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Flexible Sigmoidoscopy vs. Whole Colon Imaging for Colorectal Cancer Diagnosis

This study compares the effectiveness of flexible sigmoidoscopy and whole colon imaging in diagnosing colorectal cancer in patients with symptoms. Results show varying miss rates for different imaging methods. Findings indicate that patients with specific symptoms may benefit more from tailored diagnostic approaches.

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Flexible Sigmoidoscopy vs. Whole Colon Imaging for Colorectal Cancer Diagnosis

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  1. Flexible Sigmoidoscopy And Whole Colon Imaging In The Diagnosis Of Cancer In Patients With Colorectal Symptoms Peter O’Leary Journal Club 13/10/08

  2. Aims • Identify patients with colorectal symptoms most likely to benefit from Whole Colon Imaging (WCI) to diagnose colorectal cancer • Identify patients for whom flexible sigmoidoscopy may be sufficient initially

  3. Methods • Prospective observational study • 3 Hospitals • 17,271 new referrals • Between 1986 and 2001 • Most patients examined with flexible sigmoidoscopy alone or followed by barium enema, colonoscopy or CT colongraphy

  4. Methods • A cancer was defined as missed if • Not detected at initial examination in the colorectal outpatient clinic or after referral for WCI, but was diagnosed within 3 years • Cancers diagnosed using flexible sigmoidoscopy were defined as distal • Cancers not diagnosed with fs but diagnosed with WCI were defined as proximal

  5. Methods • Outcome variable was detection of proximal or distal cancer • Other variables collected • Sex, age group (under/over 60 years of age) • Presence/absence of suspicious bowel symptoms • Rectal bleeding • Change in bowel habit • Abdominal pain • Weight loss • Fe deficiency anaemia • Abdominal mass

  6. Results • 17,271 new referrals • 838 referrals were excluded • 100 diagnosed at another clinic • 738 had DRE and no further investigation • Remaining 16,433 referrals • 969 patients had multiple referrals • 881 had 2 referrals • 76 had 3 referrals • 11 had 4 referrals • 1 had 5 referrals • Median age of referrals was 61 • 56% of referrals were female • 94.1% of referrals presented with one or more suspicious bowel symptoms outlined • The remaining referrals were for a variety of reasons including positive family history, anal symptoms and incontinence

  7. Results

  8. Results

  9. Discussion • Patients with Fe deficiency anaemia together with an abdominal mass, have a high (15.6%) chance of having a proximal colonic cancer • This group constituted only 3.7% of all patients in this study • By contrast, 96.3% of all patients referred with rectal bleeding, altered bowel habit or abdominal pain without Fe def anaemia or abdominal mass had a 0.2% chance of having a proximal colonic cancer • 24 colorectal cancers were missed from a total of 946 cancers diagnosed • 1.3% miss rate for flexi sigmoidoscopy • 14% miss rate for double contrast barium enema • 0.6% miss rate for colonoscopy • In conclusion, a patient who presents without fe def anaemia, abdominal mass or severe symptoms and has had a normal flexible sigmoidoscopy - ‘treat, wait and watch’ approach is appropriate

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