Background & Aims

Recommendations for surveillance after curative surgery for colorectal cancer (CRC) include a 1-year post-resection abdominal-pelvic computed tomography (CT) scan and optical colonoscopy (OC). CT colonography (CTC), when used in CRC screening, effectively identifies colorectal polyps ≥10 mm and cancers. We performed a prospective study to determine whether CTC, concurrent with CT, could substitute for OC in CRC surveillance.

Methods

Our study enrolled 231 patients with resected stage 0–III CRC, identified at 5 tertiary care academic centers. Approximately 1 year after surgery, participants underwent outpatient CTC plus CT, followed by same-day OC. CTC results were revealed after endoscopic visualization of sequential colonic segments, which were re-examined for discordant findings. The primary outcome was performance of CTC in the detection of colorectal adenomas and cancers using endoscopy as the reference standard.

Results

Of the 231 participants, 116 (50.2%) had polyps of any size or histology identified by OC, and 15.6% had conventional adenomas and/or serrated polyps ≥6 mm. No intra-luminal cancers were detected. CTC detected patients with polyps of ≥6 mm with 44.0% sensitivity (95% CI, 30.2–57.8) and 93.4% specificity (95% CI, 89.7–97.0). CTC detected polyps ≥10 mm with 76.9% sensitivity (95% CI, 54.0–99.8) and 89.0% specificity (95% CI, 84.8–93.1). Similar values were found when only adenomatous polyps were considered. The negative predictive value of CTC for adenomas ≥6 mm was 90.7% (95% CI, 86.7–94.5) and for adenomas ≥10 mm the negative predictive value was 98.6% (95% CI, 97.0–100).

Conclusions

In a CRC surveillance population 1 year following resection, CTC was inferior to OC for detecting patients with polyps ≥6 mm. Clinical Trials.gov Registration Number: NCT02143115.

中文翻译：

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计算机断层扫描结肠造影术与结肠镜检查对结肠直肠癌手术后的监测。

背景与目标

大肠癌（CRC）根治性手术后的监测建议包括切除后1年的腹腔盆腔计算机断层扫描（CT）扫描和光学结肠镜检查（OC）。当用于CRC筛查时，CT结肠造影（CTC）可有效地识别≥10 mm的结直肠息肉和癌症。我们进行了一项前瞻性研究，以确定在CRC监测中，CTC与CT结合是否可以替代OC。

方法

我们的研究招募了5个三级护理学术中心确定的231例0-III期CRC切除患者。手术后大约1年，参与者接受了门诊CTC加CT检查，随后进行了当天OC。内窥镜检查连续的结肠节段后显示了CTC结果，对结肠节段进行了重新检查以发现不一致的发现。主要结果是使用内窥镜检查作为参考标准，CTC在检测大肠腺瘤和癌症中的性能。

结果

在231名参与者中，有116名（50.2％）患有由OC鉴别出的任何大小或组织学的息肉，而15.6％的患有常规腺瘤和/或锯齿状息肉≥6 mm。未检测到管腔内癌。CTC检测到息肉≥6mm的患者，敏感性为44.0％（95％CI，30.2-57.8），特异性为93.4％（95％CI，89.7-97.0）。CTC检测到≥10 mm的息肉，灵敏度为76.9％（95％CI，54.0-99.8），特异性为89.0％（95％CI，84.8-93.1）。当仅考虑腺瘤性息肉时，发现相似的值。对于≥6mm的腺瘤，CTC的阴性预测值为90.7％（95％CI，86.7–94.5），对于≥10mm的腺瘤，CTC的阴性预测值为98.6％（95％CI，97.0-100）。

结论

在切除后1年的CRC监测人群中，在检测息肉≥6 mm的患者中，CTC不如OC。Clinical Trials.gov注册号：NCT02143115。