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Sensitivity and specificity of CT colonography for the detection of colonic neoplasia after positive faecal occult blood testing: systematic review and meta-analysis

  • Gastrointestinal
  • Published:
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Abstract

Objective

CT colonography (CTC) is recommended after positive faecal occult blood testing (FOBt) when colonoscopy is incomplete or infeasible. We aimed to estimate the sensitivity and specificity of CTC for colorectal cancer and adenomatous polyps following positive FOBt via systematic review.

Methods

The MEDLINE, EMBASE, AMED and Cochrane Library databases were searched for CTC studies reporting sensitivity and specificity for colorectal cancer and adenomatous polyps. Included subjects had tested FOBt-positive by guaiac or immunochemical methods. Per-patient detection rates were summarized via forest plots. Meta-analysis of sensitivity and specificity was conducted using a bivariate random effects model and the average operating point calculated.

Results

Of 538 articles considered, 5 met inclusion criteria, describing results from 622 patients. Research study quality was good. CTC had a high per-patient average sensitivity of 88.8 % (95 % CI 83.6 to 92.5 %) for ≥6 mm adenomas or colorectal cancer, with low between-study heterogeneity. Specificity was both more heterogeneous and lower, at an average of 75.4 % (95 % CI 58.6 to 86.8 %).

Conclusion

Few studies have investigated CTC in FOBt-positive individuals. CTC is sensitive at a ≥6 mm threshold but specificity is lower and variable. Despite the limited data, these results suggest that CTC may adequately substitute for colonoscopy when the latter is undesirable.

Key Points

• FOBt is the most common mass screening test for colorectal cancer.

• Few studies evaluate CT colonography after positive FOBt.

• CTC is approximately 89 % sensitive for ≥6 mm adenomas/cancer in this setting.

• Specificity is lower, at approximately 75 %, and more variable.

• CT colonography is a good alternative when colonoscopy is undesirable.

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Abbreviations

CAD:

computer-assisted detection

CTC:

computed tomographic colonography

CRC:

colorectal cancer

gFOBt:

guaiac faecal occult blood test

FIT:

faecal immunochemical test

NPV:

negative predictive value

PPV:

positive predictive value

QUADAS-2:

quality assessment of diagnostic accuracy studies, second revision

References

  1. Ferlay J, Shin H-R, Bray F et al (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917. doi:10.1002/ijc.25516

    Article  CAS  PubMed  Google Scholar 

  2. Benson VS, Atkin WS, Green J et al (2012) Toward standardizing and reporting colorectal cancer screening indicators on an international level: the International Colorectal Cancer Screening Network. Int J Cancer 130:2961–2973. doi:10.1002/ijc.26310

    Article  CAS  PubMed  Google Scholar 

  3. Hewitson P, Glasziou P, Irwig L et al. (2007) Screening for colorectal cancer using the faecal occult blood test, Hemoccult. Cochrane Database Syst Rev 1:CD001216. doi:10.1002/14651858.CD001216.pub2

  4. Benson VS, Patnick J, Davies AK et al (2008) Colorectal cancer screening: a comparison of 35 initiatives in 17 countries. Int J Cancer 122:1357–1367. doi:10.1002/ijc.23273

    Article  CAS  PubMed  Google Scholar 

  5. Weller D, Coleman D, Robertson R et al (2007) The UK colorectal cancer screening pilot: results of the second round of screening in England. Br J Cancer 97:1601–1605. doi:10.1038/sj.bjc.6604089

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Tappenden P, Chilcott J, Eggington S et al (2007) Option appraisal of population-based colorectal cancer screening programmes in England. Gut 56:677–684. doi:10.1136/gut.2006.095109

    Article  PubMed Central  PubMed  Google Scholar 

  7. Lee TJW, Rutter MD, Blanks RG et al (2012) Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme. Gut 61:1050–1057. doi:10.1136/gutjnl-2011-300651

    Article  PubMed  Google Scholar 

  8. Taylor SA, Burling DN, Patnick J (2012) Guidelines for the use of imaging in the NHS Bowel Cancer Screening Programme: Second Edition. NHS Cancer Screening Programmes. Available at www.cancerscreening.nhs.uk/bowel/publications/nhsbcs05.pdf. Accessed Jan 2014

  9. Pickhardt PJ, Hassan C, Halligan S, Marmo R (2011) Colorectal cancer: CT colonography and colonoscopy for detection–systematic review and meta-analysis. Radiology 259:393–405. doi:10.1148/radiol.11101887

    Article  PubMed Central  PubMed  Google Scholar 

  10. Halligan S, Altman DG, Taylor SA et al (2005) CT colonography in the detection of colorectal polyps and cancer: systematic review, meta-analysis, and proposed minimum data set for study level reporting. Radiology 237:893–904. doi:10.1148/radiol.2373050176

    Article  PubMed  Google Scholar 

  11. De Haan MC, van Gelder RE, Graser A et al (2011) Diagnostic value of CT-colonography as compared to colonoscopy in an asymptomatic screening population: a meta-analysis. Eur Radiol 21:1747–1763. doi:10.1007/s00330-011-2104-8

    Article  PubMed Central  PubMed  Google Scholar 

  12. Halligan S, Wooldrage K, Dadswell E et al (2013) Computed tomographic colonography versus barium enema for diagnosis of colorectal cancer or large polyps in symptomatic patients (SIGGAR): a multicentre randomised trial. Lancet 381:1185–1193. doi:10.1016/S0140-6736(12)62124-2

    Article  PubMed  Google Scholar 

  13. Atkin W, Dadswell E, Wooldrage K et al (2013) Computed tomographic colonography versus colonoscopy for investigation of patients with symptoms suggestive of colorectal cancer (SIGGAR): a multicentre randomised trial. Lancet 381:1194–1202. doi:10.1016/S0140-6736(12)62186-2

    Article  PubMed  Google Scholar 

  14. Morris EJA, Whitehouse LE, Farrell T et al (2012) A retrospective observational study examining the characteristics and outcomes of tumours diagnosed within and without of the English NHS Bowel Cancer Screening Programme. Br J Cancer 107:757–764. doi:10.1038/bjc.2012.331

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Bretagne J-F, Manfredi S, Piette C et al (2010) Yield of high-grade dysplasia based on polyp size detected at colonoscopy: a series of 2295 examinations following a positive fecal occult blood test in a population-based study. Dis Colon Rectum 53:339–345. doi:10.1007/DCR.0b013e3181c37f9c

    Article  PubMed  Google Scholar 

  16. Kolligs FT, Crispin A, Graser A et al (2013) Risk factors for advanced neoplasia within subcentimetric polyps: implications for diagnostic imaging. Gut 62:863–870. doi:10.1136/gutjnl-2011-300111

    Article  PubMed  Google Scholar 

  17. Chaparro M, Gisbert JP, Del Campo L et al (2009) Accuracy of computed tomographic colonography for the detection of polyps and colorectal tumors: a systematic review and meta-analysis. Digestion 80:1–17. doi:10.1159/000215387

    Article  PubMed  Google Scholar 

  18. Hassan C, Pickhardt PJ, Kim DH et al (2010) Systematic review: distribution of advanced neoplasia according to polyp size at screening colonoscopy. Aliment Pharmacol Ther 31:210–217. doi:10.1111/j.1365-2036.2009.04160.x

    CAS  PubMed  Google Scholar 

  19. Taylor SA, Laghi A, Lefere P et al (2007) European Society of Gastrointestinal and Abdominal Radiology (ESGAR): consensus statement on CT colonography. Eur Radiol 17:575–579. doi:10.1007/s00330-006-0407-y

    Article  PubMed  Google Scholar 

  20. Barish M (2003) Consensus statement. Proc. 4th Int. Symp. Virtual Colonoscopy, Boston, pp 137–143

    Google Scholar 

  21. Whiting PF, Rutjes AWS, Westwood ME et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536. doi:10.7326/0003-4819-155-8-201110180-00009

    Article  PubMed  Google Scholar 

  22. Viechtbauer W (2010) Metafor: meta-analysis package for R. J Stat Softw 36:1–48

    Google Scholar 

  23. R Core Team (2011) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

    Google Scholar 

  24. Gatsonis C, Paliwal P (2006) Meta-analysis of diagnostic and screening test accuracy evaluations: methodologic primer. AJR Am J Roentgenol 187:271–281. doi:10.2214/AJR.06.0226

    Article  PubMed  Google Scholar 

  25. Reitsma JB, Glas AS, Rutjes AWS et al (2005) Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 58:982–990. doi:10.1016/j.jclinepi.2005.02.022

    Article  PubMed  Google Scholar 

  26. Liedenbaum MH, de Vries AH, van Rijn AF et al (2010) CT colonography with limited bowel preparation for the detection of colorectal neoplasia in an FOBT positive screening population. Abdom Imaging 35:661–668. doi:10.1007/s00261-009-9586-8

    Article  PubMed Central  PubMed  Google Scholar 

  27. Liedenbaum MH, van Rijn AF, de Vries AH et al (2009) Using CT colonography as a triage technique after a positive faecal occult blood test in colorectal cancer screening. Gut 58:1242–1249. doi:10.1136/gut.2009.176867

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Regge D, Laudi C, Galatola G et al (2009) Diagnostic accuracy of computed tomographic colonography for the detection of advanced neoplasia in individuals at increased risk of colorectal cancer. JAMA J Am Med Assoc 301:2453–2461. doi:10.1001/jama.2009.832

    Article  CAS  Google Scholar 

  29. Sali L, Falchini M, Monica P et al (2010) CT colonography before colonoscopy in subjects with positive faecal occult blood test. Preliminary experience. Radiol Med (Torino) 115:1267–1278. doi:10.1007/s11547-010-0569-1

    Article  CAS  Google Scholar 

  30. Heresbach D, Djabbari M, Riou F et al (2011) Accuracy of computed tomographic colonography in a nationwide multicentre trial, and its relation to radiologist expertise. Gut 60:658–665. doi:10.1136/gut.2010.225623

    Article  CAS  PubMed  Google Scholar 

  31. Boone D, Halligan S, Taylor SA (2011) Evidence review and status update on computed tomography colonography. Curr Gastroenterol Rep 13:486–494. doi:10.1007/s11894-011-0217-5

    Article  PubMed  Google Scholar 

  32. Brenner H, Hoffmeister M, Stegmaier C et al (2007) Risk of progression of advanced adenomas to colorectal cancer by age and sex: estimates based on 840,149 screening colonoscopies. Gut 56:1585–1589. doi:10.1136/gut.2007.122739

    Article  PubMed Central  PubMed  Google Scholar 

  33. Pickhardt PJ, Wise SM, Kim DH (2010) Positive predictive value for polyps detected at screening CT colonography. Eur Radiol 20:1651–1656. doi:10.1007/s00330-009-1704-z

    Article  PubMed  Google Scholar 

  34. Zueco Zueco C, Sobrido Sampedro C, Corroto JD et al (2012) CT colonography without cathartic preparation: positive predictive value and patient experience in clinical practice. Eur Radiol 22:1195–1204. doi:10.1007/s00330-011-2367-0

    Article  PubMed  Google Scholar 

  35. Plumb AA, Halligan S, Nickerson C et al (2013) Use of CT colonography in the English Bowel Cancer Screening Programme. Gut. doi:10.1136/gutjnl-2013-304697

    PubMed  Google Scholar 

  36. Sweet A, Lee D, Gairy K et al (2011) The impact of CT colonography for colorectal cancer screening on the UK NHS: costs, healthcare resources and health outcomes. Appl Health Econ Health Policy 9:51–64. doi:10.2165/11588110-000000000-00000

    Article  PubMed  Google Scholar 

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Acknowledgments

The scientific guarantor of this publication is Steve Halligan. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study was funded by the National Institute for Healthcare Research (NIHR) under its Programme Grants for Applied Research funding scheme (RP-PG-0407-10338) and by the Royal College of Radiologists Kodak Fund Scholarship. This work was undertaken at University College London Hospital (UCLH) and University College London (UCL), which receive a proportion of funding from the NIHR Comprehensive Biomedical Research Centre funding scheme. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health. One of the authors has significant statistical expertise. Institutional review board approval was not required for this systematic review.

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Authors and Affiliations

  1. Centre for Medical Imaging, University College London, London, UK

    Andrew A. Plumb, Steve Halligan, Douglas A. Pendsé & Stuart A. Taylor

  2. Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

    Susan Mallett

  3. Centre for Medical Imaging, Podium Level 2, University College London, University College Hospital, 235 Euston Rd, London, NW1 2BU, UK

    Steve Halligan

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  1. Andrew A. Plumb
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Correspondence to Steve Halligan.

Appendix

Appendix

Table 5 Studies excluded from the systematic review after full text was reviewed
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Plumb, A.A., Halligan, S., Pendsé, D.A. et al. Sensitivity and specificity of CT colonography for the detection of colonic neoplasia after positive faecal occult blood testing: systematic review and meta-analysis. Eur Radiol 24, 1049–1058 (2014). https://doi.org/10.1007/s00330-014-3106-0

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