Variation in Diagnostic Performance among Radiologists at Screening CT Colonography

Pooler, B. Dustin; Kim, David H.; Hassan, Cesare; Rinaldi, Antonio; Burnside, Elizabeth S.; Pickhardt, Perry J.

doi:10.1148/radiol.13121246

Cited by 29 publications

(23 citation statements)

References 28 publications

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“…Programs that include radiologists with appropriate (CTC-specific) training should expect similar numbers. Using this systematic approach, we have shown that the variation in lesion detection rates among radiologists in our program is quite narrow [22], especially compared with the wide variation in performance typically seen at colonoscopy [23]. …”

Section: Discussionmentioning

confidence: 99%

CT Colonography Reporting and Data System (C-RADS): Benchmark Values From a Clinical Screening Program

Pooler

Kim

Lam

et al. 2014

American Journal of Roentgenology

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OBJECTIVE The CT Colonography Reporting and Data System (C-RADS) is a well-recognized standard for reporting findings at CT colonography (CTC). However, few data on benchmark values for clinical performance have been published to date, especially for screening. The purpose of this study was to establish baseline C-RADS values for CTC screening. SUBJECTS AND METHODS From 2005 to 2011, 6769 asymptomatic adults (3110 men and 3659 women) 50–79 years old (mean [± SD] age, 56.7 ± 6.1 years) were enrolled for first-time CTC screening at a single center. CTC results were prospectively classified according to C-RADS for both colorectal and extracolonic findings. C-RADS classification rates and outcomes for positive patients were analyzed. RESULTS C-RADS classification rates for colorectal evaluation were C0 (0.7%), C1 (85.0%), C2 (8.6%), C3 (5.2%), and C4 (0.6%). Overall, 14.3% of subjects were positive (C2–C4), and positive findings were more frequent among men (17.5%) than women (11.6%; p< 0.0001). Positivity also increased with age, from 13.4% of patients 50–64 years old to 21.8% of patients 65–79 years old (p< 0.0001). Regarding extracolonic evaluation, 86.6% of patients were either negative for extracolonic findings or had unimportant extracolonic findings (E1 or E2). Likely unimportant but indeterminate extracolonic findings where further workup might be indicated (E3) were found in 11.3% of patients, whereas 2.1% had likely important extracolonic findings (E4). Overall, E3 and E4 rates were increased for older (p< 0.0001) and female (p= 0.008) cohorts. CONCLUSION C-RADS results from our initial experience with CTC screening may serve as an initial benchmark for program comparison and quality assurance measures.

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Section: Discussionmentioning

confidence: 99%

CT Colonography Reporting and Data System (C-RADS): Benchmark Values From a Clinical Screening Program

Pooler

Kim

Lam

et al. 2014

American Journal of Roentgenology

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“…The estimated number of CTC examinations for a sufficient sensitivity was 164, suggesting that sufficient training requires at least 164 training cases. However, among radiologists experienced with CTC, Pooler et al 36 showed a much more uniform performance among radiologists for polyp detection compared with published variation among gastroenterologists at colonoscopy.…”

Section: Accuracy In Screeningmentioning

confidence: 99%

CT colonography: accuracy, acceptance, safety and position in organised population screening

Haan

Pickhardt

Stoker

2014

Gut

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Colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-related deaths in Europe. The introduction of CRC screening programmes using stool tests and flexible sigmoidoscopy, have been shown to reduce CRC-related mortality substantially. In several European countries, population-based CRC screening programmes are ongoing or being rolled out. Stool tests like faecal occult blood testing are non-invasive and simple to perform, but are primarily designed to detect early invasive cancer. More invasive tests like colonoscopy and CT colonography (CTC) aim at accurately detecting both CRC and cancer precursors, thus providing for cancer prevention. This review focuses on the accuracy, acceptance and safety of CTC as a CRC screening technique and on the current position of CTC in organised population screening. Based on the detection characteristics and acceptability of CTC screening, it might be a viable screening test. The potential disadvantage of radiation exposure is probably overemphasised, especially with newer technology. At this time-point, it is not entirely clear whether the detection of extracolonic findings at CTC is of net benefit and is cost effective, but with responsible handling, this may be the case. Future efforts will seek to further improve the technique, refine appropriate diagnostic algorithms and study cost-effectiveness.

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“…[1, 2] CTC has also demonstrated high reliability,[3] cost-effectiveness,[4, 5] and patient acceptance. [6] Due to the cross-sectional nature of CTC, unsuspected extracolonic findings are inexorably detected in some patients, and the handling of extracolonic findings remains an active area of discussion in regards to widespread implementation of CTC for colorectal cancer screening.…”

Section: Introductionmentioning

confidence: 99%

Potentially Important Extracolonic Findings at Screening CT Colonography: Incidence and Outcomes Data From a Clinical Screening Program

Pooler

Kim

Pickhardt

2016

American Journal of Roentgenology

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Objective The impact of detection of extracolonic findings at screening CT colonography (CTC) remains controversial. Our objective is to analyze the incidence and outcomes of unsuspected potentially significant (C-RADS extracolonic category E4) findings in a clinical CTC screening population. Methods Over 98 months (April 2004 – June 2012), 7,952 consecutive asymptomatic adults (mean age 56.7 ± 7.3 years, 3,675 men, 4,277 women) underwent first-time screening CTC. Examinations were prospectively interpreted by radiologists within our abdominal imaging section and extracolonic findings recorded and categorized. Potentially significant (ie, C-RADS extracolonic category E4) findings were retrospectively reviewed with additional analysis of follow-up and ultimate clinical outcome. Results Overall, 2.5% (202/7952) of patients had a potentially significant (E4) extracolonic finding for which further imaging (55.9%, 113/202) or clinical follow-up (44.1%, 89/202) was recommended. No patients had multiple E4 findings. 22 patients were lost to follow-up. Of the remaining 180 patients, 68% (123/180) proved to have clinically significant disease, including 23% (42/180) with malignant or potentially malignant neoplasms and 32% (57/180) with abdominal aortic or other visceral artery aneurysms requiring treatment or surveillance. The most commonly involved organ systems included vascular (26.2%, 53/202), liver (14.9%, 30/202), genitourinary (13.9%, 28/202), gastrointestinal (9.9%, 20/202), lung (9.4%, 19/202), and gynecologic (6.9%, 14/202). Conclusions Potentially significant extracolonic findings in asymptomatic adults at screening CTC are uncommon, seen in 2–3% of cases. However, the majority of these findings will prove to be clinically significant, including a number of malignancies and aneurysms requiring treatment or surveillance.

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Variation in Diagnostic Performance among Radiologists at Screening CT Colonography

Cited by 29 publications

References 28 publications

CT Colonography Reporting and Data System (C-RADS): Benchmark Values From a Clinical Screening Program

CT Colonography Reporting and Data System (C-RADS): Benchmark Values From a Clinical Screening Program

CT colonography: accuracy, acceptance, safety and position in organised population screening

Potentially Important Extracolonic Findings at Screening CT Colonography: Incidence and Outcomes Data From a Clinical Screening Program

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