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Identification of extracolonic pathologies by computed tomographic colonography in colorectal cancer symptomatic patients

Identification of extracolonic pathologies by computed tomographic colonography in colorectal cancer symptomatic patients
Identification of extracolonic pathologies by computed tomographic colonography in colorectal cancer symptomatic patients
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.
detection, diagnostic, digestive system, colon cancer
0016-5085
89-101.e5
Halligan, S.
d4660e12-21e6-498c-b52c-96a3262a914c
Woolrage, K.
3e3f73f1-46e8-443b-89e3-ddfc20585d6d
Dadswell, E.
65749d23-cdf5-47a1-87a7-e7116132dd15
Shah, U.
b05b8165-558f-4bdf-9dcc-a8a43d8f550f
Kralj-Hans, I.
3a6808ab-ad83-4073-9105-9fa51831b737
von Wagner, C.
2e0a9eb1-b1cf-41eb-ade1-dfb0234a9f66
Faiz, O.
2dbdeac9-e5d7-461d-9f4a-3122b027de7d
Teare, J.
4ca19134-a36b-4911-997e-f85f321873e2
Edwards, R.
93648ffb-c74d-4c6c-8851-3419c2a16f9d
Kay, C.
7515821c-375e-40ae-9a85-62ece8cf96fd
Yao, G.
d777f84c-cf3d-4fad-bbc1-ea01dec01695
Lilford, R.J.
c23dbd37-c90e-43d9-9309-d6bf66dbaab4
Morton, D.
18c5e38b-eda1-4a4f-9236-a29f32a7fcc3
Wardle, J.
495e80aa-d1b7-4b02-8b1e-8596e5df2550
Atkin, W.
e108946c-932a-4f57-a177-df4beb6afaf2
Halligan, S.
d4660e12-21e6-498c-b52c-96a3262a914c
Woolrage, K.
3e3f73f1-46e8-443b-89e3-ddfc20585d6d
Dadswell, E.
65749d23-cdf5-47a1-87a7-e7116132dd15
Shah, U.
b05b8165-558f-4bdf-9dcc-a8a43d8f550f
Kralj-Hans, I.
3a6808ab-ad83-4073-9105-9fa51831b737
von Wagner, C.
2e0a9eb1-b1cf-41eb-ade1-dfb0234a9f66
Faiz, O.
2dbdeac9-e5d7-461d-9f4a-3122b027de7d
Teare, J.
4ca19134-a36b-4911-997e-f85f321873e2
Edwards, R.
93648ffb-c74d-4c6c-8851-3419c2a16f9d
Kay, C.
7515821c-375e-40ae-9a85-62ece8cf96fd
Yao, G.
d777f84c-cf3d-4fad-bbc1-ea01dec01695
Lilford, R.J.
c23dbd37-c90e-43d9-9309-d6bf66dbaab4
Morton, D.
18c5e38b-eda1-4a4f-9236-a29f32a7fcc3
Wardle, J.
495e80aa-d1b7-4b02-8b1e-8596e5df2550
Atkin, W.
e108946c-932a-4f57-a177-df4beb6afaf2

Halligan, S., Woolrage, K., Dadswell, E., Shah, U., Kralj-Hans, I., von Wagner, C., Faiz, O., Teare, J., Edwards, R., Kay, C., Yao, G., Lilford, R.J., Morton, D., Wardle, J. and Atkin, W. (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). (PMID:25796362)

Record type: Article

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.

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More information

Accepted/In Press date: 6 March 2015
e-pub ahead of print date: 18 March 2015
Published date: July 2015
Keywords: detection, diagnostic, digestive system, colon cancer
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 380905
URI: http://eprints.soton.ac.uk/id/eprint/380905
ISSN: 0016-5085
PURE UUID: bd45f406-68fb-4de6-9890-e6e1c0c0ebbb

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Date deposited: 14 Sep 2015 15:33
Last modified: 14 Mar 2024 21:07

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Contributors

Author: S. Halligan
Author: K. Woolrage
Author: E. Dadswell
Author: U. Shah
Author: I. Kralj-Hans
Author: C. von Wagner
Author: O. Faiz
Author: J. Teare
Author: R. Edwards
Author: C. Kay
Author: G. Yao
Author: R.J. Lilford
Author: D. Morton
Author: J. Wardle
Author: W. Atkin

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