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  • September 2008

    Accuracy of CT Colonography in Screening for Colorectal Cancer

    New England Journal of Medicine | C. Daniel Johnson et al.

    Article:

    Accuracy of CT Colonography for Detection of Large Adenomas and Cancers

    Authors:

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

    Journal:

    New England Journal of Medicine, September 18, 2008

    Summary:

    Colorectal cancer is the second-leading cause of cancer-related deaths in the United States, yet studies estimate that only one-third of individuals at-risk for the disease actually undergo complete screening. Some attribute this statistic to the fact that a majority of screening procedures are highly invasive. Computer tomography (CT) colonography is a noninvasive screening tool for colorectal cancer – however, prior to this trial, the diagnostic accuracy of CT colonography had not been proven.

    The ACRIN trial, which was funded by NIH and led by Dr. Daniel Johnson of the Mayo clinic, utilized data from 2,531 asymptomatic patients in 15 study centers across the country, making it the most comprehensive CT colonography study to date. The primary purpose of the study was to evaluate CT sensitivity for detecting adenoma growths one centimeter or larger in diameter, with sensitivity in detecting smaller lesions (6mm to 9mm) also evaluated. Optical colonoscopy and histological review were performed at each center to serve as a reference standard for comparison.

    In this definitive study, CT colonography proved highly effective, with the procedure identifying 90% of patients with asymptomatic large colorectal adenomas or cancers also detected by optical colonoscopy. These findings augment and extend the findings of other studies, such as a 2007 study by Yun et al, which demonstrated a 91% sensitivity for CT detection of adenomas one centimeter in diameter or larger, and 89% for 6mm or larger. Some studies have demonstrated sensitivities as high as 94%. “The ACRIN trial has now validated that CT colonography could serve as an initial screening exam for the population in which screening is indicated,” said trial statistician Mei-Hsiu Chen, PhD, from Brown University in Providence, RI.

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