title: A comparison of optical colonoscopy and CT colonography screening strategies in the detection and recovery of subcentimeter adenomas.
abstract: OBJECTIVE
  Evidence has shown that computerized tomographic colonography (CTC) and optical colonoscopy (OC) can detect advanced adenomas at an equal rate; however, a comparison of the subcentimeter adenoma detection has not been performed. The objective of this study is to compare CTC and OC screening programs, with a focus on the detection and recovery of subcentimeter adenomas.
  
  
  METHODS
  In all, 1,700 screening OC examinations in average-risk patients were compared with 1,307 CTC examinations in similar patients drawn from the same referral pool completed in 2006-2008. The detection rate for adenomas ≤ 5 mm, 6-9 mm, and <10 mm with advanced histology were compared.
  
  
  RESULTS
  In the OC group, 23.2% of patients had at least one adenoma removed; in the CTC screening group, 5.9% of patients had at least one adenoma detected and removed, P<0.001. There were significantly more ≤ 5 mm adenomas (detection rate 0.22, 378/1,700) detected by OC than by CTC (detection rate 0.04, 56/1,307), P<0.001. There were significantly more adenomas 6-9 mm (detection rate 0.12, 204/1,700) detected by OC than by CTC (detection rate 0.05, 67/1,307), with 70 patients with polyps of unknown histology in CTC surveillance, P<0.001. The number of advanced lesions <10 mm detected by OC (15/1,700) compared with CTC (4/1,307) were not significantly different, P=0.06. In the OC group, 27.1% of patients had non-adenomatous polyps removed; in the CTC group, 4.1% of patients had non-adenomatous polyps removed, P<0.001.
  
  
  CONCLUSIONS
  (i) An OC screening program detects and recovers a significant four and a half fold greater number of non-advanced adenomas compared with a CTC screening program. (ii) The primary difference between screening with OC and CTC is the recovery and management of the subcentimeter adenoma.
authors.affiliation: Department of Medicine, Section of Gastroenterology and Hepatology, University of Wisconsin Medical School, Madison, Wisconsin 53792-5124, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Benson
authors.forename: Parul
authors.initials: P
authors.lastname: Dureja
authors.forename: Deepak
authors.initials: D
authors.lastname: Gopal
authors.forename: Mark
authors.initials: M
authors.lastname: Reichelderfer
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Pfau
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002400:Cathartics / Q000008:administration & dosage; D016009:Chi-Square Distribution; D003111:Colonic Polyps / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D023881:Colonography, Computed Tomographic / Q000379:methods*; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D002400:Cathartics