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Abstract
Objective Reports on the accuracy of computed tomographic colonography (CTC) mainly involve series from expert institutions. The aims of this study were to assess CTC accuracy in a nationwide population and to relate it to radiologist performance in their initial training.
Design Nationwide multicentre trial.
Setting Twenty-eight radiologists, working in 26 mostly academic clinical units, were involved in the study after having attended a formal specialised 2-day training session on CTC. They worked through a training set of 52 cases with automatic feedback after an attempt at each case.
Patients The study enrolled 845 patients with average and high risk of colorectal cancer, 737 of whom had both complete CTC and videocolonoscopy data, which constituted the dataset.
Interventions Patients underwent same-day CTC followed by videocolonoscopy with segmental unblinding of CTC results.
Main outcome measures Sensitivity, specificity and positive and negative predictive values for detection of polyps ≥6 mm in per-patient and per-lesion analyses of CTC without computer-aided detection.
Results Sensitivity, specificity and positive and negative predictive values for patients with polyps ≥6 mm were 69% (95% CI 61% to 77%), 91% (95% CI 89% to 94%), 67% (95% CI 59% to 74%) and 92% (95% CI 90% to 94%), respectively. Univariate analysis showed that the detection rate for polyps ≥6 mm was linked to neither radiologist case volume nor number of polyps, but was related to sensitivity achieved in the training set. Pooled sensitivity was 72% (95% CI 63% to 80%) versus 51% (95% CI 40% to 60%) for radiologists achieving above and below median sensitivity in the training set (61%), respectively. Multivariate analysis showed that sensitivity for polyps ≥6 mm in the training set was the only remaining significant predictive factor for subsequent performance.
Conclusions Radiologist sensitivity CTC for detection of polyps ≥6 mm in training was the sole independent predictor for subsequent sensitivity in detection of such polyps.
- CT colonography
- radiology
- colorectal cancer screening
- learning curve
- training program
- clinical trials
- colonic polyps
- colorectal neoplasia
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Footnotes
For other participants see end of the article
The following also participated in this study: Anne Ganivet (University Hospital, CHU Rennes), Franck Pilleul (University Hospital, CHU Lyon Edouard Herriot), Séverine Poupeney (Assistance Publique-Hôpitaux de Paris (APHP), Lariboisière), Pascal Burtin (University Hospital, CHU Angers), Vincent Barrau (Assistance Publique-Hôpitaux de Paris, APHP Beaujon), Thierry Vallot (Assistance Publique-Hôpitaux de Paris, APHP Bichat), Clément Subtil (Centre Hospitalier Universitaire (CHU) de Bordeaux Haut-Lévêque), Marion Simon (Assistance Publique-Hôpitaux de Paris, APHP Saint-Louis), Cédric De Bazelaire (Assistance Publique-Hôpitaux de Paris, APHP Saint-Louis), Jean Marc Gornet (Assistance Publique-Hôpitaux de Paris, APHP Saint-Louis), Nicolas Sellier (Assistance Publique-Hôpitaux de Paris, APHP Jean Verdier), Michel Beaugrand (Assistance Publique-Hôpitaux de Paris, APHP Jean Verdier), Sophie Maitre (Assistance Publique-Hôpitaux de Paris, APHP Antoine Béclère), Amani Asnacios (Assistance Publique-Hôpitaux de Paris, APHP Antoine Béclère), Bertrand Bessoud (Assistance Publique-Hôpitaux de Paris, APHP Bicêtre), Anne-Sophie Rangheard (Assistance Publique-Hôpitaux de Paris, APHP Bicêtre), Isabelle Boytchev (Assistance Publique-Hôpitaux de Paris, APHP Bicêtre), Nathalie Siauve (Assistance Publique-Hôpitaux de Paris, APHP HEGP), Francis Bloch (Assistance Publique-Hôpitaux de Paris, APHP HEGP), Achène Belkacem (Assistance Publique-Hôpitaux de Paris, APHP Louis Mourier), Benoit Coffin (Assistance Publique-Hôpitaux de Paris, APHP Louis Mourier), Elsa Guillot (University Hospital CHU Lyon Sud), Jean-Christophe Saurin (University Hospital CHU Lyon Sud), Philippe Beaurain (Private Hospital Marseille Saint-Joseph), Christian Boustière (Private Hospital Marseille Saint-Joseph), Denis Marion (University Hospital CHU Lyon Hotel Dieu), François Bailly (University Hospital CHU Lyon Hotel Dieu), Valérie Laurent (University Hospital CHU Nancy), Gérard Gay (University Hospital CHU Nancy), Céline Savoye-Collet (University Hospital CHU Rouen), Emmanuel Ben Soussan (University Hospital CHU Rouen), Franck Boudghène (Assistance Publique-Hôpitaux de Paris, APHP Tenon), Jean-Didier Grangé (Assistance Publique-Hôpitaux de Paris, APHP Tenon), Medhi Cadi (Assistance Publique-Hôpitaux de Paris, APHP Pitié Salpêtrière), Robert Chollet (Assistance Publique-Hôpitaux de Paris, APHP Pitié Salpêtrière).
Funding This study was funded by a grant from the National Cancer Institute of France (INCa (Institut National du Cancer)), under the French Department of Health STIC (2005) programme, the French Society of Digestive Endoscopy (SFED (Société Française d'Endoscopie Digestive)), and SFR (Société Française de Radiologie). The STIC programme supports research into new high-cost techniques (‘Soutien aux Techniques Innovantes et Coûteuses’).
Competing interests None.
Patient consent Obtained.
Ethics approval This study was registered with the Health General Directory (No DGS: 2006/0412; 11 August 2006) and conducted with the approval of the Ethics and Subjects Protection Committee (CPP) (6 July 2006).
Provenance and peer review Not commissioned; externally peer reviewed.