nLahey Hospital and Medical Center, Burlington, Massachusetts. oBeth Israel Deaconess Medical Center, Boston, Massachusetts. pUniversity of California San Francisco, San Francisco, California. qSpecialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia. Reprint requests to: publications@acr.org Colorectal Cancer Screening of adenoma or carcinoma), and 3) high risk (individuals with hereditary syndromes, such as hereditary nonpolyposis colorectal cancer (HNPCC), or a personal history of ulcerative colitis or Crohn colitis). The ACR practice parameter also includes suggestions regarding the interpretation and reporting of extracolonic findings [28]. To avoid unnecessary further workup and patient anxiety, caution is emphasized when reporting findings that are likely to be of low clinical significance. There is evidence that using structured reporting constructs, such as CT Colonography Reporting and Data System, can decrease workups related to incidental extracolonic findings to <10% [30-32]. Unsuspected extracolonic malignancies and previously unknown aortic aneurysms are detected with CTC examinations in approximately 2% to 3% of patients [30,31,33-36]. Regarding barium enema, as utilization of DCBE has declined, training in this modality has also decreased [37], and it is not known if the barium enema data collected from studies performed by radiologists with extensive experience in the technique can be extrapolated to radiologists with lesser experience. For this document, it is assumed procedures are performed and interpreted by experts. Colorectal Cancer Screening sensitivities by patient of 85% and 93%, with pooled specificities of 97% [43,44]. Some older studies have shown poorer performance of CTC (sensitivity of 55% to 59%) [45,46]. These discrepant results were likely related to differences in study design, lack of reader training, and CTC technique (eg, no fecal tagging) in these older studies.
Colorectal Cancer Screening. nLahey Hospital and Medical Center, Burlington, Massachusetts. oBeth Israel Deaconess Medical Center, Boston, Massachusetts. pUniversity of California San Francisco, San Francisco, California. qSpecialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia. Reprint requests to: publications@acr.org Colorectal Cancer Screening of adenoma or carcinoma), and 3) high risk (individuals with hereditary syndromes, such as hereditary nonpolyposis colorectal cancer (HNPCC), or a personal history of ulcerative colitis or Crohn colitis). The ACR practice parameter also includes suggestions regarding the interpretation and reporting of extracolonic findings [28]. To avoid unnecessary further workup and patient anxiety, caution is emphasized when reporting findings that are likely to be of low clinical significance. There is evidence that using structured reporting constructs, such as CT Colonography Reporting and Data System, can decrease workups related to incidental extracolonic findings to <10% [30-32]. Unsuspected extracolonic malignancies and previously unknown aortic aneurysms are detected with CTC examinations in approximately 2% to 3% of patients [30,31,33-36]. Regarding barium enema, as utilization of DCBE has declined, training in this modality has also decreased [37], and it is not known if the barium enema data collected from studies performed by radiologists with extensive experience in the technique can be extrapolated to radiologists with lesser experience. For this document, it is assumed procedures are performed and interpreted by experts. Colorectal Cancer Screening sensitivities by patient of 85% and 93%, with pooled specificities of 97% [43,44]. Some older studies have shown poorer performance of CTC (sensitivity of 55% to 59%) [45,46]. These discrepant results were likely related to differences in study design, lack of reader training, and CTC technique (eg, no fecal tagging) in these older studies.