Clin Endosc.  2022 Jan;55(1):101-112. 10.5946/ce.2021.066.

Colorectal Cancer Screening with Computed Tomography Colonography: Single Region Experience in Kazakhstan

• Amankulov J
• Kaidarova D
• Zholdybay Z
• Zagurovskaya M
• Baltabekov N
• Gabdullina M
• Ainakulova A
• Toleshbayev D
• Panina A
• Satbayeva E
• Kalieva Z

• KMID: 2525056
• DOI: http://doi.org/10.5946/ce.2021.066

Abstract

Background/Aims
The aim of our study was to determine the efficacy of computed tomography colonography (CTC) in screening for colorectal cancer (CRC).
Methods
A total of 612 females and 588 males aged 45 to 75 years were enrolled in CTC screening. CTC was performed following standard bowel preparation and colonic insufflation with carbon dioxide. The main outcomes were the detection rate of CRC and advanced adenoma (AA), prevalence of colorectal lesions in relation to socio-demographic and health factors, and overall diagnostic performance of CTC.
Results
Overall, 56.5% of the 1,200 invited subjects underwent CTC screening. The sensitivity for CRC and AA was 0.89 and 0.97, respectively, while the specificity was 0.71 and 0.99, respectively. The prevalence of CRC and AA was 3.0% (18/593) and 7.1% (42/593), respectively, with the highest CRC prevalence in the 66-75 age group (≥12 times; odds ratio [OR], 12.11; 95% confidence interval [CI], 4.45-32.92). CRC and AA prevalence were inversely correlated with Asian descent, physical activity, and negative fecal immunochemical test results (OR=0.43; 95% CI, 0.22-0.83; OR=0.16; 95% CI, 0.04-0.68; OR=0.5; 95% CI, 0.07-3.85, respectively).
Conclusions
Our study revealed high accuracy of CTC in diagnosing colonic neoplasms, good compliance with CTC screening, and high detection rate of CRC.

Keyword

Cancer screening; Colonoscopy; Colorectal neoplasms; Computed tomography colonography

Figure

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  Fig. 1. Flowchart of participant recruitment algorithm. CRC, colorectal cancer; CT, computed tomography; FIT, fecal immunochemical test; GP, general practitioner.

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  Fig. 2. Colonic lipoma, C1 category finding by computed tomography colonography reporting and data system. Axial computed tomography image showing a well-circumscribed fat density colonic lesion in the hepatic flexure (arrow).

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  Fig. 3. Diverticulosis and inverted diverticulum, C1 category by computed tomography colonography reporting and data system. (A) Oblique reformatted computed tomography colonography (CTC) image demonstrates multiple bulging pouches in the colonic wall (arrowheads). One of the diverticula is inverted into the colonic lumen (arrow). (B) Endoluminal three-dimensional CTC image shows the inverted diverticulum as a polypoid lesion, without any mucosal changes in (C) endoscopic view (arrow). (D) Gentle pressure with closed biopsy forceps reverts the lesion to the typical diverticular appearance.

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  Fig. 4. Solitary colonic adenoma, C2 category by computed tomography colonography reporting and data system. (A) Endoluminal three-dimensional computed tomography colonography and (B) endoscopic images show 8 mm sessile colonic polyp (arrows). (C) Histologic evaluation represents a serrated polyp.

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  Fig. 5. Pedunculated adenoma of the upper rectum, C3 category by computed tomography colonography reporting and data system. (A) Sagittal two-dimensional and (B) endoluminal three-dimensional images of computed tomography colonography demonstrate 26 mm adenoma (arrows), connected to the mucosa by an elongated stalk (arrowhead). (C) Endoscopic image shows pedunculated adenoma with hyperemic and edematous mucosa. (D) Histologic evaluation reveals morphological changes consistent with severe dysplasia.

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  Fig. 6. Sigmoid colon carcinoma, C4 category by computed tomography colonography reporting and data system. Blue arrows on (A) three-dimensional and (B) coronal computed tomography colonography images indicate marked circumferential wall thickening of the sigmoid colon. (C) Endoscopic view reveals circumferential sigmoid tumor, with severe luminal compromise. (D) Histologic evaluation is positive for grade II adenocarcinoma.

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