical Center, Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, The Netherlands., Stoker J; Academic Medical Center, Department of Radiology, University of Amsterdam, Amsterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	The American journal of gastroenterology [Am J Gastroenterol] 2016 Apr; Vol. 111 (4), pp. 516-22. Date of Electronic Publication: 2016 Mar 29.
DOI:	10.1038/ajg.2016.58
Abstrakt:	Objectives: Sessile serrated polyps (SSPs) are suggested to be the precursors of 15-30% of all colorectal cancers (CRCs). Therefore, CRC screening modalities should also be designed to detect high-risk SSPs. We compared computed tomography colonography (CTC) with colonoscopy-based screening for the detection of high-risk SSPs in average-risk individuals. Methods: Data from a randomized controlled trial that compared CTC with colonoscopy for population screening were used for the analysis. Individuals diagnosed at CTC with a lesion ≥10 mm in size were referred for colonoscopy. Individuals with only 6-9 mm lesions were offered surveillance CTC. This surveillance CTC was followed by a colonoscopy when a lesion ≥6 mm was detected. Yield of both was accumulated to mimic current American College of Radiology CTC referral strategy (referral of individuals with any lesion ≥6 mm). Per participant detection of ≥1 high-risk (dysplastic and/or ≥10 mm) SSP was compared with colonoscopy using multiple logistic regression analysis. Results: In total, 8,844 individuals were invited to participate (in 2:1 allocation), of which 1,276 colonoscopy and 982 CTC invitees participated in the study. In the colonoscopy arm, 4.3% of individuals were diagnosed with ≥1 high-risk SSP, compared with 0.8% in the CTC arm (odds ratio (OR) 5.5; 95% confidence interval (CI) 2.6-11.6; P<0.001). In total, 3.1% of individuals in the colonoscopy arm were diagnosed with high-risk SSPs as most advanced lesion, compared with 0.4% in the CTC arm (OR 7.7; 95% CI 2.7-21.6; P<0.001). The current CTC strategy showed a marked lower detection for especially flat high-risk SSPs (17 vs. 0), high-risk SSP located in the proximal colon (32 vs. 1), and SSPs with dysplasia (30 vs. 1). Conclusions: In a randomized controlled setting, the detection rate of high-risk SSPs was significantly higher with colonoscopy than CTC. These results might have implications for CTC as a CRC modality for opportunistic screening in average-risk adults.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu