Primary 2D Versus Primary 3D Polyp Detection at Screening CT Colonography

Pickhardt, Perry J.; Lee, Andrew D.; Taylor, Andrew; Michel, Steven J.; Winter, Thomas C.; Shadid, Anthony; Meiners, Ryan J.; Chase, Peter J.; Hinshaw, J. Louis; Williams, John G.; Prout, Tyler M.; Husain, Sara; Kim, David H.

doi:10.2214/ajr.07.2291

Cited by 98 publications

(57 citation statements)

References 21 publications

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“…OC sensitivity for cancer cannot be ascertained in previous tandem colonoscopy studies owing to the small sample sizes, the very low prevalence of cancer in these studies, and the suboptimal method of using colonoscopy as its own reference standard ( 67 ). The only available estimates of OC cancer sensitivity have previously been limited to is important to note that the use of either a primary 2D mode or a primary 3D mode for lesion detection, which is a critical distinction for polyp sensitivity ( 65 ), had little impact on cancer detection, as most invasive cancers are readily detectable on 2D views. Interestingly, fi ve continents were represented in our prone imaging versus single-position imaging.…”

Section: Evidence-based Practice: Meta-analysis Of Ct Colonography Vementioning

confidence: 99%

Colorectal Cancer: CT Colonography and Colonoscopy for Detection—Systematic Review and Meta-Analysis

Pickhardt

Hassan²,

Halligan³

et al. 2011

Radiology

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Purpose:To perform a systematic review and meta-analysis of published studies assessing the sensitivity of both computed tomographic (CT) colonography and optical colonoscopy (OC) for colorectal cancer detection. Materials and Methods:Analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The primary data source was the results of a detailed PubMed search from 1994 to 2009. Diagnostic studies evaluating CT colonography detection of colorectal cancer were assessed by using predefi ned inclusion and exclusion criteria, in particular requiring both OC and histologic confi rmation of disease. Studies that also included a mechanism to assess true-positive versus false-negative diagnoses at OC (eg, segmental unblinding) were used to calculate OC sensitivity. Assessment and data extraction were performed independently by two authors. Potential bias was ascertained by using Quality Assessment of Diagnostic Accuracy Studies guidelines. Specifi c CT colonography techniques were cataloged. Forest plots of per-patient sensitivity were produced on the basis of random-effect models. Potential bias across primary studies was assessed by using the I 2 statistic. Original study authors were contacted for data clarifi cation when necessary. Results:Forty-nine studies provided data on 11 151 patients with a cumulative colorectal cancer prevalence of 3.6% (414 cancers). The sensitivity of CT colonography for colorectal cancer was 96.1% (398 of 414; 95% confi dence interval [CI]: 93.8%, 97.7%). No heterogeneity ( I 2 = 0%) was detected. No cancers were missed at CT colonography when both cathartic and tagging agents were combined in the bowel preparation. The sensitivity of OC for colorectal cancer, derived from a subset of 25 studies including 9223 patients, was 94.7% (178 of 188; 95% CI: 90.4%, 97.2%). A moderate degree of heterogeneity ( I 2 = 50%) was present. Conclusion:CT colonography is highly sensitive for colorectal cancer, especially when both cathartic and tagging agents are combined in the bowel preparation. Given the relatively low prevalence of colorectal cancer, primary CT colonography may be more suitable than OC for initial investigation of suspected colorectal cancer, assuming reasonable specifi city.

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Section: Evidence-based Practice: Meta-analysis Of Ct Colonography Vementioning

confidence: 99%

Colorectal Cancer: CT Colonography and Colonoscopy for Detection—Systematic Review and Meta-Analysis

Pickhardt

Hassan²,

Halligan³

et al. 2011

Radiology

Self Cite

397

216

View full text Add to dashboard Cite

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“…Although initial reports indicated that 3D might improve sensitivity [13,16], recent results show no significant differences in diagnostic accuracy between primary 3D and primary 2D strategies for the detection of large adenomas, but decreased reading times by about 6 min when a primary 2D approach is used [2]. However, a primary 3D review of CTC may have some inherent differences compared to a primary 2D review.…”

Section: Discussionmentioning

confidence: 97%

Comparison of diagnostic accuracy and interpretation times for a standard and an advanced 3D visualisation technique in CT colonography

et al. 2010

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Objective To compare the diagnostic accuracy of a standard bi-directional, three-dimensional (3D) CT colonography (CTC) fly-through (standard view, SV) with a unidirectional, 3D unfolding technique (panoramic view, PV). Methods 150 consecutive endoscopically-validated CTC patient datasets were retrospectively reviewed twice by two expert radiologists: first, with bidirectional SV, second, after 6-15 months, with unidirectional PV. Per-polyp sensitivities, percentage of visualised colonic mucosa, and reading times were calculated for both 3D visualisations. Results were tested for statistical significance by equivalence analysis for paired proportions and Student's paired t-test. Results In 81 patients, 236 polyps (101 adenomas, 135 nonadenomas) were detected. Sensitivities for polyps ≤5 mm, 6-9 mm and ≥10 mm were 60.1% (113/188), 92.9% (26/28) and 95.0% (19/20) with bidirectional SV, and 60.6% (114/ 188), 96.4% (27/28) and 95.0% (19/20) with unidirectional PV. Overall sensitivity for adenomas was 86.1% and 84.2% for SV and PV. Both methods provided equivalent polyp detection, with an equivalence limit set at 5%. PV and SV visualised 98.9 ± 1.1% (97.0-99.9%) and 96.2 ± 2.3% (91.4-98.8%) of the colonic mucosa (p>0.05). Mean interpretation time decreased from 14.6±2.5 (9.2-22.8) minutes with SV to 7.5 ± 3.2 (5.0-14.4) using PV (p<0.0001). Conclusion 3D CTC interpretation using unidirectional PV is equally as accurate, but significantly faster than an interpretation based on bidirectional SV.

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“…Although the discussion as to whether to read the data in 2D or 3D is still not settled, a (slight) superiority in terms of polyp detection with 3D is reported by some studies [37,38]. Since the reported sensitivities of a primary 2D paradigm tend to be lower, CAD may have a larger additional value when used in a 2D reading protocol.…”

Section: Discussionmentioning

confidence: 99%

Does a computer-aided detection algorithm in a second read paradigm enhance the performance of experienced computed tomography colonography readers in a population of increased risk?

et al. 2008

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Does a computer-aided detection algorithm in a second read paradigm enhance the performance of experienced computed tomography colonography readers in a population of increased risk?Abstract We prospectively determined whether computer-aided detection (CAD) could improve the performance characteristics of computed tomography colonography (CTC) in a population of increased risk for colorectal cancer. Therefore, we included 170 consecutive patients that underwent both CTC and colonoscopy. All findings ≥6 mm were evaluated at colonoscopy by segmental unblinding. We determined perpatient sensitivity and specificity for polyps ≥6 mm and ≥10 mm without and with computer-aided detection (CAD). The McNemar test was used for comparison the results without and with CAD. Unblinded colonoscopy detected 50 patients with lesions ≥6 mm and 25 patients with lesions ≥10 mm. Sensitivity of CTC without CAD for these size categories was 80% (40/50, 95% CI: 69-81%) and 64% (16/25, 95% CI: 45-83%), respectively. CTC with CAD detected one additional patient with a lesion ≥6 mm and two with a lesion ≥10 mm, resulting in a sensitivity of 82% (41/50, 95% CI: 71-93%) (p=0.50) and 72% (18/25, 95% CI: 54-90%) (p=1.0), respectively. Specificity without CAD for polyps ≥6 mm and ≥10 mm was 84% (101/120, 95% CI: 78-91%) and 94% (136/145, 95% CI: 90-98%), respectively. With CAD, the specificity remained (nearly) unchanged: 83% (99/120, 95% CI: 76-89%) and 94% (136/145, 95% CI: 90-98%), respectively. Thus, although CTC with CAD detected a few more patients than CTC without CAD, it had no statistically significant positive influence on CTC performance.

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Primary 2D Versus Primary 3D Polyp Detection at Screening CT Colonography

Abstract: Primary 2D CTC is less sensitive than primary 3D CTC for polyp detection in low-prevalence screening cohorts. The disappointing 2D sensitivity in this study was very similar to results obtained with primary 2D evaluation in previous CTC trials.

Cited by 98 publications

References 21 publications

Colorectal Cancer: CT Colonography and Colonoscopy for Detection—Systematic Review and Meta-Analysis

Colorectal Cancer: CT Colonography and Colonoscopy for Detection—Systematic Review and Meta-Analysis

Comparison of diagnostic accuracy and interpretation times for a standard and an advanced 3D visualisation technique in CT colonography

Does a computer-aided detection algorithm in a second read paradigm enhance the performance of experienced computed tomography colonography readers in a population of increased risk?

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