Straight-to-test faecal tagging CT colonography for exclusion of colon cancer in symptomatic patients under the English 2-week-wait cancer investigation pathway: a service review. Issue 9 (September 2018)

• Record Type: Journal Article
• Authors: Stephenson, J.A.; Pancholi, J.; Ivan, C.V.; Mullineux, J.H.; Patel, H.; Verma, R.; Elabassy, M.
• Is Part Of: Clinical radiology. Volume 73:Issue 9(2018)
• Page Start: 836.e1
• Page End: 836.e7
• Publication Date: 2018-09
• Subjects: Medical radiology -- Periodicals; Radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiology -- Periodicals; Societies, Medical -- Periodicals; Medical radiology; Radiotherapy; Electronic journals; Periodicals; 616.0757
• DOI: 10.1016/j.crad.2018.05.013
• Languages: English
• ISSNs: 0009-9260

Abstract

Abstract : Aim: To present the initial 12 months of data of a straight-to-test (STT) computed tomography colonography (CTC) protocol as the first-line investigation for change in bowel habit (CIBH) and iron deficiency anaemia (IDA) in patients over 60 referred directly from primary care. Materials and methods: In 12 months, 1, 792 STT CTC for IDA and CIBH were performed. No colonoscopies were performed as the primary investigation in this cohort. Data from this cohort were gathered prospectively. Results: The colorectal cancer (CRC) detection rate was 4.9% and polyp detection rate was 13.5%. The CRC rate increased related to age ( p= 0.001), the CRC detection rate was 2.6% in patients aged 60–69 years, compared to 4.9%, 7.4%, and 11.4% in the 70–79, 80–89, and >90 years age groups. The CRC rate was higher in patients with IDA compared to CIBH (6.8% versus 3.9%, p= 0.017). There were significantly more left-sided cancers ( p= 0.0165). Non-colonic cancers were found in 4.3% of patients and 6.8% had incidental findings that required further investigation and 11.9% had a new, potentially significant, incidental finding. Conclusion: These results are comparable to colonoscopy in terms of diagnostic accuracy and similar to those of CTC in published multicentre trials. This exciting model of care within radiology enables earlier testing, reduces waiting times, with fewer outpatient appointments, and results in good clinician and patient satisfaction. Highlights: 2WW STT CTC is an appropriate first line test in the exclusion of colorectal cancer. Almost as many non-colonic cancers were identified in this patient cohort as colorectal cancers. There are potentially significant health economic benefits to this pathway over those employing colonoscopy.