Computed tomographic colonography for colorectal cancer screening: risk factors for the detection of advanced neoplasia

Cancer. 2013 Jul 15;119(14):2549-54. doi: 10.1002/cncr.28007. Epub 2013 Jun 10.


Background: The objective of this study was to determine whether age, sex, a positive family history of colorectal cancer, and body mass index (BMI) are important predictors of advanced neoplasia in the setting of screening computed tomographic colonography (CTC).

Methods: Consecutive patients who were referred for first-time screening CTC from 2004 to 2011 at a single medical center were enrolled. Results at pathology were recorded for all patients who underwent polypectomy. Logistic regression was used to identify significant predictor variables for advanced neoplasia (any adenoma ≥ 10 mm or with villous component, high-grade dysplasia, or adenocarcinoma). Odds ratios (ORs) were used to express associations between the study variables (age, sex, BMI, and a positive family history of colorectal cancer) and advanced neoplasia.

Results: In total, 7620 patients underwent CTC screening. Of these, 276 patients (3.6%; 95% confidence interval [CI], 3.2%-4.1%) ultimately were diagnosed with advanced neoplasia. At multivariate analysis, age (mean OR per 10-year increase, 1.8; 95% CI, 1.6-2.0) and being a man (OR, 1.7; 95% CI, 1.3-2.2) were independent predictors of advanced neoplasia, whereas BMI and a positive family history of colorectal cancer were not. The number needed to screen to detect 1 case of advanced neoplasia varied from 51 among women aged ≤ 55 years to 10 among men aged >65 years. The number of post-CTC colonoscopies needed to detect 1 case of advanced neoplasia varied from 2 to 4.

Conclusions: Age and sex were identified as important independent predictors of advanced neoplasia risk in individuals undergoing screening CTC, whereas BMI and a positive family history of colorectal cancer were not. These results have implications for appropriate patient selection.

Keywords: advanced adenomas; advanced neoplasia; colorectal cancer prevention; colorectal cancer screening; computed tomographic colonography.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenocarcinoma / diagnosis
  • Adenoma / diagnosis
  • Adult
  • Age Factors
  • Aged
  • Body Mass Index
  • Colonic Polyps / pathology
  • Colonic Polyps / surgery
  • Colonoscopy / methods*
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / diagnostic imaging
  • Colorectal Neoplasms / genetics
  • Colorectal Neoplasms / pathology
  • Early Detection of Cancer / methods*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Mass Screening
  • Medical History Taking
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Predictive Value of Tests
  • Risk Factors
  • Sex Factors
  • Tomography, X-Ray Computed*