title: Accuracy of capsule colonoscopy and computed tomographic colonography in individuals with positive results from the fecal occult blood test.
abstract: OBJECTIVE
  Computed tomographic colonography (CTC) is a reliable option for screening subjects who are unable or unwilling to undergo optical colonoscopy (OC). A colon capsule (PillCam Colon2 [CC2]; GivenImaging Ltd., Yokneam, Israel) has shown promising results in detecting polyps larger than 6 mm. We compared the accuracy of CC2 and CTC in identifying individuals with at least 1 polyp greater than 6 mm and subjects' attitude toward the procedures.
  
  
  METHODS
  Fifty individuals (mean age, 59.2 ± 5.8 y; 58% male) with positive results from the immunochemical fecal occult blood test (iFOBT-positive) underwent CC2, CTC, and OC. The unblinded colonoscopy, integrating OC, CTC, and CC2 results, was used as the reference standard. In a per-patient analysis, the accuracy of CC2 and CTC were assessed for individuals with at least 1 polyp 6 mm or larger. Individuals were asked to choose which procedure they would be willing to repeat between CTC and CC2.
  
  
  RESULTS
  The combination of OC, CTC, and CC2 identified 16 cases with at least 1 polyp 6 mm or larger (reference standard). CTC identified the polyps with 88.2% sensitivity, 84.8% specificity, a 3.0 positive likelihood ratio, and a 0.07 negative likelihood ratio. CC2 identified the polyps with 88.2% sensitivity, 87.8% specificity, a 3.75 positive likelihood ratio, and a 0.06 negative likelihood ratio. Thirty-nine subjects (78%) said they preferred CC2 to CTC.
  
  
  CONCLUSIONS
  CC2 and CTC detect polyps 6 mm and larger with high levels of accuracy; these techniques are effective in selecting iFOBT-positive individuals who do not need to be referred for colonoscopy. CC2 seems to be better tolerated than CTC, and could be a reliable alternative to CTC for iFOBT-positive individuals who are unable or unwilling to undergo OC. ClinicalTrials.gov number: NCT01744509.
authors.affiliation: Gastroenterology Unit, Ospedale Valduce, Como, Italy. Electronic address: ema.rondo@gmail.com.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Rondonotti
authors.affiliation: Department of Radiology, Ospedale Valduce, Como, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Borghi
authors.affiliation: Gastroenterology Unit, Ospedale Valduce, Como, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Mandelli
authors.affiliation: Gastroenterology Unit, Ospedale Valduce, Como, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Radaelli
authors.affiliation: Gastroenterology Unit, Ospedale Valduce, Como, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Paggi
authors.affiliation: Gastroenterology Unit, Ospedale Valduce, Como, Italy.
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Amato
authors.affiliation: Gastroenterology Unit, Ospedale Valduce, Como, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Imperiali
authors.affiliation: Gastroenterology Unit, Ospedale Valduce, Como, Italy.
authors.forename: Natalia
authors.initials: N
authors.lastname: Terreni
authors.affiliation: Gastroenterology Unit, Ospedale Valduce, Como, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Lenoci
authors.affiliation: Gastroenterology Unit, Ospedale Valduce, Como, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Terruzzi
authors.affiliation: Gastroenterology Unit, Ospedale Valduce, Como, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Baccarin
authors.affiliation: Department of Radiology, Ospedale Valduce, Como, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Martegani
authors.affiliation: Gastroenterology Unit, Ospedale Valduce, Como, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Spinzi
mesh_terms: D000368:Aged; D003106:Colon / Q000473:pathology*; D003110:Colonic Neoplasms / Q000175:diagnosis*; D023881:Colonography, Computed Tomographic / Q000379:methods*; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D011127:Polyps / Q000175:diagnosis*
keywords: Capsule Colonoscopy; Colon Cancer; Computer Tomographic Colonography; Early Detection; Optical Colonoscopy