title: Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison.
abstract: BACKGROUND
  The usefulness of currently available colon imaging tests, including air contrast barium enema (ACBE), computed tomographic colonography (CTC), and colonoscopy, to detect colon polyps and cancers is uncertain. We aimed to assess the sensitivity of these three imaging tests.
  
  
  METHODS
  Patients with faecal occult blood, haematochezia, iron-deficiency anaemia, or a family history of colon cancer underwent three separate colon-imaging studies--ACBE, followed 7-14 days later by CTC and colonoscopy on the same day. The primary outcome was detection of colonic polyps and cancers. Outcomes were assessed by building an aggregate view of the colon, taking into account results of all three tests.
  
  
  RESULTS
  614 patients completed all three imaging tests. When analysed on a per-patient basis, for lesions 10 mm or larger in size (n=63), the sensitivity of ACBE was 48% (95% CI 35-61), CTC 59% (46-71, p=0.1083 for CTC vs ACBE), and colonoscopy 98% (91-100, p<0.0001 for colonoscopy vs CTC). For lesions 6-9 mm in size (n=116), sensitivity was 35% for ACBE (27-45), 51% for CTC (41-60, p=0.0080 for CTC vs ACBE), and 99% for colonoscopy (95-100, p<0.0001 for colonoscopy vs CTC). For lesions of 10 mm or larger in size, the specificity was greater for colonoscopy (0.996) than for either ACBE (0.90) or CTC (0.96) and declined for ACBE and CTC when smaller lesions were considered.
  
  
  CONCLUSIONS
  Colonoscopy was more sensitive than other tests, as currently undertaken, for detection of colonic polyps and cancers. These data have important implications for diagnostic use of colon imaging tests.
authors.affiliation: Duke University Medical Center, Durham, NC 27710, USA. dcrockey@acpub.duke.edu
authors.forename: D C
authors.initials: DC
authors.lastname: Rockey
authors.forename: E
authors.initials: E
authors.lastname: Paulson
authors.forename: D
authors.initials: D
authors.lastname: Niedzwiecki
authors.forename: W
authors.initials: W
authors.lastname: Davis
authors.forename: H B
authors.initials: HB
authors.lastname: Bosworth
authors.forename: L
authors.initials: L
authors.lastname: Sanders
authors.forename: J
authors.initials: J
authors.lastname: Yee
authors.forename: J
authors.initials: J
authors.lastname: Henderson
authors.forename: P
authors.initials: P
authors.lastname: Hatten
authors.forename: S
authors.initials: S
authors.lastname: Burdick
authors.forename: A
authors.initials: A
authors.lastname: Sanyal
authors.forename: D T
authors.initials: DT
authors.lastname: Rubin
authors.forename: M
authors.initials: M
authors.lastname: Sterling
authors.forename: G
authors.initials: G
authors.lastname: Akerkar
authors.forename: M S
authors.initials: MS
authors.lastname: Bhutani
authors.forename: K
authors.initials: K
authors.lastname: Binmoeller
authors.forename: J
authors.initials: J
authors.lastname: Garvie
authors.forename: E J
authors.initials: EJ
authors.lastname: Bini
authors.forename: K
authors.initials: K
authors.lastname: McQuaid
authors.forename: W L
authors.initials: WL
authors.lastname: Foster
authors.forename: W M
authors.initials: WM
authors.lastname: Thompson
authors.forename: A
authors.initials: A
authors.lastname: Dachman
authors.forename: R
authors.initials: R
authors.lastname: Halvorsen
mesh_terms: D001466:Barium Sulfate; D003106:Colon / Q000000981:diagnostic imaging*; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003111:Colonic Polyps / Q000175:diagnosis; D023881:Colonography, Computed Tomographic; D003113:Colonoscopy; D004733:Enema; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011029:Pneumoradiography; D012680:Sensitivity and Specificity
chemical_list: D001466:Barium Sulfate