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3-D Virtual Colonoscopy Is More Sensitive Than Conventional Procedure

One of the yuckiest medical screening tests we have may be the screening colonoscopy, recommended for all adults over age 50 as an early detection tool for colon cancer, the second highest cancer killer of men and women.  Patients too often go to great lengths to avoid having this test, which involves inserting a scope through the rectum (usually under gentle sedation) and also involves an comprehensive "cleansing" preparation the day before the procedure.  Despite the discomfort-physical and psychological-with this procedure, it can be truly life-saving, but researchers have long sought a more socially acceptable and less invasive alternative.  A new procedure, 3-D virtual colonoscopy, may provide that alternative. 

A prospective multi-center trial was to evaluate the benefits of the 3-D virtual colonoscopy as compared with traditional colonoscopy.  Published in the New England Journal of Medicine (12/1/03), this study found that 3-D virtual colonoscopy is more sensitive than conventional colonoscopy in screening average-risk patients.   Virtual colonoscopy is less costly, less invasive and less time-consuming than conventional colonoscopy.  Also called "three-dimensional computed tomography (CT) colonography", this new technology allows radiologists to obtain 3-D images from different angles, providing a "movie" of the interior of the colon without having to insert a scope.

Within the past few years, radiologists have used CT colonography to screen for colon polyps. Although less invasive, until now the procedure primarily used 2-D CT images to detect polyps, which are less sensitive.  With the addition of 3-D images, virtual colonoscopy provides a more complete picture, creating precise and detailed images of the interior of the colon in a non-invasive manner.

With virtual colonoscopy, there is no risk of bleeding or of perforating the colon. Unlike traditional colonoscopy, there is no need for intravenous sedation, and the procedure is less costly than conventional colonoscopy. It also is more convenient, taking 15 minutes or less, because patients don't need to recover from sedation.

Colon polyps are benign growths that may develop into colon cancer if not removed. Many people resist screening because of the discomfort caused by conventional colonoscopy and other tests.   The disadvantage of virtual screening over traditional colonoscopy, however, is that if a patient is found to have a polyp or a suspicious area needed biopsy, a follow-up procedure would be required; with traditional colonoscopy, biopsies or polyp removal can be done during the same procedure.

For this study, researchers performed both conventional and virtual colonoscopy on 1,233 asymptomatic adults, 97.4 percent of whom were at average risk of having colonic polyps. Overall, virtual colonoscopy detected more than 90 percent of significant polyps. For example, virtual colonoscopy detected 92.6 percent of polyps 8 mm and greater, whereas conventional colonoscopy detected 89.5 percent of such polyps. Two malignant polyps were present, and virtual colonoscopy detected both of them, while conventional colonoscopy missed one.

The findings of this study establish virtual colonoscopy as a viable screening option and may encourage more adults to seek testing.  A recent commentary in the Journal of the American Medical Association (JAMA) advised that colon screening with any test is recommended for anyone over the age of 50. 

Created: 1/16/2004  -  Donnica Moore, M.D.

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