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CT colonography accurate in those at high risk for colorectal cancers

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For patients at high risk for colorectal cancer, CT colonography may be a less invasive alternative to the gold standard colonoscopy, according to the results of a multicenter cross-sectional study. The results indicated that compared with colonoscopy, CT colonography had a negative predictive value of 96.3% overall in high-risk patients.

“While the use of CT colonography as a screening and surveillance modality is still a matter of debate, the study by Regge et al suggests that CT colonography may be an acceptable alternative to colonoscopy in patients with a history of adenoma and those with a family history of colorectal neoplasm,” Emily Finlayson, MD, MS, department of surgery, University of Michigan, Ann Arbor, Mich., wrote in an accompanying editorial.

However, study results also indicated that in those patients at high risk due to a positive fecal occult blood test the negative predictive value of the exam decreased to 84.9%.

In the study, patients (n=973) underwent CT colonography followed by colonoscopy on the same day. All patients classified as high risk met one of three criteria: first-degree relatives of people with advanced colorectal neoplasia (39.8%), patients undergoing screening after removal of colorectal adenomas (36.6%) and patients with positive fecal occult blood tests (23.6%).

Overall, CT colonography had 85.3% sensitivity and 87.8% specificity to detect advanced neoplasia 6 mm or larger. The positive predictive value for the test was 61.9%; the negative predictive value was 96.3%.

The negative predictive values ranged from 84.9% in the fecal occult blood test group to 98.5% in the family history group.

“CT colonography has been shown to be better accepted than colonoscopy and has a negligible risk of serious adverse events,” the researchers wrote.

However, according to Finlayson, “the question remains whether clinicians are willing to accept a study with decreased sensitivity for the potential of increased adherence with recommended screening and surveillance guidelines.”

Regge D. JAMA. 2009;301:2453-2461.