The Role of Computed Tomographic Colonography in Colorectal Cancer Screening

Abstract

Objective: We conducted a literature review to identify the current state of knowledge regarding the optimal clinical use of computed tomographic colonography (CTC) in Canada, based on accuracy, patient safety, and costeffectiveness.
Methods: Articles were retrieved from PubMed and the Cochrane Library. Retrieved studies were included based on relevance and appropriateness as determined by reviewing titles and abstracts. Studies were excluded if they were duplicated, grey literature, or non-peer-reviewed. Of the studies remaining after exclusions, reference lists were scanned to obtain further relevant articles.
Results: The literature reports comparable accuracy for detecting cancers and large polyps, yet CTC is less sensitive than colonoscopy for detecting small polyps. Most would agree that CTC is safer than colonoscopy, yet it is not without risk or adverse events. Lastly, although the true costs of CTC vs. colonoscopy are complex, the literature consistently demonstrates that CRC screening with CTC is less cost-effective than screening with colonoscopy.
Conclusion: Unless there are modifications to CTC that improve cost-effectiveness and/or accuracy, the future of CRC screening in Canada will remain reliant on colonoscopy. CTC is beneficial as an alternative to colonoscopy, but should remain available for selected indications. CTC has value, however, it has fallen short of initial expectations.