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（由申请人提供）：尽管结直肠癌是美国男性和女性癌症死亡的第二大原因，但如果检测到其前体病变并早点去除，则可以在很大程度上预防。大多数结直肠癌是由无梗或梗概的多型肿瘤发展出来的。已经观察到这种肿瘤的早期去除以减少结直肠癌的发生。在没有前体息肉样肿瘤的情况下，已经观察到结直肠癌也会发展。最近的研究表明，扁平或抑郁的非类型病变可能是这种从头癌的来源。直到最近，在日本以外的非多型病变被认为是罕见的，在最新的光学结肠镜检查（OC）检查中，它们的报道频率相对频繁。非型病变的检测是具有挑战性的，因为它们的高度往往小于3 mm，并且通常模仿正常的结肠粘膜或增厚褶皱。然而，在存在时，非多型病变具有比多型肿瘤更高的恶性肿瘤。尽管OC在当前检查结肠的方法中具有最高的诊断准确性，但人们担心足够的筛查能力和患者遵守结直肠筛查指南。研究表明，计算机断层扫描（CTC）的性能与OC在检测临床上显着大小的息肉性肿瘤中的性能相当。因此，通过CTC进行初级结直肠筛查，然后进行可选的治疗OC可用于提供足够的筛查能力，并最大程度地提高患者在大规模结直肠检查中的依从性。但是，试点研究表明，CTC倾向于错过非型病变。以前，引入了计算机辅助检测（CAD），其中计算机方案自动检测结直肠病变并将其位于放射科医生的位置，以最大程度地提高CTC检查的检测准确性和一致性。但是，大多数CAD方案已设计用于检测息肉样的肿瘤，最近的初步研究表明，将需要对它们进行调整以检测非多型病变，以再现有关息肉性肿瘤肿瘤CAD的高检测准确性。在此提案中，我们将开发一个CAD方案，用于检测CTC中非型病变，以提高放射科医生在检测此类病变中的解释的准确性和一致性。可靠且一致地检测非型型病变将大大提高最低侵入性CTC的基于CTC的临床实施，以筛选结直肠肿瘤的筛查，从而增加患者对结直肠筛查指南的依从性，从癌症。公共卫生相关性：我们将开发一种计算机辅助检测（CAD）方案，用于在计算机断层造影术（CTC）中检测非型病变（CTC），以提高放射科医生在检测非型型病变中的准确性和一致性。 CAD对放射学家性能的影响将通过使用观察者研究来评估。我们假设CAD的应用可以显着改善放射科医生在CTC中检测非型病变的敏感性。可靠且一致地检测非型型病变将大大提高最低侵入性CTC基于CTC的大规模筛查的临床实现结直肠癌。