In population screening, a single CT colonography (virtual colonoscopy) has an identification rate of colorectal cancer (CRC) and advanced adenoma greater than a single fecal immunochemical test (FIT for the detection of occult blood in feces). However, three rounds of FIT have a significantly higher identification rate than virtual colonoscopy.To say it is an Italian randomized study, just published in the prestigious journal Lancet Gastroenterology & Hepatology, which clarifies the lights and shadows of virtual colonoscopy as a screening technique.
Interest in virtual colonoscopy for bowel cancer screening has been growing in recent years, so much so that in 2016 the U.S. Preventive Services Task Force recommended it as a potential screening test. Some researchers from the University of Florence and the Institute for the Study, Prevention and Oncology Network (ISPRO) wanted to directly compare this new technique with the method currently used in Tuscany.
The study involved nearly 15,000 citizens between the ages of 54 and 65 who had never been screened for CRC. Participants were randomized (1:2) to a single virtual colonoscopy or three rounds of FIT (3 tests performed 2 years apart).Participants with positive screening tests (at least one polyp ≥6 mm in the virtual colonoscopy group and at least 20 micrograms of hemoglobin per gram of stool in the FIT group) were recalled to undergo optical colonoscopy. The primary outcome of the study was the identification rate of advanced malignancy.
The crucial data of the study is adherence to screening: only 26.7% of those who received the invitation for virtual colonoscopy accepted, while 64.9% of those who received the invitation for FIT participated in at least one round, 49.2% in two rounds and 33.4% in all three rounds. The virtual colonoscopy identification rate was 1.4% (95%CI 1.1-1.8), while that of three rounds of FIT was 2.0% (1.7-2.3; P=0.0094). In the protocol analysis, however, the virtual colonoscopy identification rate was 5.2% (4.1-6.6) while that of FIT was 3.1% (2.7-3.6; P<0.0001).
«In our randomized trial, the results of the primary outcome suggest that, in the context of a population screening for colorectal cancer, compared to three rounds of FIT a single CT colonography has a significantly lower identification rate of advanced malignancy per invited person in the screening intention analysis, but a higher identification rate per participant in the analysis by protocol. Opposite analyses by screening intention and protocol are remarkable, however they can be explained by considering the key role of participation, which was significantly higher for FIT than for colonography and which justifies the overall increased finding of advanced neoplasia».The conclusions drawn by the Tuscan researchers are therefore that the fecal immunochemical test remains the preferable tool for population screening, but that virtual colonoscopy could be used for opportunistic screening in light of the higher detection rate and the lower number of optical colonoscopies necessary for diagnostic work-up.
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Source — https://www.univadis.it/viewarticle/screening-per-il-tumore-colorettale-colonscopia-virtuale-vs-fit