National audit of the sensitivity of double-contrast barium enema for colorectal carcinoma, using control charts

Tawn, D J; Squire, C.J.; Mohammed, M A; Adam, Emily

doi:10.1016/j.crad.2004.09.014

Cited by 33 publications

(13 citation statements)

References 10 publications

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“…79 A similar audit of 20 US hospitals found a miss rate of 15% 10 and a national audit of UK hospital radiology departments examining CRCs diagnosed within 12 months of BE found an average miss rate of 15%, with variation from 0% to 50%. 80 In the present trial, 9 of the 12 cancers missed at BE were diagnosed more than 12 months after the randomised procedure, so it is likely that the prior UK audit underestimated the actual BE miss rate. There are no comparable data on miss rates following CTC in routine clinical practice.…”

Section: Chapter 7 Discussionmentioning

confidence: 91%

Computed tomographic colonography compared with colonoscopy or barium enema for diagnosis of colorectal cancer in older symptomatic patients: two multicentre randomised trials with economic evaluation (the SIGGAR trials)

Halligan

Dadswell

Wooldrage

et al. 2015

Health Technol Assess

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BackgroundComputed tomographic colonography (CTC) is a relatively new diagnostic test that may be superior to existing alternatives to investigate the large bowel.ObjectivesTo compare the diagnostic efficacy, acceptability, safety and cost-effectiveness of CTC with barium enema (BE) or colonoscopy.DesignParallel randomised trials: BE compared with CTC and colonoscopy compared with CTC (randomisation 2 : 1, respectively).SettingA total of 21 NHS hospitals.ParticipantsPatients aged ≥ 55 years with symptoms suggestive of colorectal cancer (CRC).InterventionsCTC, BE and colonoscopy.Main outcome measuresFor the trial of CTC compared with BE, the primary outcome was the detection rate of CRC and large polyps (≥ 10 mm), with the proportion of patients referred for additional colonic investigation as a secondary outcome. For the trial of CTC compared with colonoscopy, the primary outcome was the proportion of patients referred for additional colonic investigation, with the detection rate of CRC and large polyps as a secondary outcome. Secondary outcomes for both trials were miss rates for cancer (via registry data), all-cause mortality, serious adverse events, patient acceptability, extracolonic pathology and cost-effectiveness.ResultsA total of 8484 patients were registered and 5384 were randomised and analysed (BE trial: 2527 BE, 1277 CTC; colonoscopy trial: 1047 colonoscopy, 533 CTC). Detection rates in the BE trial were 7.3% (93/1277) for CTC, compared with 5.6% (141/2527) for BE (p = 0.0390). The difference was due to better detection of large polyps by CTC (3.6% vs. 2.2%;p = 0.0098), with no significant difference for cancer (3.7% vs. 3.4%;p = 0.66). Significantly more patients having CTC underwent additional investigation (23.5% vs. 18.3%;p = 0.0003). At the 3-year follow-up, the miss rate for CRC was 6.7% for CTC (three missed cancers) and 14.1% for BE (12 missed cancers). Significantly more patients randomised to CTC than to colonoscopy underwent additional investigation (30% vs. 8.2%;p < 0.0001). There was no significant difference in detection rates for cancer or large polyps (10.7% for CTC vs. 11.4% for colonoscopy;p = 0.69), with no difference when cancers (p = 0.94) and large polyps (p = 0.53) were analysed separately. At the 3-year follow-up, the miss rate for cancer was nil for colonoscopy and 3.4% for CTC (one missed cancer). Adverse events were uncommon for all procedures. In 1042 of 1748 (59.6%) CTC examinations, at least one extracolonic finding was reported, and this proportion increased with age (p < 0.0001). A total of 149 patients (8.5%) were subsequently investigated, and extracolonic neoplasia was diagnosed in 79 patients (4.5%) and malignancy in 29 (1.7%). In the short term, CTC was significantly more acceptable to patients than BE or colonoscopy. Total costs for CTC and colonoscopy were finely balanced, but CTC was associated with higher health-care costs than BE. The cost per large polyp or cancer detected was £4235 (95% confidence interval £395 to £9656).ConclusionsCTC is superior to BE for detection of cancers and large polyps in symptomatic patients. CTC and colonoscopy detect a similar proportion of large polyps and cancers and their costs are also similar. CTC precipitates significantly more additional investigations than either BE or colonoscopy, and evidence-based referral criteria are needed. Further work is recommended to clarify the extent to which patients initially referred for colonoscopy or BE undergo subsequent abdominopelvic imaging, for example by computed tomography, which will have a significant impact on health economic estimates.Trial registrationCurrent Controlled Trials ISRCTN95152621.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 54. See the NIHR Journals Library website for further project information. Funding was also provided by the UK Department of Health, which stipulated a randomised controlled design but had no involvement in the collection, analysis or interpretation of data, in writing the report, or in the decision to submit for publication. This was also the case for manufacturers who donated equipment for the study (Bracco UK Ltd, High Wycombe, UK; Viatronix Inc., Stony Brook, NY, USA; Medicsight plc, London, UK; Barco Ltd, Bracknell, UK).

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Section: Chapter 7 Discussionmentioning

confidence: 91%

Computed tomographic colonography compared with colonoscopy or barium enema for diagnosis of colorectal cancer in older symptomatic patients: two multicentre randomised trials with economic evaluation (the SIGGAR trials)

Halligan

Dadswell

Wooldrage

et al. 2015

Health Technol Assess

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“…In most studies, the sensitivity for DCBE in detecting colon cancer was reported as 85% to 97%. [76][77][78][79][80][81][82][83][84][85][86][87][88] However, a recent study showed a rate of new or missed colon cancer after DCBE of 22.4%, demonstrating that the diagnostic performance of DCBE was affected by several factors, including the quality of the study or the person who performed the study. 89 Comparing different studies regarding the performance of DCBE in diagnosing polyps is more difficult owing to heterogeneous study designs.…”

Section: ) Dcbementioning

confidence: 99%

“…[76][77][78][79][80][81][82][83][84][85][86][87][88] Many studies assessing the detection rate of colon cancer using DCBE analyzed all patients in an institution-or population-based database who had been diagnosed with colon cancer and had been assessed with a prior DCBE within a certain period of time. In most studies, the sensitivity for DCBE in detecting colon cancer was reported as 85% to 97%.…”

Section: ) Dcbementioning

confidence: 99%

Korean Guidelines for Colorectal Cancer Screening and Polyp Detection

Lee

Hong

Kim

et al. 2012

J Korean Soc Radiol

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According to the statistical yearbook of the Ministry of Health and Welfare, crude colorectal cancer incidence rates in Korea in 2008 were 54.7 and 36.9 per 100,000 among males and females, respectively. Colorectal cancer is thus the second most common cancer in males and the fourth most common Clin Endosc 2012;45:25-43 Copyright © 2012 The Korean Society of Gastrointestinal Endoscopy 25 cancer in females. 1 The mortality rates (the number of deaths per 100,000 people, %) of colorectal cancer in 2008 were 15.4% among males and 12.1% among females. Colorectal cancer is thus the fourth most common cause of cancer death among Korean males and the second most common cause of cancer death among Korean females. The age-standardized mortality rates of colorectal cancer continue to increase, unlike those of other common cancers, including lung cancer, liver cancer and stomach cancer, whose mortality rates have decreased in recent years. Increases in the incidence of colorectal cancer may be partly due to Westernization of many Koreans' lifestyles. Greater public awareness of colorectal cancer and the addition of colorectal cancer in 2004 to the national cancer screening program are likely also responsible in part for the increased incidence rates. Participation rates in the national colorectal screening program increased from ap Now colorectal cancer is the second most common cancer in males and the fourth most common cancer in females in Korea. Since most of colorectal cancers occur after the prolonged transformation of adenomas into carcinomas, early detection and removal of colorectal adenomas are one of the most effective methods to prevent colorectal cancer. Considering the increasing incidence of colorectal cancer and polyps in Korea, it is very important to establish Korean guideline for colorectal cancer screening and polyp detection. The guideline was developed by the Korean Multi-Society Take Force and we tried to establish the guideline by evidence-based methods. Parts of the statements were draw by systematic reviews and meta-analyses. Herein we discussed epidemiology of colorectal cancers and adenomas in Korea and optimal methods for screening of colorectal cancer and detection of adenomas including fecal occult blood tests, radiologic tests, and endoscopic examinations.

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“…The majority of these studies showed sensitivity for cancer of 85% to 97%. [137][138][139][140][141][142][143][144][145][146][147][148][149][150] Review of the literature concerning the performance of DCBE for polyps is more difficult due to the described biases and heterogeneity of study design; in particular, the target lesion and thresholds considered clinically significant often varied based upon size and/or morphology. Two studies involving truly asymptomatic individuals were performed in surveillance groups with a history of prior adenoma removal.…”

Section: Screening and Surveillance For The Early Detection Of Colorementioning

confidence: 99%

Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology

Levin

Lieberman

McFarland

et al. 2008

CA: A Cancer Journal for Clinicians

1,568

916

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In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer. CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized. In 2006 to 2007, the American Cancer Society, the US Multi Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average-risk adults. In this update of each organization's guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy. When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps and a screening test that primarily is effective at early cancer detection. It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening. (CA Cancer J Clin 2008;58:130-160.)

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National audit of the sensitivity of double-contrast barium enema for colorectal carcinoma, using control charts

Cited by 33 publications

References 10 publications

Computed tomographic colonography compared with colonoscopy or barium enema for diagnosis of colorectal cancer in older symptomatic patients: two multicentre randomised trials with economic evaluation (the SIGGAR trials)

Computed tomographic colonography compared with colonoscopy or barium enema for diagnosis of colorectal cancer in older symptomatic patients: two multicentre randomised trials with economic evaluation (the SIGGAR trials)

Korean Guidelines for Colorectal Cancer Screening and Polyp Detection

Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology

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