title: Colorectal cancer: screening double-contrast barium enema examination in average-risk adults older than 50 years.
abstract: OBJECTIVE
  To retrospectively determine the diagnostic yield of double-contrast barium enema examinations performed for colorectal cancer screening of neoplasms 1 cm or larger or advanced neoplastic lesions of any size in average-risk adults older than 50 years.
  
  
  METHODS
  The Institutional Review Board at the affiliated Veterans Affairs Medical Center approved this HIPAA-compliant study protocol and did not require informed consent from patients. Computerized databases revealed 276 double-contrast barium enema examinations performed for colorectal cancer screening in average-risk adults older than 50 years. Radiographic and pathologic reports were reviewed to determine the number of patients who had polypoid lesions 1 cm or larger, polyps smaller than 1 cm, or advanced neoplastic lesions of any size. Forty-five (16.3%) of the 276 patients underwent follow-up sigmoidoscopy or colonoscopy. Medical, endoscopic, and pathologic records were reviewed and compared with radiographic findings.
  
  
  RESULTS
  The results of double-contrast barium enema examination revealed 74 (26.8%) of 276 patients with 104 polypoid lesions in the colon, including 32 patients (11.6%) with 41 polypoid lesions 1 cm or larger, 15 patients (5.4%) with 19 polyps 6-9 mm, and 27 patients (9.8%) with 44 polyps 5 mm or smaller. Endoscopy was performed in 24 (75%) of 32 patients, the results of which confirmed 23 (72%) of 32 radiographically diagnosed lesions 1 cm or larger in 16 (67%) of 24 patients. In two of these individuals, the polyps were hyperplastic. The remaining 14 patients had a total of 21 neoplastic lesions 1 cm or larger, including 11 tubular adenomas, seven tubulovillous adenomas, one villous adenoma with marked dysplasia, and two cancers. The diagnostic yield of screening double-contrast barium enema examination was 5.1% (14 of 276 patients) for neoplastic lesions 1 cm or larger and 6.2% (17 of 276 patients) for advanced neoplastic lesions of any size.
  
  
  CONCLUSIONS
  Double-contrast barium enema examinations performed in average-risk adults older than 50 years have a diagnostic yield of 5.1% for neoplastic lesions 1 cm or larger and 6.2% for advanced neoplastic lesions, regardless of size.
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA.
authors.forename: Justin W
authors.initials: JW
authors.lastname: Kung
authors.forename: Marc S
authors.initials: MS
authors.lastname: Levine
authors.forename: Seth N
authors.initials: SN
authors.lastname: Glick
authors.forename: Paras
authors.initials: P
authors.lastname: Lakhani
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Rubesin
authors.forename: Igor
authors.initials: I
authors.lastname: Laufer
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D003111:Colonic Polyps / Q000000981:diagnostic imaging / Q000473:pathology; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D004733:Enema; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate