Computerized tomographic colonography: performance evaluation in a retrospective multicenter setting.
OBJECTIVE
No multicenter study has been reported evaluating the performance and interobserver variability of computerized tomographic colonography. The aim of this study was to assess the accuracy of computerized tomographic colonography for detecting clinically important colorectal neoplasia (polyps >or=10 mm in diameter) in a multi-institutional study.


METHODS
A retrospective study was developed from 341 patients who had computerized tomographic colonography and colonoscopy among 8 medical centers. Colonoscopy and pathology reports provided the standard. A random sample of 117 patients, stratified by criterion standard, was requested. Ninety-three patients were included (47% with polyps >or=10 mm; mean age, 62 years; 56% men; 84% white; 40% reported colorectal symptoms; 74% at increased risk for colorectal cancer). Eighteen radiologists blinded to the criterion standard interpreted computerized tomography colonography examinations, each using 2 of 3 different software display platforms.


RESULTS
The average area under the receiver operating characteristic curve for identifying patients with at least 1 lesion >or=10 mm was 0.80 (95% lower confidence bound, 0.74). The average sensitivity and specificity were 75% (95% lower confidence bound, 68%) and 73% (95% lower confidence bound, 66%), respectively. Per-polyp sensitivity was 75%. A trend was observed for better performance with more observer experience. There was no difference in performance across software display platforms.


CONCLUSIONS
Computerized tomographic colonography performance compared favorably with reported performance of fecal occult blood testing, flexible sigmoidoscopy, and barium enema. A prospective study evaluating the performance of computerized tomography colonography in a screening population is indicated.
Johnson
C Daniel
CD
Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Toledano
Alicia Y
AY
Herman
Benjamin A
BA
Dachman
Abraham H
AH
McFarland
Elizabeth G
EG
Barish
Matthew A
MA
Brink
James A
JA
Ernst
Randy D
RD
Fletcher
Joel G
JG
Halvorsen
Robert A
RA
Hara
Amy K
AK
Hopper
Kenneth D
KD
Koehler
Robert E
RE
Lu
David S k
DS
Macari
Michael
M
Maccarty
Robert L
RL
Miller
Frank H
FH
Morrin
Martina
M
Paulson
Erik K
EK
Yee
Judy
J
Zalis
Michael
M
D003110:Colonic Neoplasms / Q000175:diagnosis; D003111:Colonic Polyps / Q000175:diagnosis; D023881:Colonography, Computed Tomographic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity