CT‐Colonography vs. Colonoscopy for Detection of High‐Risk Sessile Serrated Polyps. (April 2016)

• Record Type: Journal Article
• Authors: IJspeert, J E G; Nolthenius, C J Tutein; Kuipers, E J; van Leerdam, M E; Nio, C Y; Thomeer, M G J; Biermann, K; van de Vijver, M J; Dekker, E; Stoker, J
• Is Part Of: American journal of gastroenterology. Volume 111:Number 4(2016)
• Publication Date: 2016-04
• Subjects: Stomach -- Diseases -- Periodicals; Intestines -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Gastrointestinal Diseases -- Periodicals; Electronic journals; Periodicals; 616.33
• DOI: 10.1038/ajg.2016.58
• Languages: English
• ISSNs: 0002-9270

Abstract

Abstract : Objectives: Sessile serrated polyps (SSPs) are suggested to be the precursors of 15–30% of all colorectal cancers (CRCs). Therefore, CRC screening modalities should also be designed to detect high‐risk SSPs. We compared computed tomography colonography (CTC) with colonoscopy‐based screening for the detection of high‐risk SSPs in average‐risk individuals. Methods: Data from a randomized controlled trial that compared CTC with colonoscopy for population screening were used for the analysis. Individuals diagnosed at CTC with a lesion ≥10 mm in size were referred for colonoscopy. Individuals with only 6–9 mm lesions were offered surveillance CTC. This surveillance CTC was followed by a colonoscopy when a lesion ≥6 mm was detected. Yield of both was accumulated to mimic current American College of Radiology CTC referral strategy (referral of individuals with any lesion ≥6 mm). Per participant detection of ≥1 high‐risk (dysplastic and/or ≥10 mm) SSP was compared with colonoscopy using multiple logistic regression analysis. Results: In total, 8, 844 individuals were invited to participate (in 2:1 allocation), of which 1, 276 colonoscopy and 982 CTC invitees participated in the study. In the colonoscopy arm, 4.3% of individuals were diagnosed with ≥1 high‐risk SSP, compared with 0.8% in the CTC arm (odds ratio (OR) 5.5; 95% confidence interval (CI) 2.6–11.6; P <0.001). In total, 3.1% of individuals in the colonoscopy arm were diagnosed with high‐risk SSPs as most advanced lesion, compared with 0.4% in the CTC arm (OR 7.7; 95% CI 2.7–21.6; P <0.001). The current CTC strategy showed a marked lower detection for especially flat high‐risk SSPs (17 vs. 0), high‐risk SSP located in the proximal colon (32 vs. 1), and SSPs with dysplasia (30 vs. 1). Conclusions: In a randomized controlled setting, the detection rate of high‐risk SSPs was significantly higher with colonoscopy than CTC. These results might have implications for CTC as a CRC modality for opportunistic screening in average‐risk adults.