Colon cancer screening with CT colonography: logistics, cost-effectiveness, efficiency and progress

Abstract

Colorectal cancer (CRC) incidence and mortality can be significantly reduced by population screening. Several different screening methods are currently in use, and this review focuses specifically on the imaging technique computed tomographic colonography (CTC). The challenges and logistics of CTC screening, as well as the importance of test accuracy, uptake, quality assurance and cost-effectiveness will be discussed. With comparable advanced adenoma detection rates to colonoscopy (the most commonly used whole-colon investigation), CTC is a less-invasive alternative, requiring less laxative, and with the potential benefit that it permits assessment of extra colonic structures. Three large-scale European trials have contributed valuable evidence supporting the use of CTC in population screening, and highlight the importance of selecting appropriate clinical management pathways based on initial CTC findings. Future research into CTC-screening will likely focus on radiologist training and CTC quality assurance, with identification of evidence-based key performance indicators that are associated with clinically-relevant outcomes such as the incidence of post-test interval cancers (CRC occurring after a presumed negative CTC). In comparison to other CRC screening techniques, CTC offers a safe and accurate option that is particularly useful when colonoscopy is contraindicated. Forthcoming cost-effectiveness analyses which evaluate referral thresholds, the impact of extra-colonic findings and real-world uptake will provide useful information regarding the feasibility of future CTC population screening.

Cutoff of 25% for Ki67 expression is a good classification tool for prognosis in colorectal cancer in the AJCC‑8 stratification

“…In 2015, 376,000 new CRC cases were diagnosed in China, with 191,000 succumbing to the malignancy (9). National polyp screening programs constitute an early diagnosis tool, which can markedly improve CRC prognosis (10)(11)(12)(13)(14). Early diagnosis and treatment of CRC is becoming increasingly important to surgeons.…”

A 6 lncRNA-Based Risk Score System for Predicting the Recurrence of Colon Adenocarcinoma Patients

“…As a common malignancy occurring in the colon, colon cancer is divided into adenocarcinoma, undifferentiated carcinoma, and mucinous adenocarcinoma (1). Colon cancer is induced mainly by a high-fat low-fiber diet, and its symptoms include hematochezia, purulent stools, the change of bowel habits, abdominal mass, ileus, bellyache, and anemia (2).…”

Kolorektales Karzinom: Rolle bildgebender Verfahren in der Vorsorge

“…Das betrifft vor allem die Gewährleistung der Qualität der Untersuchung, der Standardisierung der Untersuchungs-und Auswertetechnik sowie der spezifischen fachlichen Qualifikation der Untersucher. Darüber hinaus müssen Strategien zur Qualitätskontrolle und standardisierten Dokumentation etabliert werden [63].…”

“…Die Akquisitionszeiten in der MRT sind länger als bei der CTK, und der Darm wird meist mit Flüssigkeit (Wasser oder Gadolinium markierter Flüssigkeit) oder Gas gefüllt. Diese Rahmenbedingungen können besonders in den engen räumlichen Verhältnissen eines MRT für den Patienten belastend sein [63]. Eine i.v.-KM-Gabe wird als notwendig erachtet, was gegen einen Einsatz bei potenziell Gesunden spricht [66].…”