Diminutive Polyps on Computed Tomographic Colonography - An Investigation of Positive Predictive Value and Interpretation Method

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  • 大腸CT検査における微小ポリープの陽性的中率，読影についての検討
  • ダイチョウ CT ケンサ ニ オケル ビショウ ポリープ ノ ヨウセイ テキチュウリツ,ドクエイ ニ ツイテ ノ ケントウ

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<p>Objective: The optimal method of interpreting diminutive polyps (≤5 mm) on standardized computed tomographic (CT) colonography in Japan has not been determined. To help standardize interpretation, for diminutive polyps, we investigated the diagnostic accuracy of CT colonography as well as factors aiding diagnosis and policies for interpreting findings.</p><p>Methods: We used total colonoscopy as a reference standard, and calculated positive predictive values (PPVs) for 50 diminutive polyps ≤ 5 mm detected by CT colonography. Additionally, we compared these PPVs with those of polyps ≥ 6 mm. We used multivariate analysis to investigate factors aiding the diagnosis of diminutive polyps. We also compared the time required to meticulously interpret all diminutive findings with the time taken to meticulously interpret high-confidence findings only.</p><p>Results: The per-polyp PPV was 100% (7/7) for polyps ≥ 10 mm, 62.5% (15/24) for polyps ≥ 6 mm, and 28% (14/50) for polyps ≤5 mm. The PPV was significantly lower for diminutive polyps. Height was a significant factor aiding diagnosis for diminutive polyps (cutoff: 1.5 mm). The median interpretation time when all diminutive findings were meticulously interpreted was 18 minutes and 14 minutes when only findings considered to be high-confidence were meticulously interpreted (p=0.02). </p><p>Conclusions: The PPV for diminutive polyps was low. We determined that height helps in diagnosing diminutive polyps. Meticulously interpreting only high-confidence diminutive findings may decrease the burden on CT readers. In Japan, a consensus for the interpretation of diminutive polyps on CT colonography will hopefully be reached.</p>

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