ct colonography: it is ready for screening · andrea laghi m.d. dept of radiological sciences,...
TRANSCRIPT
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CT Colonography: it is ready for screening ?
Andrea Laghi M.D.Dept of Radiological Sciences, Oncology and Pathology
“Sapienza”, University of RomePolo Pontino – Latina
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• The best radiological test for colon imaging
• Replacement of BE
• Complementary to CS
CT COLONOGRAPHY IN 2015
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PATIENT FRIENDLY
REDUCED bowel prep / laxative-free
REDUCED bowel prep / laxative-free
They are testing laxatives today…
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EASY AND FAST
• No SEDATION• Colon distention
(room air/CO2)• Two 10s scans• Overall time, 15 min
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• EFFICACY
• ACCEPTABILITY
• SAFETY
• COST-EFFECTIVENESS
CTC AND POPULATION CRC SCREENING
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• EFFICACY
• ACCEPTABILITY
• SAFETY
• COST-EFFECTIVENESS
CTC AND POPULATION CRC SCREENING
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RCT Multi-centertrials
Single center trials Meta-analyses
COCOS
SIGGAR
ACRIN
IMPACT
Munich
Pickhardt
Sosna
Mulhall
Halligan
Rosman
Chaparro
Pickhardt
De Haan
Plumb
CTC: THE EVIDENCES
• CTC = CS for CRC and >10 mm polyps
• CTC < CS for 6-9 mm polyps
• CTC << CS for <6 mm polyps
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RCT Multi-centertrials
Single center trials Meta-analyses
COCOS
SIGGAR
ACRIN
IMPACT
Munich
Pickhardt
Sosna
Mulhall
Halligan
Rosman
Chaparro
Pickhardt
De Haan
Plumb
CTC: THE EVIDENCES
• CTC > FS (only left colon)
• CTC >> FOBT (cancer only)
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• EFFICACY
• ACCEPTABILITY
• SAFETY
• COST-EFFECTIVENESS
CTC AND POPULATION CRC SCREENING
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CC CTC
CTC: ADHERENCE RATE
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CTC: ADHERENCE RATE
Protéus trialRCT: FS vs CS
• CTC: 30.4%• FS: 27.0%
• Male uptake of CTC higher than FS (OR, 1.6; 95% CI: 1.1-2.3; P=0.01)
Regge D et al, data presented at ECR 2015
p=ns
OPEN ISSUES• “Unfair” comparison between a well-established
test and a “new-comer” in a region where population-based CRC screening using FS works
• Further “marketing” of CTC (PCP; public opinion)• Unexplained higher adherence in males• Bowel preparation and level of embarrassment in
favor of FS
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SAFE: RCT, CTC vs FOBTPI: M. Mascalchi
COCOS: RCT, CTC vs CSY
PROTEUS: RCT, CTC vs SigmoPI: D. Regge
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• EFFICACY
• ACCEPTABILITY
• SAFETY
• COST-EFFECTIVENESS
CTC AND POPULATION CRC SCREENING
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SAFE: PERFORATION
CTC, 0.02% vs CS, 0.03%
Meta-analysis>100,000 patients
• CS data are underestimated• Surgical rate: CTC, 0.008% (1:12,500)
CS, 100% • NO CTC-related deaths
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• Current recommendations
• Reasonably low-dose exam
• Total effective dose: ≈ 5 mSv
RADIATION EXPOSURE
2nd ESGAR Consensus Statement on CTC
• Benefits clearly outweigh radiation risks
Risk/benefit: 1:24 / 1:35Berrington de Gonzalez, AJR, 2010
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• New technology (ITERATIVE algorithm)
• Dose exposure lower than natural background
RADIATION EXPOSURE
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• EFFICACY
• ACCEPTABILITY
• SAFETY
• COST-EFFECTIVENESS
CTC AND POPULATION CRC SCREENING
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CTC dominated by CC, FSIG + gFOBT
COST/EFFECTIVENESS OF CTC
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COST/EFFECTIVENESS OF CTC
• Dutch costs of CT-screening were substantiallylower than cost assumptions used in publishedcost-effectiveness analyses on CTC screening
• Average costs per participant: €169.40• Math models need to be re-calculated
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CTC and SCREENING in 2015
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ESGE – ESGAR CTC GUIDELINES
ESGE/ESGAR do not recommend CTC as a primary test for population screening or in subjects with a first-degreepositive family history (EL: Moderate ; RG: Weak )
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ESGE – ESGAR CTC GUIDELINES
ESGE/ESGAR …suggest (CTC) as a CRC screening test on an individual basis providing the screenes are adequatelyinformed about test characteristics, benefits and risks. (EL: Moderate ; RG: Weak )
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When the facts change, I change my opinion. And you, sir?
John Maynard Keynes,Economist (1883-1946)
CONCLUSIONS
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