https://www.medpagetoday.com/upload/2008/3/6/CRC.pdf

Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology.

http://www.bccancer.bc.ca/screening/Documents/COLON_GuidelinesManual-AGAGuidelinesColonoscopySurveillance.pdf

Guidelines for Colonoscopy Surveillance After Screening and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer

In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized In 2006 to 2007, the American Cancer Society, the US Multi Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average-risk adults In this update of each organization's guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps and a screening test that primarily is effective at early cancer detection It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening

https://onlinelibrary.wiley.com/doi/pdf/10.3322/CA.2007.0018

Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi‐Society Task Force on Colorectal Cancer, and the American College of Radiology*†

Background Computed tomographic (CT) colonography is a noninvasive option in screening for colorectal cancer. However, its accuracy as a screening tool in asymptomatic adults has not been well defined. Methods We recruited 2600 asymptomatic study participants, 50 years of age or older, at 15 study centers. CT colonographic images were acquired with the use of standard bowel preparation, stool and fluid tagging, mechanical insufflation, and multidetector-row CT scanners (with 16 or more rows). Radiologists trained in CT colonography reported all lesions measuring 5 mm or more in diameter. Optical colonoscopy and histologic review were performed according to established clinical protocols at each center and served as the reference standard. The primary end point was detection by CT colonography of histologically confirmed large adenomas and adenocarcinomas (10 mm in diameter or larger) that had been detected by colonoscopy; detection of smaller colorectal lesions (6 to 9 mm in diameter) was also evaluated. Results Complete data were available for 2531 participants (97%). For large adenomas and cancers, the mean (±SE) per-patient estimates of the sensitivity, specificity, positive and negative predictive values, and area under the receiver-operating-characteristic curve for CT colonography were 0.90±0.03, 0.86±0.02, 0.23±0.02, 0.99±<0.01, and 0.89±0.02, respectively. The sensitivity of 0.90 (i.e., 90%) indicates that CT colonography failed to detect a lesion measuring 10 mm or more in diameter in 10% of patients. The per-polyp sensitivity for large adenomas or cancers was 0.84±0.04. The per-patient sensitivity for detecting adenomas that were 6 mm or more in diameter was 0.78. Conclusions In this study of asymptomatic adults, CT colonographic screening identified 90% of subjects with adenomas or cancers measuring 10 mm or more in diameter. These findings augment published data on the role of CT colonography in screening patients with an average risk of colorectal cancer. (ClinicalTrials.gov number, NCT00084929; American College of Radiology Imaging Network [ACRIN] number, 6664.)

/pdf/accuracy-of-ct-colonography-for-detection-of-large-adenomas-ejzfi9azrz.pdf

Accuracy of CT Colonography for Detection of Large Adenomas and Cancers

https://www.gastrojournal.org/article/S0016-5085(06)00561-0/pdf

Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society.

ContextConventional colonoscopy is the best available method for detection
of colorectal cancer; however, it is invasive and not without risk. Computed
tomographic colonography (CTC), also known as virtual colonoscopy, has been
reported to be reasonably accurate in the diagnosis of colorectal neoplasia
in studies performed at expert centers.ObjectiveTo assess the accuracy of CTC in a large number of participants across
multiple centers.Design, Setting, and ParticipantsA nonrandomized, evaluator-blinded, noninferiority study design of 615
participants aged 50 years or older who were referred for routine, clinically
indicated colonoscopy in 9 major hospital centers between April 17, 2000,
and October 3, 2001. The CTC was performed by using multislice scanners immediately
before standard colonoscopy; findings at colonoscopy were reported before
and after segmental unblinding to the CTC results.Main Outcome MeasuresThe sensitivity and specificity of CTC and conventional colonoscopy
in detecting participants with lesions sized at least 6 mm. Secondary outcomes
included detection of all lesions, detection of advanced lesions, possible
technical confounders, participant preferences, and evidence for increasing
accuracy with experience.ResultsA total of 827 lesions were detected in 308 of 600 participants who
underwent both procedures; 104 participants had lesions sized at least 6 mm.
The sensitivity of CTC for detecting participants with 1 or more lesions sized
at least 6 mm was 39.0% (95% confidence interval [CI], 29.6%-48.4%) and for
lesions sized at least 10 mm, it was 55.0% (95% CI, 39.9%-70.0%). These results
were significantly lower than those for conventional colonoscopy, with sensitivities
of 99.0% (95% CI, 97.1%->99.9%) and 100%, respectively. A total of 496 participants
were without any lesion sized at least 6 mm. The specificity of CTC and conventional
colonoscopy for detecting participants without any lesion sized at least 6
mm was 90.5% (95% CI, 87.9%-93.1%) and 100%, respectively, and without lesions
sized at least 10 mm, 96.0% (95% CI, 94.3%-97.6%) and 100%, respectively.
Computed tomographic colonography missed 2 of 8 cancers. The accuracy of CTC
varied considerably between centers and did not improve as the study progressed.
Participants expressed no clear preference for either technique.ConclusionsComputed tomographic colonography by these methods is not yet ready
for widespread clinical application. Techniques and training need to be improved.

https://jamanetwork.com/journals/jama/articlepdf/198538/JOC32308.pdf

John Affronti

Papers

Computed Tomographic Colonography (Virtual Colonoscopy) A Multicenter Comparison With Standard Colonoscopy for Detection of Colorectal Neoplasia

Pancreas divisum, an evidence-based review: part I, pathophysiology.

Pancreas divisum, an evidence-based review: part II, patient selection and treatment.

Incidental findings of thickening luminal gastrointestinal organs on computed tomography: an absolute indication for endoscopy.

Biliary disease in the elderly patient.