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Diagnostic accuracy of computed tomographic colonography for the detection of advanced neoplasia in individuals at increased risk of colorectal cancer
JAMA, 06/18/09

Regge D et al. - In a trial to assess the use of computed tomographic (CT) colonography in individuals at increased risk of colorectal cancer (CRC), it was concluded that CT colonography, compared with colonoscopy, resulted in a negative predictive value of 96.3% overall. When limited to FOBT-positive persons, the negative predictive value was 84.9%.

Methods

Individuals at increased risk of CRC due to either family history of advanced neoplasia in first-degree relatives, personal history of colorectal adenomas, or positive results from fecal occult blood tests (FOBTs) were recruited.
Each participant underwent CT colonography followed by colonoscopy on the same day.
Outcome measures were sensitivity and specificity of CT colonography in detecting individuals with advanced neoplasia (ie, advanced adenoma or CRC) ≥6 mm.

Results

Of 1103 participants, 937 were included in the final analysis: 373 cases in the family-history group, 343 in the group with personal history of adenomas, and 221 in the FOBT-positive group.
CT colonography identified 151 of 177 participants with advanced neoplasia 6 mm or larger (sensitivity, 85.3%) and correctly classified results as negative for 667 of 760 participants without such lesions (specificity, 87.8%).
Positive and negative predictive values were 61.9% and 96.3%, respectively; after group stratification, a significantly lower negative predictive value was found for the FOBT-positive group (84.9%).

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