TY - JOUR
T1 - Computed Tomography Colonography in Fecal Immunochemical Test Positives in a Colorectal Cancer Screening Program
AU - Moen, Sarah
AU - Marijnissen, Fleur E.
AU - Terhaar sive Droste, Jochim S.
AU - de Vos tot Nederveen Cappel, Wouter H.
AU - Spanier, B. W.Marcel
AU - Huisman, Jelle F.
AU - Dekker, Evelien
AU - Stoker, Jaap
AU - Kuipers, Ernst J.
AU - Thomeer, Maarten G.J.
AU - Spaander, Manon C.W.
AU - Wolters, Leonieke M.M.
AU - Leeuwenburgh, Ivonne
AU - Tielemans, Merel M.
AU - Vos, Xander G.
AU - van Kouwen, Mariette C.A.
AU - Kerkhof, Marjon
AU - Schrauwen, Ruud W.M.
AU - Veenstra, Renzo P.
AU - Capelle, Lisette G.
AU - Bigirwamungu-Bargeman, Marloes
AU - Wientjes, Caroline A.
AU - van Enckevort, Conny
AU - Mulder, Sanna A.
AU - Cahen, Djuna L.
AU - Seerden, Tom C.
AU - Gilissen, Lennard P.L.
AU - Eichhorn, Robbert
AU - Bus, Paul
AU - de Ridder, Rogier J.J.
AU - Buster, Erik H.C.J.
AU - van Nunen, Annick B.
N1 - Publisher Copyright:
© 2025 The Author(s).
PY - 2025/12
Y1 - 2025/12
N2 - Background & Aims:In the Dutch colorectal cancer (CRC) screening program, fecal immunochemical test (FIT)-positives are offered computed tomography colonography (CTC) instead of colonoscopy in case of comorbidities or patient refusal. Literature on CTC in FIT-positives is scarce, and the risk of post-CT interval CRC (PCT-CRC) in this population is unknown. Methods: In this cohort study, we assessed CTC yield, clinical management, and risk of PCT-CRC in FIT-positives who underwent CTC between 2014 and 2019 in the Dutch CRC screening program. Data were linked with the National Cancer Registry to identify PCT-CRCs. Results: Of 4506 FIT-positives scheduled for CTC (1.32% of all FIT-positives), 2794 (62%) underwent CTC (median age, 69 years; 58.8% male, 72.2% due to comorbidities). CRC was detected in 160 (5.7%), polyps ≥10 mm in 554 (19.8%), and polyps 6 to 9 mm in 512 (18.3%). A total of 1047 additional endoscopies (37.5%) were indicated for polyps ≥6 mm or CRC. A total of 987 additional endoscopies (35.3%) were performed. Histologically confirmed advanced neoplasia (AN) was present in 590 (21.1%), CRC in 112 (4.0%), and advanced adenomas in 502 (18.0%). Sixteen PCT-CRCs (0.6%) occurred during a median follow-up of 49 months (interquartile range, 36–64 months). Quality reporting was often lacking, and 5 complications (0.2%) occurred. Conclusions: CTC in FIT-positive screenees was associated with a lower AN detection rate and a higher PCT-CRC rate compared with what is known from colonoscopy. A substantial proportion of complications occurred, and quality reporting was often lacking. This underlines the need for a structured quality assurance program for CTCs performed in FIT-positives. Critical appraisal of who to refer for CTC and communication about the benefits and pitfalls of CTC are warranted.
AB - Background & Aims:In the Dutch colorectal cancer (CRC) screening program, fecal immunochemical test (FIT)-positives are offered computed tomography colonography (CTC) instead of colonoscopy in case of comorbidities or patient refusal. Literature on CTC in FIT-positives is scarce, and the risk of post-CT interval CRC (PCT-CRC) in this population is unknown. Methods: In this cohort study, we assessed CTC yield, clinical management, and risk of PCT-CRC in FIT-positives who underwent CTC between 2014 and 2019 in the Dutch CRC screening program. Data were linked with the National Cancer Registry to identify PCT-CRCs. Results: Of 4506 FIT-positives scheduled for CTC (1.32% of all FIT-positives), 2794 (62%) underwent CTC (median age, 69 years; 58.8% male, 72.2% due to comorbidities). CRC was detected in 160 (5.7%), polyps ≥10 mm in 554 (19.8%), and polyps 6 to 9 mm in 512 (18.3%). A total of 1047 additional endoscopies (37.5%) were indicated for polyps ≥6 mm or CRC. A total of 987 additional endoscopies (35.3%) were performed. Histologically confirmed advanced neoplasia (AN) was present in 590 (21.1%), CRC in 112 (4.0%), and advanced adenomas in 502 (18.0%). Sixteen PCT-CRCs (0.6%) occurred during a median follow-up of 49 months (interquartile range, 36–64 months). Quality reporting was often lacking, and 5 complications (0.2%) occurred. Conclusions: CTC in FIT-positive screenees was associated with a lower AN detection rate and a higher PCT-CRC rate compared with what is known from colonoscopy. A substantial proportion of complications occurred, and quality reporting was often lacking. This underlines the need for a structured quality assurance program for CTCs performed in FIT-positives. Critical appraisal of who to refer for CTC and communication about the benefits and pitfalls of CTC are warranted.
UR - https://www.scopus.com/pages/publications/105007413753
U2 - 10.1016/j.cgh.2025.03.009
DO - 10.1016/j.cgh.2025.03.009
M3 - Article
C2 - 40345412
AN - SCOPUS:105007413753
SN - 1542-3565
VL - 23
SP - 2616-2624.e3
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 13
ER -
