title: CT colonography for surveillance of patients with colorectal cancer: Systematic review and meta-analysis of diagnostic efficacy.
abstract: OBJECTIVE
  To review primary research evidence investigating performance of CT colonography for colorectal cancer surveillance. The financial impact of using CT colonography for surveillance was also estimated.
  
  
  METHODS
  We identified primary studies of CT colonography for surveillance of colorectal cancer patients. A summary ROC curve was constructed. Inter-study heterogeneity was explored using the I2 value. Financial impact was estimated for a theoretical cohort of patients, based on Cancer Research UK statistics.
  
  
  RESULTS
  Seven studies provided data on 880 patients. Five of seven studies (765 patients) were included for qualitative analysis. Sensitivity of CT colonography for detection of anastomotic recurrence was 95 % (95 % CI 62 - 100), specificity 100 % (95 % CI 75 - 100) and sensitivity for metachronous cancers was 100 %. No statistical heterogeneity was detected (I2 = 0 %). We estimated that CT colonography as a 'single test' alternative to colonoscopy and standard CT for surveillance would potentially save €20,785,232 (£14,803,404) for an annual cohort of UK patients.
  
  
  CONCLUSIONS
  CT colonography compares favourably to colonoscopy for detection of anastomotic recurrence and metachronous colorectal cancer, and appears financially beneficial. These findings should be considered alongside limitations of small patient numbers and high clinical heterogeneity between studies.
  
  
  CONCLUSIONS
  • CT colonography compares favourably to colonoscopy/standard CT for colorectal cancer surveillance. • CT colonography offers single-test luminal, serosal and extra-colonic assessment. • CT colonography is a potentially cost-saving alternative to standard surveillance protocols.
authors.affiliation: Department of Radiology, St Mark's Hospital, Harrow, UK.
authors.forename: François
authors.initials: F
authors.lastname: Porté
authors.affiliation: Surgical Epidemiology, Trials and Outcome Centre (SETOC) St Mark's Hospital, Harrow, UK.
authors.forename: Mallikarjuna
authors.initials: M
authors.lastname: Uppara
authors.affiliation: Surgical Epidemiology, Trials and Outcome Centre (SETOC) St Mark's Hospital, Harrow, UK.
authors.forename: George
authors.initials: G
authors.lastname: Malietzis
authors.affiliation: Surgical Epidemiology, Trials and Outcome Centre (SETOC) St Mark's Hospital, Harrow, UK.
authors.forename: Omar
authors.initials: O
authors.lastname: Faiz
authors.affiliation: Department of Radiology, University College London, London, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Halligan
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.affiliation: Department of Radiology, St Mark's Hospital, Harrow, UK. dburling@nhs.net.
authors.forename: David
authors.initials: D
authors.lastname: Burling
mesh_terms: D023881:Colonography, Computed Tomographic / Q000379:methods*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods*; D006801:Humans; D012372:ROC Curve
keywords: CT colonography; Colonoscopy; Colorectal cancer; Imaging; Surveillance