Advanced neoplasia represents the primary target for colorectal-cancer screening and prevention.
Dr David Kim and colleagues compared the diagnostic yield from parallel computed tomographic colonography and optical colonoscopy screening programs.
|Advanced neoplasia was confirmed in 3% in both groups|
|The New England Journal of Medicine|
The team compared primary computed tomographic colonography screening in 3120 consecutive adults with primary optical colonoscopy screening in 3163 consecutive adults.
The main outcome measures included the detection of advanced neoplasia, and the total number of harvested polyps.
Referral for polypectomy during optical colonoscopy was offered for all computed tomographic colonography-detected polyps of at least 6 mm in size.
Patients with 1 or 2 small polyps also were offered the option of computed tomographic colonography surveillance.
During primary optical colonoscopy, nearly all detected polyps were removed, regardless of size, according to established practice guidelines.
The researchers found 123 advanced neoplasms including 14 invasive cancers during computed tomographic colonography.
Optical colonoscopy screening identified 121 advanced neoplasms including 4 invasive cancers.
The researchers noted that the referral rate for optical colonoscopy in the primary computed tomographic colonography screening group was 8%.
The team noted that advanced neoplasia was confirmed in 3% of patients in both the computed tomographic colonography and optical colonoscopy groups.
The total numbers of polyps removed in the computed tomographic colonography and optical colonoscopy groups were 561 and 2434, respectively.
There were 7 colonic perforations in the optical colonoscopy group, and none in the computed tomographic colonography group.
Dr Kim's team concluded, "Primary computed tomographic colonography and optical colonoscopy screening strategies resulted in similar detection rates for advanced neoplasia."
"However, the numbers of polypectomies and complications were considerably smaller in the computed tomographic colonography group."
"These findings support the use of computed tomographic colonography as a primary screening test before therapeutic optical colonoscopy."