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Institute of Medicine (US); National Research Council (US); Pignone M, Russell L, Wagner J, editors. Economic Models of Colorectal Cancer Screening in Average-Risk Adults: Workshop Summary. Washington (DC): National Academies Press (US); 2005.

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Economic Models of Colorectal Cancer Screening in Average-Risk Adults: Workshop Summary.

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Appendix JRecent Findings on Test Performance

, M.D., M.P.H.

Slide 1. Appendix J Recent Findings on Test Performance.

Slide 1

Appendix J Recent Findings on Test Performance. SLIDE 1 NOTES: I was asked to cover recent evidence on test performance for all the major colorectal cancer screening tests. I tried to take a meta-analytic approach to every test I examined, but was frustrated (more...)

Slide 2. Colorectal Cancer Screening Viable Tests.

Slide 2

Colorectal Cancer Screening Viable Tests. SLIDE 2 NOTES: Here is a list of what I consider tests that are viable for colorectal cancer screening. They begin with FOBTs and barium enema. These are to some extent viewed by both clinicians and the public (more...)

Slide 3. Fecal Occult Blood Tests.

Slide 3

Fecal Occult Blood Tests. SLIDE 3 NOTES: Fecal Occult Blood Tests (FOBTs) have been in use for several decades and provide some of the best data supporting the indication for CRC screening in order to prevent colorectal cancer (Ederer et al., 1997; Mandel (more...)

Slide 4. Test Performance FOBTs.

Slide 4

Test Performance FOBTs. SLIDE NOTES 4: FOBTs - There is a range of results reported for the GUAIAC-based stool studies, with sensitivity for detection of polyps ranging from 5-98% and sensitivity for detection of cancer of 18-92 percent. Specificity for (more...)

Slide 5. Test Performance Immunochemical FOBTs.

Slide 5

Test Performance Immunochemical FOBTs. SLIDE 5 NOTES: IFOBTS -- There is a broad range of results for Immunochemical FOBTs (IFOBTs) impacted by the number of studies used, the population screened, the ‘gold standard’ used and the lesion (more...)

Slide 6. FOBT vs. IFOBT.

Slide 6

FOBT vs. IFOBT. SLIDE 6 NOTES: A new article published by Ko and colleagues (Ko et al., 2003) looked at a population of veterans at varied risk for colorectal cancer, almost all male. The purpose of the study was to compare the overall performance of (more...)

Slide 7. Test Performance Barium Enema.

Slide 7

Test Performance Barium Enema. SLIDE 7 NOTES: Barium Enema --Though more widely used in the past, double-contrast barium enema (DCBE) has fallen out of favor with primary care providers, radiologists and gastroenterologists. The reason for this bias against (more...)

Slide 8. Test Performance Flexible Sigmoidoscopy.

Slide 8

Test Performance Flexible Sigmoidoscopy. SLIDE 8 NOTES: Flexible Sigmoidoscopy: This test has long been used for CRC screening, but has obvious limitations based on the length of insertion of the traditional Flexible Sigmoidoscopy (FlexSig) endoscope. (more...)

Slide 9. Test Performance Colonoscopy.

Slide 9

Test Performance Colonoscopy. SLIDE 9 NOTES: Colonoscopy -- Long considered the ‘gold standard’ for CRC screening, this test provides visualization of the entire colon and allows for removal of specimens for histopathologic assessment. (more...)

Slide 10. SLIDE 10 NOTES: STOOL DNA --Stool DNA is a provocative new technology.

Slide 10

SLIDE 10 NOTES: STOOL DNA --Stool DNA is a provocative new technology. Its development was based on a number of observations about the natural history of colorectal cancer. The progression of normal colonic mucosa through a series of mutational events (more...)

Slide 11. Test Performance Stool DNA.

Slide 11

Test Performance Stool DNA. SLIDE 11 NOTES: It has been determined from patients with proven CRC that a number of mutations can be detected in cells obtained from stool specimens that correspond to mutations in the neoplasm in those affected individuals. (more...)

Slide 12. Test Performance Virtual Colonoscopy.

Slide 12

Test Performance Virtual Colonoscopy. SLIDE 12 NOTES: Virtual colonoscopy is the latest technology to receive high visibility in the press. It is important to recognize, though, that this is still an evolving technology. As such, there has been a broad (more...)

Slide 13. Virtual Colonoscopy Studies All with n > 100.

Slide 13

Virtual Colonoscopy Studies All with n > 100. SLIDE 13 NOTES: Here is a list of the six studies with a sample size of 100 or greater. All have been reported in the recent past, before the conduct of this workshop. Note that the populations studied (more...)

Slide 14. V.C. Study Results Per Patient Analysis.

Slide 14

V.C. Study Results Per Patient Analysis. SLIDE 14 NOTES: Looking at the per-patient data gives the possibility of determining what will happen to patients who are subjected to screening by this modality. Across all six studies, the sensitivity for small (more...)

Slide 15. The Pickhardt Study -Methods.

Slide 15

The Pickhardt Study -Methods. SLIDE 15 NOTES: The Pickhardt Study -- In my opinion, The Pickhardt study (Pickhardt et al., 2003) is the one against which many others will be assessed in the future. This was a multi-center enrollment study. Average-risk (more...)

Slide 16. The Pickhardt Study –Diagnostic Methods.

Slide 16

The Pickhardt Study –Diagnostic Methods. SLIDE 16 NOTES: No notes.

Slide 17. The Pickhardt Study -Statistical Analysis.

Slide 17

The Pickhardt Study -Statistical Analysis. SLIDE 17 NOTES: The Pickhardt study employed segmental unblinding, which means that as the colonoscope passes through a segment, any indication from the VC results that a lesion may have been missed would lead (more...)

Slide 18. Pickhardt Results.

Slide 18

Pickhardt Results. SLIDE 18 NOTES: No notes.

Slide 19. Pickhardt Results – Test Performance.

Slide 19

Pickhardt Results – Test Performance. SLIDE 19 NOTES: To summarize comparative test performance, VC found 55 polyps not seen on OC, and 21 of those were tubular adenomas greater than 6 mm. The sensitivity for advanced neoplasia was 91.5 percent (more...)

Slide 20. Pickhardt Results.

Slide 20

Pickhardt Results. SLIDE 20 NOTES: The additional outcome measures described in this slide – extra-colonic findings, procedural time, and patient satisfaction – are secondary outcomes that may be important in evaluating the cost-effectiveness (more...)

Slide 21. Pickhardt Results Summary Statistics.

Slide 21

Pickhardt Results Summary Statistics. SLIDE 21 NOTES: Overall summary statistics for VC performance --with a cutoff range of 8 mm or greater, sensitivity and specificity of VC are greater than 90 percent. However, test positivity rates are high, which (more...)

Slide 22. Pickhardt Study: Questions/Issues.

Slide 22

Pickhardt Study: Questions/Issues. SLIDE 22 NOTES: No notes.

Slide 23. Test Performance Other Studies.

Slide 23

Test Performance Other Studies. SLIDE 23 NOTES: Here is a brief description of some provocative technologies ‘not (yet) ready for prime time:’ Flurodioxyglucose Positron Emission Tomography (FDG-PET) FDGs take up metabolically active cells. (more...)

Slide 24. Test Performance The Bottom-Line.

Slide 24

Test Performance The Bottom-Line. SLIDE 24 NOTES: This table shows the broad range of sensitivity and specificity for polyps and cancer across all of the technologies reviewed here.

Slide 25. Test Performance The Bottom-Line.

Slide 25

Test Performance The Bottom-Line. SLIDE 25 NOTES: No notes.

Slide 26. Summary Comments.

Slide 26

Summary Comments. SLIDE 26 NOTES: To summarize the entire literature, I would say that at present we have no clear gold standard for overall analysis. However, the segmentally unblinded colonoscopy using complementary studies is probably the best approach (more...)

Slide 27. Summary Comments.

Slide 27

Summary Comments. SLIDE 27 NOTES: No notes.

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Copyright © 2005, National Academy of Sciences.
Bookshelf ID: NBK83901

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