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Review
. 2018 Feb 21:14:349-360.
doi: 10.2147/TCRM.S152147. eCollection 2018.

Computed tomography colonography versus colonoscopy for the diagnosis of colorectal cancer: a systematic review and meta-analysis

Ralph B Duarte  1 , Wanderley M Bernardo  1 , Christiano M Sakai  1 , Gustavo Lr Silva  1 , Hugo G Guedes  1 , Rogerio Kuga  1 , Edson Ide  1 , Robson K Ishida  1 , Paulo Sakai  1 , Eduardo Gh de Moura  1
Affiliations
Review

Computed tomography colonography versus colonoscopy for the diagnosis of colorectal cancer: a systematic review and meta-analysis

Ralph B Duarte et al. Ther Clin Risk Manag. .

Abstract

Colorectal cancer (CRC) is a significant cause of morbidity and mortality. Optical colonoscopy (OC) is the first choice of investigation for assessing the state of the colon and it is excellent for CRC screening. Newer technologies such as computed tomography colonography (CTC) may also be useful in CRC screening. This systematic review compares the benefits of CTC and OC for CRC screening. This review includes all the available randomized clinical trials comparing CTC and OC for CRC screening in asymptomatic patients. Three studies were included in the systematic review and were submitted for meta-analysis. In the analysis of participation rates, only 2,333 of 8,104 (29%) patients who were invited for screening underwent the CTC, and only 1,486 of the 7,310 (20%) patients who were invited for screening underwent OC. The absolute risk difference in participation rate in the two procedures was 0.1 (95% CI, 0.05-0.14) in favor of CTC. In the analysis of advanced colorectal neoplasia (ACN) detection rates, 2,357 patients undergoing CTC and 1,524 patients undergoing OC were included. Of these, 135 patients (5.7%) who underwent a CTC and 130 patients (8.5%) who underwent an OC were diagnosed with ACN. The absolute risk difference in ACN detection rate in the two procedure types was -0.02 (with a 95% CI between -0.04 and -0.00) in favor of OC. CTC is an option for CRC screening in asymptomatic patients. However, as CTC was inferior in detecting ACN, it should not replace OC, which remains the gold standard.

Keywords: CT colonography; colonic adenoma; colonic polyp; colonography; colonoscopy; colorectal cancer; colorectal cancer screening; colorectal neoplasm; computed tomography colonography; virtual colonoscopy.

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Conflict of interest statement

Disclosure The researchers were responsible for the study design, data collection and analysis, writing of the paper, and the decision to submit the research for publication. The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Study selection flowchart. Abbreviations: CRC, colorectal cancer; CTC, computed tomography colonography; OC, optical colonoscopy.
Figure 2
Figure 2
Forest plot: rate of participation. Abbreviations: CTC, computed tomography colonography; OC, optical colonoscopy.
Figure 3
Figure 3
Forest plot: rate of detection of ACN per participant. Abbreviations: ACN, advanced colorectal neoplasia; CTC, computed tomography colonography; OC, optical colonoscopy.
Figure 4
Figure 4
Forest plot: rate of detection of ACN per invitee. Abbreviations: ACN, advanced colorectal neoplasia; CTC, computed tomography colonography; OC, optical colonoscopy.
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