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Utility of minimal preparation computed tomography colonography in detecting colorectal cancer in elderly and frail patients
Author(s) -
Meiklejohn David J.,
Ridley Lloyd J.,
Ngu Meng C.,
Cowlishaw James L.,
Duller Alex,
Ridley William
Publication year - 2018
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.13999
Subject(s) - medicine , colonoscopy , colorectal cancer , sedation , tertiary referral hospital , radiology , overdiagnosis , population , perforation , surgery , cancer , retrospective cohort study , environmental health , materials science , metallurgy , punching
Background Colorectal cancers result in substantial morbidity and mortality to the Australian society each year. The usual investigation for bowel malignancy is optical colonoscopy (OC), with computed tomography colonography (CTC) used as an alternative investigation. The catharsis and colon insufflation associated with these investigations pose a higher risk in the elderly and frail. Risks include perforation, serum electrolyte disturbance and anaesthesia/sedation risks. Minimal preparation computed tomography colonography (MPCTC) eliminates these risks. Aims To audit the accuracy of a MPCTC programme for the investigation of colonic masses in symptomatic elderly and frail patients. Methods This paper audits a 6‐year period of MPCTC in an Australian tertiary referral hospital. A total of 145 patients underwent MPCTC during the study period. Results There were seven true positives, two false positives and two false negatives. Analysis of this population indicates a sensitivity of 0.78 (95% CI 0.51–1.05), specificity of 0.99 (95% CI 0.97–1.01), positive predictive value (PPV) of 0.78 (95% CI 0.51–1.05) and negative predictive value (NPV) of 0.99 (95% CI 0.97–1.01). These findings are concordant with other published studies. Conclusions This audit confirms that minimal preparation CT colonography is a reasonable alternative to OC and CTC in detecting colorectal cancer in symptomatic elderly and frail patients, without the procedural risks inherent in more invasive investigations. For most patients, MPCTC ruled out significant colorectal carcinoma with a high NPV.