CT colonography can pinpoint cancerous colorectal segments more accurately than colonoscopy, according to Italian investigators. They say virtual, not optical, colonoscopy should be the gold standard for the preoperative staging of colorectal cancer.
The prognosis for patients diagnosed with colorectal cancer depends largely on the correct localization of diseased segments prior to tumor resection. Colonoscopy, the standard of care for this indication, could be plagued by multiple anatomical or physiological hurdles that hinder precise segment tracking in about three of every 10 patients. But CTC can overcome most of these limitations, said principal investigator Dr. Emanuele Neri, an assistant professor of diagnostic and interventional radiology at the University of Pisa.
"Gastroenterologists and surgeons should be aware of this and before surgery should always ask for a staging CT colonography," Neri told Diagnostic Imaging.
Neri and colleagues enrolled 65 patients diagnosed with colorectal cancer who underwent segmental localization of their tumors with colonoscopy and CTC before surgery. Of this group, 45 patients (69%) had to be referred to CTC after incomplete colonoscopy results due to discomfort or because of bowel narrowing from cancer.
CTC allowed a complete evaluation in all but two cases, where an obstructing lesion of the sigmoid prevented proper cleansing and insufflation. CTC accurately identified all diseased segments while colonoscopy missed 16 of them (24%). CTC's sensitivity, specificity, and positive and negative predictive values for precise location of colonic masses were, respectively, 100%, 96%, 85%, and 100%. Results appeared online in the Sept. 18 issue of Abdominal Imaging.
The accumulation of data keeps fueling the discussion regarding the value of CTC vis-à-vis colonoscopy. What is beyond any doubt is that CTC should at least replace double contrast barium enema, which has become an obsolete diagnostic tool, Neri said. Patients nowadays prefer CTC over barium enemas and the reasons go beyond comfort. For one, studies have shown a consistent reduction in radiation dose, averaging 2 to 3 mSv. Cost-effectiveness comes to the fore as well. In addition to a contrast-enhanced CTC, many surgeons still ask for a DCBE for preoperative staging and to get information on the precise location of cancer. This is absolute overkill, Neri said.
"CT colonography alone could get them better preoperative and staging information than two exams," he said.
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Diagnostic Imaging. CT colonography tops colonoscopy for mapping colon cancer segmentation
By H.A. Abella |
November 20, 2009
CT colonography tops colonoscopy for mapping colon cancer segmentation
HIMSS 2009
HIMSS 2009 promises to help guide administrators to prepare to meet an uncertain future for healthcare. It will provide a forum for discussion and a showcase of technologies developed to consider performance metrics and patient outcomes as well as gauge the means for documenting them. Diagnostic Imaging will capture this nexus of information and discussion through reports on key presentations and interviews with the makers of innovative information technologies.
--Greg Freiherr NewsfromHIMSS2009HIMSS Keynote: IT offers hope to solve impending healthcare crisis, says Greenspan
Diagnostic Imaging, April 8, 2009
Harsh economics dampen appetite for healthcare IT
Diagnostic Imaging, April 8, 2009 The weakened U.S. economy is slowing the pace of growth in healthcare IT, according to a survey conducted by HIMSS. Only a little more than half (55%) of the 304 respondents participating the 20th annual HIMSS Leadership Survey said their IT budgets would increase, compared to 78% last year. This year about 42% said their staffing levels would increase, down from 68% last year. HIMSS Video Blog: The challenge of interoperability
Diagnostic Imaging, April 8, 2009 It was designed as a showcase for the nexus of standards and IT, a testament to the ability of divergent systems to work together in a health information exchange. This “interoperability showcase,” an island on the HIMSS09 exhibit floor of kiosks, employed various clinical scenarios to demonstrate the potential of IT to deliver information that can make a crucial difference in the care of patients. HIMSS Day Four: PACS interfaces and financials get better, first responders enter the loop
Diagnostic Imaging, April 8, 2009 There’s no more natural way to convey information than speech and arguably no more difficult interface or a computer to capture. Agfa has come up with a couple new twists to help. Viztek takes a swing at tighter integration between PACS and EMRs, while IT specialists include first responders in the chain of medical communications and refine ways for providers to keep on top of their financials. Games HIMSS People Play: Marketing at the end of a pool cue
Diagnostic Imaging, April 8, 2009 Even if you’ve never been hustled at pool, you’ll appreciate the slick tricks at the Iatric HIMSS booth. Video Blog: Siemens exec wrestles with 'meaningful use'
Diagnostic Imaging, April 8, 2009 The Federal government is pushing medical practitioners toward the use of integrated electronic information systems. The hope is that these systems will improve the efficiency of medical care and reduce errors, thereby cutting costs and improving healthcare. Vioguard blasts germs off keyboards
Diagnostic Imaging, April 8, 2009 Hospital-associated infections are a growing concern for hospitals. Some 1.7 million people pick up infections each year while in hospitals. More than 99,000 die. While these infections may come from several sources, studies have shown that computer keyboards are a leading contributor. With the introduction of their first product, a self-sanitizing keyboard, Seattle-based Vioguard hopes to eliminate the keyboard as a vector of infection in hospitals. HIMSS Blog: Get ready for a fight over who owns electronic medical records
Diagnostic Imaging, April 8, 2009 In the boom leading up to sequencing of the human genome, genetics and legal experts debated the ownership of the data contained within the double helix. Now, as the U.S. readies for a surge into healthcare IT, a similar debate has broken out over EMRs. The outcome could be critical to making the best use of the huge amount of electronic medical information that the Obama Administration’s stimulus funding will create in the next few years. HIMSS Blog: Can robots give meaning to EMRs
Diagnostic Imaging, April 8, 2009 The debate over “meaningful use” has begun. At stake is nothing less than the success of President Obama’s initiative to turn paper into electronic medical records. AcceleRAD unveils easy access imaging portal
Diagnostic Imaging, April 8, 2009 Newly christened AccelaRAD unveiled at HIMSS 2009 a service that allows patients unprecedented control over their medical images. The service, called SeeMyRadiology.com, is designed to provide patients the opportunity to create personalized libraries of images in a centralized location. Using this service, patients own their digital medical images, choosing which ones to easily and securely share with whom, particularly physicians. |
VideosHIMSS Keynote: IT offers hope to solve impending healthcare crisis, says Greenspan Time is running out on Medicare, said economist Alan Greenspan in a keynote address to a capacity crowd at HIMSS09. View Video |
