title: The National CT Colonography Trial: assessment of accuracy in participants 65 years of age and older.
abstract: OBJECTIVE
  To conduct post-hoc analysis of National CT Colonography Trial data and compare the sensitivity and specificity of computed tomographic (CT) colonography in participants younger than 65 years with those in participants aged 65 years and older.
  
  
  METHODS
  Of 2600 asymptomatic participants recruited at 15 centers for the trial, 497 were 65 years of age or older. Approval of this HIPAA-compliant study was obtained from the institutional review board of each site, and informed consent was obtained from each subject. Radiologists certified in CT colonography reported lesions 5 mm in diameter or larger. Screening detection of large (≥10-mm) histologically confirmed colorectal neoplasia was the primary end point; screening detection of smaller (6-9-mm) colorectal neoplasia was a secondary end point. The differences in sensitivity and specificity of CT colonography in the two age cohorts (age < 65 years and age ≥ 65 years) were estimated with bootstrap confidence intervals (CIs).
  
  
  RESULTS
  Complete data were available for 477 participants 65 years of age or older (among 2531 evaluable participants). Prevalence of adenomas 1 cm or larger for the older participants versus the younger participants was 6.9% (33 of 477) versus 3.7% (76 of 2054) (P < .004). For large neoplasms, mean estimates for CT colonography sensitivity and specificity among the older cohort were 0.82 (95% CI: 0.644, 0.944) and 0.83 (95% CI: 0.779, 0.883), respectively. For large neoplasms in the younger group, CT colonography sensitivity and specificity were 0.92 (95% CI: 0.837, 0.967) and 0.86 (95% CI: 0.816, 0.899), respectively. Per-polyp sensitivity for large neoplasms for the older and younger populations was 0.75 (95% CI: 0.578, 0.869) and 0.84 (95% CI: 0.717, 0.924), respectively. For the older and younger groups, per-participant sensitivity was 0.72 (95% CI: 0.565, 0.854) and 0.81 (95% CI: 0.745, 0.882) for detecting adenomas 6 mm in diameter or larger.
  
  
  CONCLUSIONS
  For most measures of diagnostic performance and in most subsets, the difference between senior-aged participants and those younger than 65 years was not statistically significant.
authors.affiliation: Department of Radiology, Mayo Clinic, Scottsdale, AZ 85259, USA.
authors.forename: C Daniel
authors.initials: CD
authors.lastname: Johnson
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Herman
authors.forename: Mei-Hsiu
authors.initials: MH
authors.lastname: Chen
authors.forename: Alicia Y
authors.initials: AY
authors.lastname: Toledano
authors.forename: Jay P
authors.initials: JP
authors.lastname: Heiken
authors.forename: Abraham H
authors.initials: AH
authors.lastname: Dachman
authors.forename: Mark D
authors.initials: MD
authors.lastname: Kuo
authors.forename: Christine O
authors.initials: CO
authors.lastname: Menias
authors.forename: Bettina
authors.initials: B
authors.lastname: Siewert
authors.forename: Jugesh I
authors.initials: JI
authors.lastname: Cheema
authors.forename: Richard
authors.initials: R
authors.lastname: Obregon
authors.forename: Jeff L
authors.initials: JL
authors.lastname: Fidler
authors.forename: Peter
authors.initials: P
authors.lastname: Zimmerman
authors.forename: Karen M
authors.initials: KM
authors.lastname: Horton
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Coakley
authors.forename: Revathy B
authors.initials: RB
authors.lastname: Iyer
authors.forename: Amy K
authors.initials: AK
authors.lastname: Hara
authors.forename: Robert A
authors.initials: RA
authors.lastname: Halvorsen
authors.forename: Giovanna
authors.initials: G
authors.lastname: Casola
authors.forename: Judy
authors.initials: J
authors.lastname: Yee
authors.forename: Meredith
authors.initials: M
authors.lastname: Blevins
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Burgart
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Limburg
authors.forename: Constantine A
authors.initials: CA
authors.lastname: Gatsonis
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic; D023881:Colonography, Computed Tomographic; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology