title: Computed tomographic colonography in subjects with positive faecal occult blood test refusing optical colonoscopy.
abstract: BACKGROUND
  Refusal of colonoscopy is a drawback of colorectal cancer screening programmes based on faecal occult blood test. Computed-tomographic-colonography is generally more accepted than colonoscopy.
  
  
  OBJECTIVE
  To compare adherence to computed-tomographic-colonography and second-invitation colonoscopy in subjects with positive faecal test refusing colonoscopy.
  
  
  METHODS
  We performed a prospective study in 198 subjects with positive faecal test who refused first referral to colonoscopy in one endoscopy service of the Florence screening programme. Subjects were randomly invited to computed-tomographic-colonography (n = 100) or re-invited to colonoscopy (n = 98). Mail invitation was followed by a questionnaire administered by phone. Computed-tomographic-colonography findings were verified with colonoscopy.
  
  
  RESULTS
  32 subjects could not be reached, 71 (35.9%) had undergone colonoscopy on their own; 4 were excluded for contraindications; 30/48 (62.5%) in the computed-tomographic-colonography arm and 11/43 (25.6%) in the colonoscopy arm accepted the proposed examinations (p < 0.001). Four advanced adenomas and 1 cancer were found in the 28 subjects who ultimately underwent computed-tomographic-colonography and 2 advanced adenomas and 2 cancers in the 9 subjects who ultimately underwent second-invitation colonoscopy.
  
  
  CONCLUSIONS
  Subjects with positive faecal occult blood test refusing colonoscopy show a higher adherence to computed-tomographic-colonography than to second invitation colonoscopy.
authors.affiliation: Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Viale G. Pieraccini 6, 50139 Florence, Italy. lapo.sali@unifi.it
authors.forename: Lapo
authors.initials: L
authors.lastname: Sali
authors.forename: Grazia
authors.initials: G
authors.lastname: Grazzini
authors.forename: Leonardo
authors.initials: L
authors.lastname: Ventura
authors.forename: Massimo
authors.initials: M
authors.lastname: Falchini
authors.forename: Alessandra
authors.initials: A
authors.lastname: Borgheresi
authors.forename: Guido
authors.initials: G
authors.lastname: Castiglione
authors.forename: Michele
authors.initials: M
authors.lastname: Grimaldi
authors.forename: Nicola
authors.initials: N
authors.lastname: Ianniciello
authors.forename: Beatrice
authors.initials: B
authors.lastname: Mallardi
authors.forename: Marco
authors.initials: M
authors.lastname: Zappa
authors.forename: Mario
authors.initials: M
authors.lastname: Mascalchi
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000236:Adenoma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000368:Aged; D023881:Colonography, Computed Tomographic; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D011446:Prospective Studies; D016312:Treatment Refusal