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Gastroenterology. 2006 Oct;131(4):1011-9.

Risk stratification for colon neoplasia: screening strategies using colonoscopy and computerized tomographic colonography.

Author information

1
Gastroenterology Section, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98101, USA. Otto.Lin@vmmc.org

Abstract

BACKGROUND & AIMS:

We developed a risk index to identify low-risk patients who may be screened for colorectal cancer with computerized tomographic colonography (CTC) instead of colonoscopy.

METHODS:

Asymptomatic persons aged 50 years or older who had undergone screening colonoscopy were randomized retrospectively to derivation (n = 1512) and validation (n = 1493) subgroups. We developed a risk index (based on age, sex, and family history) from the derivation group. The expected results of 3 screening strategies--universal colonoscopy, universal CTC, and a stratified strategy of colonoscopy for high-risk and CTC for low-risk patients--were then compared. Outcomes for the 3 strategies were extrapolated from the known colonic findings in each patient, using sensitivity/specificity values for CTC from the medical literature. Results were validated in the validation subgroup.

RESULTS:

In the derivation subgroup, universal colonoscopy detected 94% of advanced neoplasia and universal CTC detected only 70% and resulted in the largest total number of procedures and number of patients undergoing both procedures. The stratified strategy detected 92% of advanced neoplasia, requiring colonoscopy in 68% and CTC in 36% of patients, with only 4% having to undergo both procedures. In the validation subgroup, universal colonoscopy detected 94% and universal CTC detected 71% of advanced neoplasia, whereas the stratified strategy detected 89%, requiring colonoscopy in 64% and CTC in 40%. Unlike universal CTC, the stratified strategy was independent of assumptions for CTC sensitivity, specificity, and threshold for colonoscopy.

CONCLUSIONS:

The stratified strategy based on our risk index may optimize the yield of colonoscopic resources and reduce the number of patients undergoing colonoscopy.

PMID:
17030171
DOI:
10.1053/j.gastro.2006.08.015
[Indexed for MEDLINE]

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