Virtual colonoscopy shows significant promise as colorectal cancer screen...( r its potential role in colorectal canc...),Health

r its potential role in colorectal cancer screening. The task force reviewed the results of recent clinical trials and quantitative mathematical models pertaining to CT colonography. Limitations in the evaluation of CT colonography included variation in results of clinical trials and limited data on its use in routine clinical practice.

One limitation of CT colonography is that the test cannot consistently detect flat polyps or those smaller than one centimeter. The clinical importance of these types of polyps remains largely uncertain but given that a small number might harbor malignancy, most clinicians advise their removal. Thus a significant proportion of patients undergoing CT colonography might need a second procedure if it is necessary to remove all small growths. Fundamental questions currently without answers based in clinical outcomes studies include:

• Is there a minimum polyp size detectable by CT colonography for which patients should be referred for polyp removal?
• What is the minimum-sized lesion by which CT colonography sensitivity should be judged?
• What polyp size, if any, would physicians and more importantly their patients, allow to remain in place and undergo surveillance rather than immediate removal?
• How will CT colongraphy screening followed by colonoscopy for patients with polyps impact patient compliance and health-system costs?

One of the largest barriers to patient compliance for colorectal cancer screening is the bowel cleansing preparation required prior to the test. Patients must undergo similar bowel preparation for CT colonography as they do for traditional colonoscopy. However, progress is being made in the development of a minimal prep or prep-less CT colonography examination. Improvements in CT colonography stool tagging to "electronically cleanse" the colon are not yet available for clinical use.

Because CT colonography is a new technology, it is not yet widely a
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Contact: Kimberly Wise
media@gastro.org
301-941-2620
American Gastroenterological Association
1-Dec-2004

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