Computed Tomographic Virtual Colonoscopy to Screen for Colorectal Neoplasia in Asymptomatic Adults

doi:10.1056/NEJMoa031618

Volume 349:2191-2200		December 4, 2003		Number 23

Computed Tomographic Virtual Colonoscopy to Screen for Colorectal Neoplasia in Asymptomatic Adults

Perry J. Pickhardt, M.D., J. Richard Choi, Sc.D., M.D., Inku Hwang, M.D., James A. Butler, M.D., Michael L. Puckett, M.D., Hans A. Hildebrandt, M.D., Roy K. Wong, M.D., Pamela A. Nugent, M.D., Pauline A. Mysliwiec, M.D., M.P.H., and William R. Schindler, D.O.

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ABSTRACT

Background We evaluated the performance characteristics of computedtomographic (CT) virtual colonoscopy for the detection of colorectalneoplasia in an average-risk screening population.

Methods A total of 1233 asymptomatic adults (mean age, 57.8years) underwent same-day virtual and optical colonoscopy. Radiologistsused the three-dimensional endoluminal display for the initialdetection of polyps on CT virtual colonoscopy. For the initialexamination of each colonic segment, the colonoscopists wereunaware of the findings on virtual colonoscopy, which were revealedto them before any subsequent reexamination. The sensitivityand specificity of virtual colonoscopy and the sensitivity ofoptical colonoscopy were calculated with the use of the findingsof the final, unblinded optical colonoscopy as the referencestandard.

Results The sensitivity of virtual colonoscopy for adenomatouspolyps was 93.8 percent for polyps at least 10 mm in diameter,93.9 percent for polyps at least 8 mm in diameter, and 88.7percent for polyps at least 6 mm in diameter. The sensitivityof optical colonoscopy for adenomatous polyps was 87.5 percent,91.5 percent, and 92.3 percent for the three sizes of polyps,respectively. The specificity of virtual colonoscopy for adenomatouspolyps was 96.0 percent for polyps at least 10 mm in diameter,92.2 percent for polyps at least 8 mm in diameter, and 79.6percent for polyps at least 6 mm in diameter. Two polyps weremalignant; both were detected on virtual colonoscopy, and oneof them was missed on optical colonoscopy before the resultson virtual colonoscopy were revealed.

Conclusions CT virtual colonoscopy with the use of a three-dimensionalapproach is an accurate screening method for the detection ofcolorectal neoplasia in asymptomatic average-risk adults andcompares favorably with optical colonoscopy in terms of thedetection of clinically relevant lesions.

Source Information

From the Departments of Radiology (P.J.P., P.A.N.) and Gastroenterology (J.A.B., P.A.M.), National Naval Medical Center; the Department of Radiology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (P.J.P., M.L.P.); and the National Cancer Institute, Division of Cancer Prevention (P.A.M.) — all in Bethesda, Md.; the Departments of Radiology (J.R.C.) and Gastroenterology (I.H., R.K.W.), Walter Reed Army Medical Center, Washington, D.C.; and the Departments of Radiology (M.L.P., H.A.H.) and Gastroenterology (W.R.S.), Naval Medical Center San Diego, San Diego, Calif.

Address reprint requests to Dr. Pickhardt at the University of Wisconsin Medical School, Department of Radiology, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI 53792-3252, or at ppickhardt{at}mail.radiology.wisc.edu.

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N Engl J Med 2004; 350:1148-1150, Mar 11, 2004. Correspondence

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