Editors' ChoiceColon Cancer Screening

A Less Controversial Colon Cleanser?

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Science Translational Medicine  04 Jan 2012:
Vol. 4, Issue 115, pp. 115ec3
DOI: 10.1126/scitranslmed.3003628

Colon cancer screening is recommended by the American Cancer Society for both men and women over the age of 50. Historically, such screening has been done by colonoscopy or a radiographic test involving an air-barium contrast enema. The discomfort of both techniques and the risk of perforating the colon during colonoscopy are a deterrent for some people who would otherwise benefit from such screening. Computed tomography colonography (CTC)—a method of visualizing the colon with a series of x-ray image slices—is preferred by many patients. However, similar to the other approaches, this examination requires that the colon be thoroughly cleansed with cathartics so as to prevent stool from obscuring polyps. Now, emerging mathematical tools—electronic “colon cleansers”—might improve the screening capabilities of CTC even without the use of cathartics.

Linguraru et al. developed a series of mathematical steps to electronically subtract stool-derived data from the CTC images. They tested this approach using data from 19 patients who underwent neither cathartic bowel preparation nor diet modification; the ingestion of contrast agents such as barium or Gastroview was the only step required in advance. The authors used a computer-aided diagnosis (CAD) system with and without the electronic stool subtraction tool and found that stool subtraction increased the sensitivity of polyp detection with the CAD system from 70.5% to 86.4%. The false-positive rate of 5.75 polyps per scan did not change with the introduction of the subtraction system.

Although the use of colon-cleansing products for “detoxification” is controversial, advances such as this virtual colon cleansing by Linguraru et al. should be less so and eventually lead to public health benefits through improved compliance with cancer screening programs.

M. G. Linguraru et al., Automated image-based colon cleansing for laxative-free CT colonography computed-aided polyp detection. Med. Phys. 38, 6633–6642 (2011). [Abstract]

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