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Related Experiment Video

Updated: May 12, 2025

Evaluation of Colorectal Cancer Risk and Prevalence by Stool DNA Integrity Detection
07:35

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Computed Tomography Colonography in Fecal Immunochemical Test Positives in a Colorectal Cancer Screening Program.

Sarah Moen1, Fleur E Marijnissen1, Jochim S Terhaar Sive Droste2

  • 1Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
|May 9, 2025
PubMed
Summary

Computed tomography colonography (CTC) in fecal immunochemical test (FIT)-positives showed a lower advanced neoplasia detection rate and a higher risk of post-CT interval colorectal cancer (CRC) compared to colonoscopy. Quality issues and complications necessitate a structured quality assurance program for CTC in CRC screening.

Keywords:
Colorectal Cancer ScreeningComputed Tomography ColonographyFecal Immunochemical TestPost Computed Tomography Interval Colorectal Cancer

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Area of Science:

  • Gastroenterology
  • Radiology
  • Public Health

Background:

  • The Dutch colorectal cancer (CRC) screening program utilizes fecal immunochemical tests (FIT).
  • FIT-positives with comorbidities or refusal of colonoscopy are offered computed tomography colonography (CTC).
  • Limited data exists on CTC performance and post-procedural CRC risk in FIT-positives.

Purpose of the Study:

  • To evaluate the yield of CTC in FIT-positives.
  • To assess clinical management and the risk of post-CT interval CRC (PCT-CRC).
  • To identify potential quality and safety concerns associated with CTC in this population.

Main Methods:

  • A cohort study analyzing data from FIT-positives undergoing CTC between 2014-2019 in the Dutch CRC screening program.
  • Data linkage with the National Cancer Registry to identify PCT-CRCs.
  • Assessment of CTC yield, management decisions, and PCT-CRC rates.

Main Results:

  • Of 2794 FIT-positives who underwent CTC, 5.7% had CRC and 19.8% had polyps ≥10 mm.
  • Advanced neoplasia was detected in 21.1%, with 4.0% confirmed CRC.
  • Sixteen PCT-CRCs (0.6%) occurred over a median follow-up of 49 months; 5 complications (0.2%) were reported, and quality reporting was often lacking.

Conclusions:

  • CTC in FIT-positives demonstrated a lower advanced neoplasia detection rate and a higher PCT-CRC rate than expected from colonoscopy data.
  • A significant proportion of complications and lacking quality reporting highlight areas for improvement.
  • A structured quality assurance program and critical appraisal of patient selection for CTC are essential.