title: CT-Colonography vs. Colonoscopy for Detection of High-Risk Sessile Serrated Polyps.
abstract: Sessile serrated polyps (SSPs) are suggested to be the precursors of 15-30% of all colorectal cancers (CRCs). Therefore, CRC screening modalities should also be designed to detect high-risk SSPs. We compared computed tomography colonography (CTC) with colonoscopy-based screening for the detection of high-risk SSPs in average-risk individuals.
  
  
  
  Data from a randomized controlled trial that compared CTC with colonoscopy for population screening were used for the analysis. Individuals diagnosed at CTC with a lesion ≥10 mm in size were referred for colonoscopy. Individuals with only 6-9 mm lesions were offered surveillance CTC. This surveillance CTC was followed by a colonoscopy when a lesion ≥6 mm was detected. Yield of both was accumulated to mimic current American College of Radiology CTC referral strategy (referral of individuals with any lesion ≥6 mm). Per participant detection of ≥1 high-risk (dysplastic and/or ≥10 mm) SSP was compared with colonoscopy using multiple logistic regression analysis.
  
  
  
  In total, 8,844 individuals were invited to participate (in 2:1 allocation), of which 1,276 colonoscopy and 982 CTC invitees participated in the study. In the colonoscopy arm, 4.3% of individuals were diagnosed with ≥1 high-risk SSP, compared with 0.8% in the CTC arm (odds ratio (OR) 5.5; 95% confidence interval (CI) 2.6-11.6; P<0.001). In total, 3.1% of individuals in the colonoscopy arm were diagnosed with high-risk SSPs as most advanced lesion, compared with 0.4% in the CTC arm (OR 7.7; 95% CI 2.7-21.6; P<0.001). The current CTC strategy showed a marked lower detection for especially flat high-risk SSPs (17 vs. 0), high-risk SSP located in the proximal colon (32 vs. 1), and SSPs with dysplasia (30 vs. 1).
  
  
  
  In a randomized controlled setting, the detection rate of high-risk SSPs was significantly higher with colonoscopy than CTC. These results might have implications for CTC as a CRC modality for opportunistic screening in average-risk adults.
authors.affiliation: Academic Medical Center, Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: J E G
authors.initials: JE
authors.lastname: IJspeert
authors.affiliation: Academic Medical Center, Department of Radiology, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: Tutein Nolthenius
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuipers
authors.affiliation: Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: M E
authors.initials: ME
authors.lastname: van Leerdam
authors.affiliation: Academic Medical Center, Department of Radiology, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: C Y
authors.initials: CY
authors.lastname: Nio
authors.affiliation: Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: M G J
authors.initials: MG
authors.lastname: Thomeer
authors.affiliation: Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Biermann
authors.affiliation: Academic Medical Center, Department of Pathology, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: van de Vijver
authors.affiliation: Academic Medical Center, Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Dekker
authors.affiliation: Academic Medical Center, Department of Radiology, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Stoker
mesh_terms: D000368:Aged; D003111:Colonic Polyps / Q000175:diagnosis*; D023881:Colonography, Computed Tomographic; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis*; D012307:Risk Factors