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http://blogs.wsj.com/health/2012/05/14/new-method-easing-preparation-may-encourage-colon-checks/
Looks like it may one day be viable.
Looks like it may one day be viable.
Virtual Colonoscopy Replacing Colonoscopy Screening?
- Thread starter RadicalRadon
- Start date
It may or may not replace screening colonoscopy. My guess is that if the insurance companies start to reimburse it, it will replace 30-40% of colonoscopies at least or even more. Despite what GI docs claim, most of screening colonoscopies are normal. Also many lesions removed are hyperplastic polyps. Probably some time in the future we come up with a system like BIRADS to characterize the lesions as benign appearing or malignant appearing.
Even with VC, I think our colon cancer screening is a killer and a ******ed system. Just imagine, putting a scope in your butt every now and then and with every rectal bleeding because you may have cancer even if you are otherwise healthy while it has about 1/1000 risk of colon perforation. It is equal to do cerebral angiogram in everyone with dizziness. At least I think a non-invasive modality is required for this purpose.
If they could come up with a stool study like highly sensitive test for blood in the stool or a marker it would be the best.
Even with VC, I think our colon cancer screening is a killer and a ******ed system. Just imagine, putting a scope in your butt every now and then and with every rectal bleeding because you may have cancer even if you are otherwise healthy while it has about 1/1000 risk of colon perforation. It is equal to do cerebral angiogram in everyone with dizziness. At least I think a non-invasive modality is required for this purpose.
If they could come up with a stool study like highly sensitive test for blood in the stool or a marker it would be the best.
C
cowme
9% is a really high miss rate for 1 cm polyps...
The problem is you do not have a gold standard. Your gold standard is optic colonoscopy done in a big academic center under best conditions including best bowel prep, having enough time to scope, likely compliant patient population.
Now you have to see what is the miss rate of optical colonoscopy in a busy GI practice in a pp, when the prep is not complete in most cases, there is always rush to get the job done and the patient is complaining of discomfort.
My guess is in a routine GI practice in pp, the miss rate is way more than what is written in books and 9% is not off at all. Otherwise, at least in theory nobody with a prior normal screening colonoscopy should get colon cancer.
Also this does not have anything to do with reimbursement by insurance companies. Otherwise, they should not reimburse barium enema. They should not reimburse half of medical tests because all of them have a lot of misses. For example you should not do head CTA, rather you should go directly to catheter angio.
Don't forget the aim of a screening test is not 100% diagnosis. Otherwise, you should replace breast MR with mammo for screening. The rate of miss of cancer in screening mammo is about 30%.
Now you have to see what is the miss rate of optical colonoscopy in a busy GI practice in a pp, when the prep is not complete in most cases, there is always rush to get the job done and the patient is complaining of discomfort.
My guess is in a routine GI practice in pp, the miss rate is way more than what is written in books and 9% is not off at all. Otherwise, at least in theory nobody with a prior normal screening colonoscopy should get colon cancer.
Also this does not have anything to do with reimbursement by insurance companies. Otherwise, they should not reimburse barium enema. They should not reimburse half of medical tests because all of them have a lot of misses. For example you should not do head CTA, rather you should go directly to catheter angio.
Don't forget the aim of a screening test is not 100% diagnosis. Otherwise, you should replace breast MR with mammo for screening. The rate of miss of cancer in screening mammo is about 30%.
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Ouch, that is pretty dismal. Sounds like a great way to get sued.
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GI buds always flaunt that immediate intervention trumps.... = /
Hey, sorry to bump this if its too old but I was really curious about what is going on with this in radiology and what people's current opinions were. I didn't see any more recent discussions so I apologize if there is one. An attending was discussing it with me and I am fascinated by what advances there are in it by the time I am practicing and if it will primarily be a radiologist's domain. Just curious about what you guys think since it is very interesting.
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It's not common here. I don't think it'll replace scoping since it still requires prep but doesn't offer treatment. They both may be largely replaced by blood tests anyway. Just my opinion.
Agree with the blood test. Sometime during our lifetime, we will come up with blood test or stool market replacing colonoscopies. It already exists and is FDA approved. It is just a matter of time and improve in quality.
Consider that a screening test is not meant to be 100% perfect. I mentioned in my post 3 years go. Whoever claims otherwise, either does not understand the concept of screening or is a GI doctor who sees his income revenue in danger.
Screening is a tool at population level. It should have a good balance between sensitivity and specificity. It does not need to be 100% sensitive. And it should be cost-effective. For example, we do screening mammogram which is an old technology. It is 60-80% sensitive for detection of breast cancer. We can do breast MRI which is almost 100% sensitive but is not cost effective.
So if a stool marker with 80% sensitivity costs 1/20 colonoscopy then it potentially can replace colonoscopy.
Consider that a screening test is not meant to be 100% perfect. I mentioned in my post 3 years go. Whoever claims otherwise, either does not understand the concept of screening or is a GI doctor who sees his income revenue in danger.
Screening is a tool at population level. It should have a good balance between sensitivity and specificity. It does not need to be 100% sensitive. And it should be cost-effective. For example, we do screening mammogram which is an old technology. It is 60-80% sensitive for detection of breast cancer. We can do breast MRI which is almost 100% sensitive but is not cost effective.
So if a stool marker with 80% sensitivity costs 1/20 colonoscopy then it potentially can replace colonoscopy.
Especially since the frequency of the test will probably be much higher due to the significant decrease in cost.
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