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Identification of extracolonic pathologies by computed tomographic colonography in colorectal cancer symptomatic patients
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SIGGAR Investigators (Including:
). (2015) Identification of extracolonic pathologies by computed tomographic colonography in colorectal cancer symptomatic patients. Gastroenterology, 149 (1). 89-101.e5. doi:10.1053/j.gastro.2015.03.011 ISSN 0016-5085.Research output not available from this repository.
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Official URL: http://dx.doi.org/10.1053/j.gastro.2015.03.011
Abstract
BACKGROUND & AIMS:
Symptoms suggestive of colorectal cancer may originate outside the colorectum. Computed tomographic colonography (CTC) is used to examine the colorectum and abdominopelvic organs simultaneously. We performed a prospective randomized controlled trial to quantify the frequency, nature, and consequences of extracolonic findings.
METHODS:
We studied 5384 patients from 21 UK National Health Service hospitals referred by their family doctor for the investigation of colorectal cancer symptoms from March 2004 through December 2007. The patients were assigned randomly to groups that received the requested test (barium enema or colonoscopy, n = 3574) or CTC (n = 1810). We determined the frequency and nature of extracolonic findings, subsequent investigations, ultimate diagnosis, and extracolonic cancer diagnoses 1 and 3 years after testing patients without colorectal cancer.
RESULTS:
Extracolonic pathologies were detected in 959 patients by CTC (58.7%), in 42 patients by barium enema analysis (1.9%), and in no patients by colonoscopy. Extracolonic findings were investigated in 142 patients (14.2%) and a diagnosis was made for 126 patients (88.1%). Symptoms were explained by extracolonic findings in 4 patients analyzed by barium enema (0.2%) and in 33 patients analyzed by CTC (2.8%). CTC identified 72 extracolonic neoplasms, however, barium enema analysis found only 3 (colonoscopy found none). Overall, CTC diagnosed extracolonic neoplasms in 72 of 1634 patients (4.4%); 26 of these were malignant (1.6%). There were significantly more extracolonic malignancies detected than expected 1 year after examination, but these did not differ between patients evaluated by CTC (22.2/1000 person-years), barium enema (26.5/1000 person-years; P = .43), or colonoscopy (32.0/1000 person-years; P = .88).
CONCLUSIONS:
More than half of the patients with symptoms of colorectal cancer are found to have extracolonic pathologies by CTC analysis. However, the proportion of patients found to have extracolonic malignancies after 1 year of CTC examination is not significantly greater than after barium enema or colonoscopy examinations. International Standard Randomised Controlled Trials no: 95152621.isrctn.com.
Item Type: | Journal Article | ||||||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||||
Journal or Publication Title: | Gastroenterology | ||||||||
Publisher: | W.B. Saunders Co. | ||||||||
ISSN: | 0016-5085 | ||||||||
Official Date: | July 2015 | ||||||||
Dates: |
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Volume: | 149 | ||||||||
Number: | 1 | ||||||||
Page Range: | 89-101.e5 | ||||||||
DOI: | 10.1053/j.gastro.2015.03.011 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published |
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