Colonoscopy for colonic wall thickening at computed tomography: a worthwhile pursuit?
BACKGROUND: In the absence of official guidance for the management of colonic wall thickening identified by computed tomography (CT), a common clinical dilemma surrounds the volume of colonoscopies subsequently performed. METHODS: To identify whether colonic wall thickening identified at CT consist...
| Main Authors: | , , , , , |
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| Format: | Journal article |
| Language: | English |
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2011
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| _version_ | 1826276722761269248 |
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| author | Nicholson, B Hyland, R Rembacken, B Denyer, M Hull, M Tolan, D |
| author_facet | Nicholson, B Hyland, R Rembacken, B Denyer, M Hull, M Tolan, D |
| author_sort | Nicholson, B |
| collection | OXFORD |
| description | BACKGROUND: In the absence of official guidance for the management of colonic wall thickening identified by computed tomography (CT), a common clinical dilemma surrounds the volume of colonoscopies subsequently performed. METHODS: To identify whether colonic wall thickening identified at CT consistently warrants colonoscopy, consecutive colonoscopies performed at Leeds Teaching Hospitals Trust in 2008 and recorded as "possible colonic lesion on cross-sectional abdominal CT" in an endoscopic database were retrospectively analyzed. Clinical, radiologic, colonoscopic, and histologic data were obtained from medical records. RESULTS: Of 4,702 colonoscopies, 94 (2%) had a full data set meeting the inclusion criteria. The primary diagnoses were normal condition (n = 11, 11.7%), adenocarcinoma (n = 25, 26.6%), adenoma (n = 23, 24.5%), diverticular disease (n = 12, 12.8%), nonspecific colitis (n = 6, 6.4%), Crohn's disease (n = 4, 4.3%), and hyperplastic polyp (n = 3, 3.2%). Computed tomography and colonoscopy were concordant for specific pathology in 79.8% of the cases (n = 75). Compared with diagnosis after histology, colonoscopy alone correctly identified specific pathology in 18.1% of the cases (n = 17), and CT alone was correct in 4.3% of the cases (n = 4)), whereas both were incorrect in 3.2% of the cases (n = 3). Computed tomography had a sensitivity of 72.3% (95% confidence interval [95% CI], 61.9-80.8%), a specificity of 96.5% (95% CI, 94.9-97.6%), a positive predictive value of 72.3%, and a negative predictive value of 96.5%. In 63.8% of the cases (n = 60), CT identified pathology necessitating further intervention at the time of colonoscopy or afterward, and in 28.7% of the cases (n = 27), CT identified pathology requiring no additional intervention. In the remaining 7.4% of the cases (n = 7), CT detected no new pathology. CONCLUSION: Computed tomography is highly predictive of colonic pathology compared with final outcome after colonoscopy and biopsy. For patients without a pre-existing diagnosis, colonic wall thickening demonstrated at CT warrants further investigation with colonoscopy. |
| first_indexed | 2024-03-06T23:18:10Z |
| format | Journal article |
| id | oxford-uuid:67d63aa1-e645-4ff8-9393-dd08f3c5a1a9 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T23:18:10Z |
| publishDate | 2011 |
| record_format | dspace |
| spelling | oxford-uuid:67d63aa1-e645-4ff8-9393-dd08f3c5a1a92022-03-26T18:40:58ZColonoscopy for colonic wall thickening at computed tomography: a worthwhile pursuit?Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:67d63aa1-e645-4ff8-9393-dd08f3c5a1a9EnglishSymplectic Elements at Oxford2011Nicholson, BHyland, RRembacken, BDenyer, MHull, MTolan, D BACKGROUND: In the absence of official guidance for the management of colonic wall thickening identified by computed tomography (CT), a common clinical dilemma surrounds the volume of colonoscopies subsequently performed. METHODS: To identify whether colonic wall thickening identified at CT consistently warrants colonoscopy, consecutive colonoscopies performed at Leeds Teaching Hospitals Trust in 2008 and recorded as "possible colonic lesion on cross-sectional abdominal CT" in an endoscopic database were retrospectively analyzed. Clinical, radiologic, colonoscopic, and histologic data were obtained from medical records. RESULTS: Of 4,702 colonoscopies, 94 (2%) had a full data set meeting the inclusion criteria. The primary diagnoses were normal condition (n = 11, 11.7%), adenocarcinoma (n = 25, 26.6%), adenoma (n = 23, 24.5%), diverticular disease (n = 12, 12.8%), nonspecific colitis (n = 6, 6.4%), Crohn's disease (n = 4, 4.3%), and hyperplastic polyp (n = 3, 3.2%). Computed tomography and colonoscopy were concordant for specific pathology in 79.8% of the cases (n = 75). Compared with diagnosis after histology, colonoscopy alone correctly identified specific pathology in 18.1% of the cases (n = 17), and CT alone was correct in 4.3% of the cases (n = 4)), whereas both were incorrect in 3.2% of the cases (n = 3). Computed tomography had a sensitivity of 72.3% (95% confidence interval [95% CI], 61.9-80.8%), a specificity of 96.5% (95% CI, 94.9-97.6%), a positive predictive value of 72.3%, and a negative predictive value of 96.5%. In 63.8% of the cases (n = 60), CT identified pathology necessitating further intervention at the time of colonoscopy or afterward, and in 28.7% of the cases (n = 27), CT identified pathology requiring no additional intervention. In the remaining 7.4% of the cases (n = 7), CT detected no new pathology. CONCLUSION: Computed tomography is highly predictive of colonic pathology compared with final outcome after colonoscopy and biopsy. For patients without a pre-existing diagnosis, colonic wall thickening demonstrated at CT warrants further investigation with colonoscopy. |
| spellingShingle | Nicholson, B Hyland, R Rembacken, B Denyer, M Hull, M Tolan, D Colonoscopy for colonic wall thickening at computed tomography: a worthwhile pursuit? |
| title | Colonoscopy for colonic wall thickening at computed tomography: a worthwhile pursuit? |
| title_full | Colonoscopy for colonic wall thickening at computed tomography: a worthwhile pursuit? |
| title_fullStr | Colonoscopy for colonic wall thickening at computed tomography: a worthwhile pursuit? |
| title_full_unstemmed | Colonoscopy for colonic wall thickening at computed tomography: a worthwhile pursuit? |
| title_short | Colonoscopy for colonic wall thickening at computed tomography: a worthwhile pursuit? |
| title_sort | colonoscopy for colonic wall thickening at computed tomography a worthwhile pursuit |
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