In Vivo Detection of Flat Colorectal Neoplasms with CT Colonography

CT 结肠成像体内检测扁平结直肠肿瘤

• 批准号: 7712639
• 负责人: Janne Johannes Nappi
• 金额: $ 23.33万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-06 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7712639
• 关键词: Arts; Cancer Etiology; Carcinoma; Cessation of life; Clinical; Colon; Colonoscopy; Colorectal; Colorectal Cancer; Colorectal Neoplasms; Computed Tomographic Colonography; Computer Assisted; Detection; Excision; Guidelines; Height; Japan; Large Intestine Carcinoma; Lesion; Location; Malignant Neoplasms; Methods; Mucous Membrane; Neoplasms; Optics; Performance; Pilot Projects; Polypoid Lesion; Reporting; Scheme; Screening procedure; Source; Therapeutic; United States; Woman; base; clinically significant; colorectal cancer prevention; compliance behavior; computerized; depressed; design; diagnostic accuracy; in vivo; men; minimally invasive; population based; public health relevance; radiologist

DESCRIPTION (provided by applicant): Although colorectal cancer is the second leading cause of cancer deaths for men and women in the United States, it would be largely preventable if its precursor lesions were detected and removed early. Most colorectal cancers develop from sessile or pedunculated polypoid neoplasms. Early removal of such neoplasms has been observed to reduce the occurrence of colorectal carcinoma. Colorectal cancer has been observed to develop also in the absence of precursor polypoid neoplasms. Recent studies have indicated that flat or depressed non-polypoid lesions may be the source of such de novo carcinomas. Until recently, non-polypoid lesions were thought to be rare outside Japan, where they are reported relatively often on state-of-the-art optical colonoscopy (OC) examinations. The detection of non-polypoid lesions is challenging, because they tend to be less than 3 mm in height and often imitate normal colonic mucosa or thickened folds. However, when present, non-polypoid lesions have a higher potential for malignancy than do polypoid neoplasms. Although OC has the highest diagnostic accuracy among current methods for examination of the colon, there are concerns about adequate screening capacity and patient adherence to colorectal screening guidelines. Studies have indicated that computed tomographic colonography (CTC) has performance comparable to that of OC in the detection of polypoid neoplasms of clinically significant size. Therefore, primary colorectal screening by CTC followed by optional therapeutic OC could be used to provide adequate screening capacity and maximize patient compliance in large-scale colorectal examinations. However, pilot studies have indicated that CTC tends to miss non-polypoid lesions. Previously, computer-aided detection (CAD), where a computerized scheme detects colorectal lesions automatically and indicates their locations to radiologists, was introduced to maximize the detection accuracy and consistency of CTC examinations. However, most CAD schemes have been designed to detect polypoid neoplasms, and recent pilot studies have indicated that they will need to be adapted for the detection of non-polypoid lesions to reproduce the high detection accuracy that has been reported for CAD of polypoid neoplasms. In this proposal, we will develop a CAD scheme for the detection of non-polypoid lesions in CTC for increasing the accuracy and consistency of radiologists' interpretation in the detection of such lesions. Reliable and consistent detection of non-polypoid lesions would substantially advance the clinical implementation of minimally invasive CTC-based population screening for colorectal neoplasms, thereby increasing patient adherence to colorectal screening guidelines, promoting early prevention of colorectal cancer, and ultimately minimizing the occurrence of colorectal cancer. PUBLIC HEALTH RELEVANCE: We will develop a computer-aided detection (CAD) scheme for the detection of non-polypoid lesions in computed tomographic colonography (CTC) for increasing the accuracy and consistency of radiologists' interpretation in the detection of non-polypoid lesions. The effect of CAD on radiologists' performance will be assessed by use of an observer study. We hypothesize that the application of CAD can provide significant improvement in radiologists' sensitivity for the detection of non-polypoid lesions in CTC. Reliable and consistent detection of non-polypoid lesions would substantially advance the clinical implementation of minimally invasive CTC-based large-scale screening for colorectal neoplasms, thereby increasing patient adherence to colorectal screening guidelines, promoting early prevention of colorectal cancer, and ultimately minimizing the occurrence of colorectal cancer.

描述(申请人提供)：虽然结直肠癌是美国男性和女性癌症死亡的第二大原因，但如果及早发现并切除其前驱病变，基本上是可以预防的。大多数结直肠癌起源于无柄或带蒂息肉样肿瘤。早期切除这类肿瘤可以减少结直肠癌的发生。在没有前体息肉样肿瘤的情况下，也观察到结直肠癌的发生。最近的研究表明，扁平或凹陷的非息肉样病变可能是此类新生癌的来源。直到最近，非息肉样病变在日本以外被认为是罕见的，在日本，最先进的光学结肠镜(OC)检查中相对频繁地报告了这种病变。非息肉样病变的检测具有挑战性，因为它们的高度往往小于3 mm，而且往往模仿正常的结肠粘膜或增厚的皱折。然而，当存在时，非息肉样病变比息肉样肿瘤有更高的恶性潜能。虽然OC在目前的结肠检查方法中具有最高的诊断准确性，但也存在对足够的筛查能力和患者遵守结直肠筛查指南的担忧。研究表明，CT结肠造影术(CTC)在检测临床显著大小的息肉状肿瘤方面具有与OC相当的性能。因此，在大规模结直肠检查中，通过CTC进行初步结直肠癌筛查，然后选择治疗性OC，可以提供足够的筛查能力，并最大限度地提高患者的依从性。然而，初步研究表明，CTC倾向于漏诊非息肉样病变。以前，计算机辅助检测(CAD)是一种计算机化的方案，它自动检测结直肠病变并向放射科医生指示其位置，以最大限度地提高CTC检查的检测准确性和一致性。然而，大多数CAD方案都是为检测息肉肿瘤而设计的，最近的初步研究表明，它们需要适应于非息肉病变的检测，以重现已报道的用于息肉肿瘤CAD的高检测精度。在这项建议中，我们将开发一种用于检测CTC中非息肉病变的计算机辅助设计方案，以提高放射科医生在检测此类病变时的准确性和一致性。可靠和一致的非息肉病变检测将大大推进基于CTC的结直肠癌微创人群筛查的临床实施，从而增加患者对结直肠癌筛查指南的遵守，促进结直肠癌的早期预防，并最终将结直肠癌的发生降至最低。与公众健康相关：我们将开发一种计算机辅助检测(CAD)方案，用于在计算机体层摄影(CTC)中检测非息肉病变，以提高放射科医生对非息肉病变检测的准确性和一致性。计算机辅助设计对放射科医生表现的影响将通过一项观察者研究来评估。我们假设CAD的应用可以显著提高放射科医生对CTC中非息肉样病变的检测灵敏度。可靠和一致的非息肉病变检测将极大地推动基于CTC的结直肠癌微创大规模筛查的临床实施，从而增加患者对结直肠癌筛查指南的遵守，促进结直肠癌的早期预防，最终将结直肠癌的发生降至最低。