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Computed tomography colonography versus colonoscopy for the diagnosis of colorectal cancer: a systematic review and meta-analysis

Authors Duarte RB, Bernardo WM, Sakai CM, Silva GLR, Guedes HG, Kuga R, Ide E, Ishida RK, Sakai P, de Moura EGH

Received 20 September 2017

Accepted for publication 13 November 2017

Published 21 February 2018 Volume 2018:14 Pages 349—360


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Garry Walsh

Ralph B Duarte, Wanderley M Bernardo, Christiano M Sakai, Gustavo LR Silva, Hugo G Guedes, Rogerio Kuga, Edson Ide, Robson K Ishida, Paulo Sakai, Eduardo GH de Moura

Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil

Abstract: Colorectal cancer (CRC) is a significant cause of morbidity and mortality. Optical colonoscopy (OC) is the first choice of investigation for assessing the state of the colon and it is excellent for CRC screening. Newer technologies such as computed tomography colonography (CTC) may also be useful in CRC screening. This systematic review compares the benefits of CTC and OC for CRC screening. This review includes all the available randomized clinical trials comparing CTC and OC for CRC screening in asymptomatic patients. Three studies were included in the systematic review and were submitted for meta-analysis. In the analysis of participation rates, only 2,333 of 8,104 (29%) patients who were invited for screening underwent the CTC, and only 1,486 of the 7,310 (20%) patients who were invited for screening underwent OC. The absolute risk difference in participation rate in the two procedures was 0.1 (95% CI, 0.05–0.14) in favor of CTC. In the analysis of advanced colorectal neoplasia (ACN) detection rates, 2,357 patients undergoing CTC and 1,524 patients undergoing OC were included. Of these, 135 patients (5.7%) who underwent a CTC and 130 patients (8.5%) who underwent an OC were diagnosed with ACN. The absolute risk difference in ACN detection rate in the two procedure types was -0.02 (with a 95% CI between -0.04 and -0.00) in favor of OC. CTC is an option for CRC screening in asymptomatic patients. However, as CTC was inferior in detecting ACN, it should not replace OC, which remains the gold standard.

Keywords: computed tomography colonography, colonography, CT colonography, virtual colonoscopy, colonoscopy, colorectal neoplasm, colorectal cancer, colorectal cancer screening, colonic polyp, colonic adenoma

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