Diagnostic accuracy of computed tomographic colonography for the detection of advanced neoplasia in individuals at increased risk of colorectal cancer
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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