A comparison of optical colonoscopy and CT colonography screening strategies in the detection and recovery of subcentimeter adenomas.
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.
Benson
Mark
M
Department of Medicine, Section of Gastroenterology and Hepatology, University of Wisconsin Medical School, Madison, Wisconsin 53792-5124, USA.
Dureja
Parul
P
Gopal
Deepak
D
Reichelderfer
Mark
M
Pfau
Patrick R
PR
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
D002400:Cathartics