Computed tomographic colonography, also known as virtual colonoscopy, administered without laxatives is as accurate as conventional colonoscopy in detecting clinically significant, potentially cancerous polyps, says a recently published study.
The study was performed jointly at the San Francisco VA Medical Center, the University of California San Francisco, and Massachusetts General Hospital.
"I think we have demonstrated that laxative-free CTC is a valid tool for detecting polyps that are clinically significant," says study co-author and site principal investigator Dr. Judy Yee, chief of radiology at SFVAMC and professor and vice chair of radiology at UCSF.
Virtual colonoscopy, which has been approved by the American Cancer Society as a valid screening test for colorectal cancer, uses a CT scanner to screen for cancers and polyps in the colon noninvasively. In standard optical colonoscopy, a physician inserts a six-foot-long scope into the entire colon. Currently, both methods call for patients to take a bowel-cleansing laxative before the procedure.
With laxative-free CTC, Yee says, patients don't have to go through bowel cleansing before the exam, but instead begin a low fiber diet two days before the test. They also ingest a tagging agent the day before the exam, which mixes with residual material in the colon and can then be identified and removed digitally when radiologists interpret the scans.
"The use of laxatives is often viewed as the worse aspect of having not only a virtual colonoscopy but an optical colonoscopy," says Yee, who has been an advocate of use of virtual colonoscopy within the VA health care system and at UCSF. "I hope that this research will encourage patients who have delayed screening for colon cancer to be examined with this less invasive method."
The study of 605 patients, aged 50 to 85, assessed the accuracy of laxative-free CTC in detecting lesions 6 millimeters or larger in size compared with standard optical colonoscopy.
The authors found that laxative-free CTC exams detected clinically significant polyps 10 millimeters or larger with 91 percent accuracy compared to OC exams, which were 95 percent accurate. Statistically, there is no difference between these two numbers, says Yee.
Scan sensitivity using laxative-free CT colonography decreases with polyp size, as it does for regular CT colonography, she says. With polyps measuring 6 millimeters, sensitivity for CTC was 59 percent, compared with standard colonoscopy at 76 percent.
The smaller the polyp, the less likely it is to harbor malignancy. For polyps 5 millimeters or less, there is an extremely low risk of cancer, and these polyps may not need to be removed.
For polyps between 6 and 9 millimeters in size, the decision about whether to remove them depends on the patient's risk factors and how many are found, Yee says.
"Polyps 10 millimeters or larger unquestionably come out," she says.
During the study, three of the 605 subjects were found to have cancerous polyps. The cancers were identified both by the laxative-free virtual colonoscopy and the standard exam.
The researchers also surveyed the research participants about their experiences. They found that laxative-free virtual colonoscopy scored higher on all survey questions.
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