Computer tomography colonography participation and yield in patients under surveillance for 6-9 mm polyps in a population-based screening trial

Abstract

Purpose: Surveillance CT colonography (CTC) is a viable option for 6-9 mm polyps at CTC screening for colorectal cancer. We established participation and diagnostic yield of surveillance and determined overall yield of CTC screening.

Material and methods: In an invitational CTC screening trial 82 of 982 participants harboured 6-9 mm polyps as the largest lesion(s) for which surveillance CTC was advised. Only participants with one or more lesion(s) ≥6 mm at surveillance CTC were offered colonoscopy (OC); 13 had undergone preliminary OC. The surveillance CTC yield was defined as the number of participants with advanced neoplasia in the 82 surveillance participants, and was added to the primary screening yield.

Results: Sixty-five of 82 participants were eligible for surveillance CTC of which 56 (86.2 %) participated. Advanced neoplasia was diagnosed in 15/56 participants (26.8 %) and 9/13 (69.2 %) with preliminary OC. Total surveillance yield was 24/82 (29.3 %). No carcinomas were detected. Adding surveillance results to initial screening CTC yield significantly increased the advanced neoplasia yield per 100 CTC participants (6.1 to 8.6; p < 0.001) and per 100 invitees (2.1 to 2.9; p < 0.001).

Conclusion: Surveillance CTC for 6-9 mm polyps has a substantial yield of advanced adenomas and significantly increased the CTC yield in population screening.

Key points: • The participation rate in surveillance CT colonography (CTC) is 86 %. • Advanced adenoma prevalence in a 6-9 mm CTC surveillance population is high. • Surveillance CTC significantly increases the yield of population screening by CTC. • Surveillance CTC for 6-9 mm polyps is a safe strategy. • Surveillance CTC is unlikely to yield new important extracolonic findings.

Keywords: Colonic polyps; Colonography, computed tomographic/methods; Colorectal neoplasms/diagnosis; Mass screening/methods; Patient participation.

Fig. 1

Participation and outcome of CTC patients in the COCOS trial including surveillance CTC. ^ahad OC prior to surveillance invitation, OC findings were used for our analyses. ^b2 refused (repeat) OC, 1 is still to be performed. AA = advanced adenoma, CRC = colorectal cancer

Fig. 2

Evolution of 6–9 mm polyps in surveillance patients on CTC reflected by the most advanced lesion per patient. ^aretrospective evaluation of the surveillance CTC by two of four experienced observers

Fig. 3

Timeframe of nine patients with an advanced adenoma at preliminary OC prior to the invitation for surveillance CTC