PubMed · 6481314
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W M Rodney. 1984. Flexible sigmoidoscopy.. https://pubmed.ncbi.nlm.nih.gov/6481314/
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BACKGROUND: Although there is general consensus concerning the efficacy of colorectal cancer screening, there is a lack of agreement about which routine screening strategy should be adopted. We compared the participation and detection rates achievable through different strategies of colorectal cancer screening. METHODS: From November 1999 through June 2001 we conducted a multicenter, randomized trial in Italy among a sample of 55-64 year olds in the general population who had an average risk of colorectal cancer. People with previous colorectal cancer, adenomas, inflammatory bowel disease, a recent (< or =2 years) colorectal endoscopy or fecal occult blood test (FOBT), or two first-degree relatives with colorectal cancer were excluded. Eligible subjects were randomly assigned, within the roster of their general practitioner, to 1) biennial FOBT (delivered by mail), 2) biennial FOBT (delivered by general practitioner or a screening facility), 3) patient's choice of FOBT or "once-only" sigmoidoscopy, 4) "once-only" sigmoidoscopy, or 5) sigmoidoscopy followed by biennial FOBT. An immunologic FOBT was used. Participation and detection rates of the strategies tested were compared using multivariable logistic regression models that adjusted for age, sex, and screening center. All statistical tests were two-sided. RESULTS: Of 28 319 people sampled, 1637 were excluded and 26 682 were randomly assigned to a screening arm. After excluding undelivered letters (n = 427), the participation rates for groups 1, 2, 3, 4, and 5 were 30.1% (682/2266), 28.1% (1654/5893), 27.1% (970/3579), 28.1% (1026/3650), and 28.1% (3049/10 867), respectively. Of the 2858 subjects screened by FOBT, 122 (4.3%) had a positive test result, 10 (3.5 per 1000) had colorectal cancer, and 39 (1.4%) had an advanced adenoma. Among the 4466 subjects screened by sigmoidoscopy, 341 (7.6%) were referred for colonoscopy, 18 (4 per 1000) had colorectal cancer, and 229 (5.1%) harbored an advanced adenoma. CONCLUSIONS: The participation rates were similar for sigmoidoscopy and FOBT. The detection rate for advanced neoplasia was three times higher following screening by sigmoidoscopy than by FOBT.
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RATIONALE AND OBJECTIVES: Radiologists often compare the supine and prone data sets of a patient to confirm potential polyp findings in computed tomographic (CT) colonography (CTC). We developed a new automated method that uses region-based supine-prone correspondence for the reduction of false-positive (FP) polyp candidates in computer-aided detection (CAD) for CTC. MATERIALS AND METHODS: Up to six anatomic landmarks are established by use of the extracted region of the colonic lumen. A region-growing scheme with distance calculations is used to divide the colonic lumen into overlapping segments that match in the supine and prone data sets. Polyp candidates detected by means of a CAD scheme are eliminated in colonic segments that have sufficient diagnostic quality and contain polyp candidates in only one of the data sets of a patient. The method was evaluated with 121 CTC cases, including 42 polyps of 5 mm or greater in 28 patients, obtained by use of single- and multidetector CT scanners with standard pre-colonoscopy cleansing. RESULTS: Complete or partial correspondence was established in 71% of cases. Based on a leave-one-patient-out evaluation, application of the method reduced 19% of FP results reported by our CAD scheme at a 90.5% by-polyp detection sensitivity, without loss of any true-positive results. The resulting CAD scheme yielded 2.4 FP results per patient, on average, with the use of the correspondence method, whereas it yielded 3.0 FP results per patient without the use of the method. CONCLUSION: The correspondence method is potentially useful for improving the specificity of CAD in CTC.