Colon Capsule Endoscopy (CCE) Versus Computed Tomographic Colonography (CTC) in the Identification of Colonic Polyps in a Screening Population.
Ontology highlight
ABSTRACT:
DISEASE(S): Colorectal Neoplasms,Colorectal Cancer Screening
PROVIDER: 2213802 | ecrin-mdr-crc |
REPOSITORIES: ECRIN MDR
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Project description:The purpose of this study is to evaluate the sensitivity of computed tomographic colonography (CTC) in detecting colorectal polyps and cancers in 1,500 subjects at increased risk of colorectal cancer (CRC), using optical colonoscopy as the reference standard.
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Project description:RATIONALE: New diagnostic procedures such as computed tomographic colonography may provide a less invasive method of identifying patients who have colorectal neoplasia.
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Project description:Interventions: CTC vs CTE
Primary outcome(s): Evaluation of detection ability of CTC and CCE
Study Design: Single arm Non-randomized
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Project description:Computed tomographic colonography (CTC) is a minimally invasive technique for colonic polyps and cancer screening. Teniae coli are three bands of longitudinal smooth muscle on the colon surface. Teniae coli are important anatomically meaningful landmarks on human colon. In this paper, the authors propose an automatic teniae coli detection method for CT colonography.The original CTC slices are first segmented and reconstructed to a 3D colon surface. Then, the 3D colon surface is unfolded using a reversible projection technique. After that the unfolded colon is projected to a 2D height map. The teniae coli are detected using the height map and then reversely projected back to the 3D colon. Since teniae are located at the junctions where the haustral folds meet, the authors apply 2D Gabor filter banks to extract features of haustral folds. The maximum response of the filter banks is then selected as the feature image. The fold centers are then identified based on local maxima and thresholding on the feature image. Connecting the fold centers yields a path of the folds. Teniae coli are extracted as lines running between the fold paths. The authors used the spatial relationship between ileocecal valve (ICV) and teniae mesocolica (TM) to identify the TM, then the teniae omentalis (TO) and the teniae libera (TL) can be identified subsequently.The authors tested the proposed method on 47 cases of 37 patients, 10 of the patients with both supine and prone CT scans. The proposed method yielded performance with an average normalized root mean square error (RMSE) ( ± standard deviation [95% confidence interval]) of 4.87% ( ± 2.93%, [4.05% 5.69%]).The proposed fully-automated teniae coli detection and identification method is accurate and promising for future clinical applications.
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Project description:Texture features have played an essential role in the field of medical imaging for computer-aided diagnosis. The gray-level co-occurrence matrix (GLCM)-based texture descriptor has emerged to become one of the most successful feature sets for these applications. This study aims to increase the potential of these features by introducing multi-scale analysis into the construction of GLCM texture descriptor. In this study, we first introduce a new parameter - stride, to explore the definition of GLCM. Then we propose three multi-scaling GLCM models according to its three parameters, (1) learning model by multiple displacements, (2) learning model by multiple strides (LMS), and (3) learning model by multiple angles. These models increase the texture information by introducing more texture patterns and mitigate direction sparsity and dense sampling problems presented in the traditional Haralick model. To further analyze the three parameters, we test the three models by performing classification on a dataset of 63 large polyp masses obtained from computed tomography colonoscopy consisting of 32 adenocarcinomas and 31 benign adenomas. Finally, the proposed methods are compared to several typical GLCM-texture descriptors and one deep learning model. LMS obtains the highest performance and enhances the prediction power to 0.9450 with standard deviation 0.0285 by area under the curve of receiver operating characteristics score which is a significant improvement.
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Project description:Background: Although subjects with first-degree relatives (FDR) with a history of colorectal cancer (CRC) are at increased risk for CRC, compliance to screening colonoscopy is suboptimal. Computed tomographic colonography (CTC) has been recognized as an alternative for CRC screening in average risk subjects, but less information is available on its performance in FDRs.
Aims: To prospectively assess the accuracy of CTC as a screening tool in FDRs using colonoscopy (OC) with segmental unblinding as reference standard.
Methods: Consecutive patients admitted with CRC diagnosis (index case, IC) were prospectively evaluated. Following the systematic identification of ICs with inherited predispositions to CRC, ICs who agreed to contact their FDRs ≥40 years old were included. Available FDRs were invited to undergo non-cathartic CTC, with OC the following day. Sensitivity/specificity/PPV/NPV of CTC was assessed for detecting subjects with any lesion ≥6 mm, ≥10 mm, and for advanced neoplasia ≥6 mm.
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Project description:Interventions: Colon Capsule Endoscopy
Primary outcome(s): To evaluate the applicability of CCE in colorectal cancer screening in terms of: diagnostic yield, participation rate, patients’ expected and perceived burden of CCE, the workability of CCE for the staff and the interobserver variability in reviewing the CCE images.
Interested patients who meet all inclusion- and exclusion criteria will get an appointment to undergo Colon Capsule Endoscopy. Patients expected and perceived burden of CCE will be measured by 2 questionnaires, one prior to the procedure and one afterwards. The workability for the staff will be measured by a questionnaire which will be handed out to all staff working with CCE within this trial.
Study Design: N/A: single arm study, Open (masking not used), N/A , unknown, Other
| 2443282 | ecrin-mdr-crc
Project description:ObjectiveTo evaluate gastrointestinal and cardiovascular adverse event risks associated with optical colonoscopy (OC) among Medicare outpatients who received computed tomography colonography (CTC) as their initial method of colorectal evaluation.MethodsMedicare claims were compared between 6,114 outpatients ≥ 66 years who received initial CTC and 149,202 outpatients who received initial OC between January 2007 and December 2008. OC patients were matched on county of residence and year of evaluation. Outcomes included lower gastrointestinal bleeding, gastrointestinal perforation, other gastrointestinal events and cardiovascular events resulting in an emergency department visit or hospitalization within 30 days.ResultsAmong 1,000 outpatients undergoing initial CTC, 12.4 experienced lower gastrointestinal bleeding, 0.7 perforation, 18.0 other gastrointestinal events and 45.5 cardiovascular events within 30 days. After multivariate adjustment, risks of lower gastrointestinal bleeding, other gastrointestinal events and cardiovascular events were higher with initial OC than CTC, with or without subsequent OC (OR 1.91 95CI [1.47,2.49], OR 1.35 95CI [1.07,1.69] and OR 1.38 95CI [1.18,1.62], respectively); however, perforation risk did not differ (p=0.10). This pattern is similar in older and symptomatic populations.ConclusionRates of gastrointestinal bleeding, other gastrointestinal events and cardiovascular events are lower following initial CTC than OC, but rates of perforation do not differ.
| S-EPMC4266938 | biostudies-literature
Project description:BackgroundThe Centers for Medicare and Medicaid Services (CMS) considered whether to reimburse computed tomographic colonography (CTC) for colorectal cancer screening of Medicare enrollees. To help inform its decision, we evaluated the reimbursement rate at which CTC screening could be cost-effective compared with the colorectal cancer screening tests that are currently reimbursed by CMS and are included in most colorectal cancer screening guidelines, namely annual fecal occult blood test (FOBT), flexible sigmoidoscopy every 5 years, flexible sigmoidoscopy every 5 years in conjunction with annual FOBT, and colonoscopy every 10 years.MethodsWe used three independently developed microsimulation models to assess the health outcomes and costs associated with CTC screening and with currently reimbursed colorectal cancer screening tests among the average-risk Medicare population. We assumed that CTC was performed every 5 years (using test characteristics from either a Department of Defense CTC study or the National CTC Trial) and that individuals with findings of 6 mm or larger were referred to colonoscopy. We computed incremental cost-effectiveness ratios for the currently reimbursed screening tests and calculated the maximum cost per scan (ie, the threshold cost) for the CTC strategy to lie on the efficient frontier. Sensitivity analyses were performed on key parameters and assumptions.ResultsAssuming perfect adherence with all tests, the undiscounted number life-years gained from CTC screening ranged from 143 to 178 per 1000 65-year-olds, which was slightly less than the number of life-years gained from 10-yearly colonoscopy (152-185 per 1000 65-year-olds) and comparable to that from 5-yearly sigmoidoscopy with annual FOBT (149-177 per 1000 65-year-olds). If CTC screening was reimbursed at $488 per scan (slightly less than the reimbursement for a colonoscopy without polypectomy), it would be the most costly strategy. CTC screening could be cost-effective at $108-$205 per scan, depending on the microsimulation model used. Sensitivity analyses showed that if relative adherence to CTC screening was 25% higher than adherence to other tests, it could be cost-effective if reimbursed at $488 per scan.ConclusionsCTC could be a cost-effective option for colorectal cancer screening among Medicare enrollees if the reimbursement rate per scan is substantially less than that for colonoscopy or if a large proportion of otherwise unscreened persons were to undergo screening by CTC.
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