Prospective study comparing multislice CT colonography with colonoscopy in the detection of colorectal cancer and polyps.

Abstract

Multislice CT colonography is an alternative to colonoscopy. The purpose of this study was to compare multislice CT colonography with colonoscopy in the detection of colorectal polyps and cancers. Between June 2000 and December 2001, 45 males and 35 females (median age, 68 (29-83) years) with symptoms of colorectal disease were studied prospectively. All patients underwent multislice CT colonography and colonoscopy, and the findings were compared. Colonoscopy was incomplete in 18 (22 percent) patients because of obstructing lesions or technical difficulty, and multislice CT colonography was unsuccessful in 4 (5 percent) because of fecal residue. Colonoscopy was normal in 26 patients and detected 29 colorectal cancers and 33 polyps in 35 patients, diverticulosis in 16 patients, and colitis in 3 patients. Multislice CT colonography identified 28 of 29 colorectal cancers with one false negative and one false positive (sensitivity, 97 percent; specificity, 98 percent; positive predictive value, 96 percent; negative predictive value, 98 percent). Multislice CT colonography identified all 12 polyps measuring >or=10 mm in diameter (sensitivity, 100 percent), 5 of 6 measuring 6 to 9 mm in diameter (sensitivity, 83 percent), 8 of 15 polyps <or=5 mm (sensitivity, 53 percent), and false-positive for 8 polyps. The overall sensitivity was 74 percent and specificity 96 percent. The positive predictive value for polyps was 88 percent, and the negative predictive value was 90 percent. Multislice CT colonography also detected 5 of 16 patients with diverticulosis (sensitivity, 31 percent; specificity, 98 percent) and colitis in 2 of 3 patients (sensitivity, 67 percent; specificity, 100 percent). In ten (13 percent) patients, extracolonic findings on multislice CT colonography altered management and included five patients with colorectal liver metastases. In 15 (19 percent) patients, there were incidental findings that did not demand further investigation. The results from this study indicate that the efficacy of multislice CT colonography in the detection of colorectal cancers and polyps >or=6 mm is similar to colonoscopy. Multislice CT colonography allows clinical staging of colorectal cancers, outlines the whole length of the colon in obstructing carcinoma when colonoscopy fails, and can identify extracolonic causes of abdominal symptoms.