Computed Tomography Colonography in Fecal Immunochemical Test Positives in a Colorectal Cancer Screening Program

Sarah Moen; Fleur E Marijnissen; Jochim S Terhaar Sive Droste; Wouter H de Vos Tot Nederveen Cappel; B W Marcel Spanier; Jelle F Huisman; Evelien Dekker; Jaap Stoker; Ernst J Kuipers; Maarten G J Thomeer; Manon C W Spaander; Leonieke M M Wolters; Ivonne Leeuwenburgh; Merel M Tielemans; Xander G Vos; Mariette C A van Kouwen; Marjon Kerkhof; Ruud W M Schrauwen; Renzo P Veenstra; Lisette G Capelle; Marloes Bigirwamungu-Bargeman; Caroline A Wientjes; Conny van Enckevort; Sanna A Mulder; Djuna L Cahen; Tom C Seerden; Lennard P L Gilissen; Robbert Eichhorn; Paul Bus; Rogier J J de Ridder; Erik H C J Buster; Annick B van Nunen; CT in BVO Study Group

doi:10.1016/j.cgh.2025.03.009

Computed Tomography Colonography in Fecal Immunochemical Test Positives in a Colorectal Cancer Screening Program

Sarah Moen
, Fleur E Marijnissen
, Jochim S Terhaar Sive Droste
, Wouter H de Vos Tot Nederveen Cappel
, B W Marcel Spanier
, Jelle F Huisman
, Evelien Dekker
, Jaap Stoker
, Ernst J Kuipers
, Maarten G J Thomeer
, Manon C W Spaander^*
, Leonieke M M Wolters
, Ivonne Leeuwenburgh
, Merel M Tielemans
, Xander G Vos
, Mariette C A van Kouwen
, Marjon Kerkhof
, Ruud W M Schrauwen
, Renzo P Veenstra
, Lisette G Capelle

Marloes Bigirwamungu-Bargeman, Caroline A Wientjes, Conny van Enckevort, Sanna A Mulder, Djuna L Cahen, Tom C Seerden, Lennard P L Gilissen, Robbert Eichhorn, Paul Bus, Rogier J J de Ridder, Erik H C J Buster, Annick B van Nunen, CT in BVO Study Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background & Aims In the Dutch colorectal cancer (CRC) screening program, fecal immunochemical test (FIT)-positives are offered computed tomography colonography (CTC) instead of colonoscopy in case of comorbidities or patient refusal. Literature on CTC in FIT-positives is scarce, and the risk of post-CT interval CRC (PCT-CRC) in this population is unknown. Methods In this cohort study, we assessed CTC yield, clinical management, and risk of PCT-CRC in FIT-positives who underwent CTC between 2014 and 2019 in the Dutch CRC screening program. Data were linked with the National Cancer Registry to identify PCT-CRCs. Results Of 4506 FIT-positives scheduled for CTC (1.32% of all FIT-positives), 2794 (62%) underwent CTC (median age, 69 years; 58.8% male, 72.2% due to comorbidities). CRC was detected in 160 (5.7%), polyps ≥10 mm in 554 (19.8%), and polyps 6 to 9 mm in 512 (18.3%). A total of 1047 additional endoscopies (37.5%) were indicated for polyps ≥6 mm or CRC. A total of 987 additional endoscopies (35.3%) were performed. Histologically confirmed advanced neoplasia (AN) was present in 590 (21.1%), CRC in 112 (4.0%), and advanced adenomas in 502 (18.0%). Sixteen PCT-CRCs (0.6%) occurred during a median follow-up of 49 months (interquartile range, 36–64 months). Quality reporting was often lacking, and 5 complications (0.2%) occurred. Conclusions CTC in FIT-positive screenees was associated with a lower AN detection rate and a higher PCT-CRC rate compared with what is known from colonoscopy. A substantial proportion of complications occurred, and quality reporting was often lacking. This underlines the need for a structured quality assurance program for CTCs performed in FIT-positives. Critical appraisal of who to refer for CTC and communication about the benefits and pitfalls of CTC are warranted.

Original language	English
Pages (from-to)	2616-2624.e3
Journal	Clinical gastroenterology and hepatology
Volume	23
Issue number	13
Early online date	7 May 2025
DOIs	https://doi.org/10.1016/j.cgh.2025.03.009
Publication status	Published - Dec 2025

Keywords

CT-colonography
Colorectal Cancer Screening
Fecal Immunochemical Test
Post-CT Interval Colorectal Cancer

Access to Document

10.1016/j.cgh.2025.03.009Licence: CC BY

Cite this

Moen, S., Marijnissen, F. E., Terhaar Sive Droste, J. S., de Vos Tot Nederveen Cappel, W. H., Spanier, B. W. M., Huisman, J. F., Dekker, E., Stoker, J., Kuipers, E. J., Thomeer, M. G. J., Spaander, M. C. W., Wolters, L. M. M., Leeuwenburgh, I., Tielemans, M. M., Vos, X. G., van Kouwen, M. C. A., Kerkhof, M., Schrauwen, R. W. M., Veenstra, R. P., ... CT in BVO Study Group (2025). Computed Tomography Colonography in Fecal Immunochemical Test Positives in a Colorectal Cancer Screening Program. Clinical gastroenterology and hepatology, 23(13), 2616-2624.e3. https://doi.org/10.1016/j.cgh.2025.03.009

@article{9112f5ab45f4414cb0e74e2e7fe66cda,

title = "Computed Tomography Colonography in Fecal Immunochemical Test Positives in a Colorectal Cancer Screening Program",

abstract = "Background \& Aims In the Dutch colorectal cancer (CRC) screening program, fecal immunochemical test (FIT)-positives are offered computed tomography colonography (CTC) instead of colonoscopy in case of comorbidities or patient refusal. Literature on CTC in FIT-positives is scarce, and the risk of post-CT interval CRC (PCT-CRC) in this population is unknown. Methods In this cohort study, we assessed CTC yield, clinical management, and risk of PCT-CRC in FIT-positives who underwent CTC between 2014 and 2019 in the Dutch CRC screening program. Data were linked with the National Cancer Registry to identify PCT-CRCs. Results Of 4506 FIT-positives scheduled for CTC (1.32\% of all FIT-positives), 2794 (62\%) underwent CTC (median age, 69 years; 58.8\% male, 72.2\% due to comorbidities). CRC was detected in 160 (5.7\%), polyps ≥10 mm in 554 (19.8\%), and polyps 6 to 9 mm in 512 (18.3\%). A total of 1047 additional endoscopies (37.5\%) were indicated for polyps ≥6 mm or CRC. A total of 987 additional endoscopies (35.3\%) were performed. Histologically confirmed advanced neoplasia (AN) was present in 590 (21.1\%), CRC in 112 (4.0\%), and advanced adenomas in 502 (18.0\%). Sixteen PCT-CRCs (0.6\%) occurred during a median follow-up of 49 months (interquartile range, 36–64 months). Quality reporting was often lacking, and 5 complications (0.2\%) occurred. Conclusions CTC in FIT-positive screenees was associated with a lower AN detection rate and a higher PCT-CRC rate compared with what is known from colonoscopy. A substantial proportion of complications occurred, and quality reporting was often lacking. This underlines the need for a structured quality assurance program for CTCs performed in FIT-positives. Critical appraisal of who to refer for CTC and communication about the benefits and pitfalls of CTC are warranted.",

keywords = "CT-colonography, Colorectal Cancer Screening, Fecal Immunochemical Test, Post-CT Interval Colorectal Cancer",

author = "Sarah Moen and Marijnissen, \{Fleur E\} and \{Terhaar Sive Droste\}, \{Jochim S\} and \{de Vos Tot Nederveen Cappel\}, \{Wouter H\} and Spanier, \{B W Marcel\} and Huisman, \{Jelle F\} and Evelien Dekker and Jaap Stoker and Kuipers, \{Ernst J\} and Thomeer, \{Maarten G J\} and Spaander, \{Manon C W\} and Wolters, \{Leonieke M M\} and Ivonne Leeuwenburgh and Tielemans, \{Merel M\} and Vos, \{Xander G\} and \{van Kouwen\}, \{Mariette C A\} and Marjon Kerkhof and Schrauwen, \{Ruud W M\} and Veenstra, \{Renzo P\} and Capelle, \{Lisette G\} and Marloes Bigirwamungu-Bargeman and Wientjes, \{Caroline A\} and \{van Enckevort\}, Conny and Mulder, \{Sanna A\} and Cahen, \{Djuna L\} and Seerden, \{Tom C\} and Gilissen, \{Lennard P L\} and Robbert Eichhorn and Paul Bus and \{de Ridder\}, \{Rogier J J\} and Buster, \{Erik H C J\} and \{van Nunen\}, \{Annick B\} and \{CT in BVO Study Group\}",

year = "2025",

month = dec,

doi = "10.1016/j.cgh.2025.03.009",

language = "English",

volume = "23",

pages = "2616--2624.e3",

journal = "Clinical gastroenterology and hepatology",

issn = "1542-3565",

publisher = "W.B. Saunders",

number = "13",

}

Moen, S, Marijnissen, FE, Terhaar Sive Droste, JS, de Vos Tot Nederveen Cappel, WH, Spanier, BWM, Huisman, JF, Dekker, E, Stoker, J, Kuipers, EJ, Thomeer, MGJ, Spaander, MCW, Wolters, LMM, Leeuwenburgh, I, Tielemans, MM, Vos, XG, van Kouwen, MCA, Kerkhof, M, Schrauwen, RWM, Veenstra, RP, Capelle, LG, Bigirwamungu-Bargeman, M, Wientjes, CA, van Enckevort, C, Mulder, SA, Cahen, DL, Seerden, TC, Gilissen, LPL, Eichhorn, R, Bus, P, de Ridder, RJJ, Buster, EHCJ, van Nunen, AB & CT in BVO Study Group 2025, 'Computed Tomography Colonography in Fecal Immunochemical Test Positives in a Colorectal Cancer Screening Program', Clinical gastroenterology and hepatology, vol. 23, no. 13, pp. 2616-2624.e3. https://doi.org/10.1016/j.cgh.2025.03.009

TY - JOUR

T1 - Computed Tomography Colonography in Fecal Immunochemical Test Positives in a Colorectal Cancer Screening Program

AU - Moen, Sarah

AU - Marijnissen, Fleur E

AU - Terhaar Sive Droste, Jochim S

AU - de Vos Tot Nederveen Cappel, Wouter H

AU - Spanier, B W Marcel

AU - Huisman, Jelle F

AU - Dekker, Evelien

AU - Stoker, Jaap

AU - Kuipers, Ernst J

AU - Thomeer, Maarten G J

AU - Spaander, Manon C W

AU - Wolters, Leonieke M M

AU - Leeuwenburgh, Ivonne

AU - Tielemans, Merel M

AU - Vos, Xander G

AU - van Kouwen, Mariette C A

AU - Kerkhof, Marjon

AU - Schrauwen, Ruud W M

AU - Veenstra, Renzo P

AU - Capelle, Lisette G

AU - Bigirwamungu-Bargeman, Marloes

AU - Wientjes, Caroline A

AU - van Enckevort, Conny

AU - Mulder, Sanna A

AU - Cahen, Djuna L

AU - Seerden, Tom C

AU - Gilissen, Lennard P L

AU - Eichhorn, Robbert

AU - Bus, Paul

AU - de Ridder, Rogier J J

AU - Buster, Erik H C J

AU - van Nunen, Annick B

AU - CT in BVO Study Group

PY - 2025/12

Y1 - 2025/12

N2 - Background & Aims In the Dutch colorectal cancer (CRC) screening program, fecal immunochemical test (FIT)-positives are offered computed tomography colonography (CTC) instead of colonoscopy in case of comorbidities or patient refusal. Literature on CTC in FIT-positives is scarce, and the risk of post-CT interval CRC (PCT-CRC) in this population is unknown. Methods In this cohort study, we assessed CTC yield, clinical management, and risk of PCT-CRC in FIT-positives who underwent CTC between 2014 and 2019 in the Dutch CRC screening program. Data were linked with the National Cancer Registry to identify PCT-CRCs. Results Of 4506 FIT-positives scheduled for CTC (1.32% of all FIT-positives), 2794 (62%) underwent CTC (median age, 69 years; 58.8% male, 72.2% due to comorbidities). CRC was detected in 160 (5.7%), polyps ≥10 mm in 554 (19.8%), and polyps 6 to 9 mm in 512 (18.3%). A total of 1047 additional endoscopies (37.5%) were indicated for polyps ≥6 mm or CRC. A total of 987 additional endoscopies (35.3%) were performed. Histologically confirmed advanced neoplasia (AN) was present in 590 (21.1%), CRC in 112 (4.0%), and advanced adenomas in 502 (18.0%). Sixteen PCT-CRCs (0.6%) occurred during a median follow-up of 49 months (interquartile range, 36–64 months). Quality reporting was often lacking, and 5 complications (0.2%) occurred. Conclusions CTC in FIT-positive screenees was associated with a lower AN detection rate and a higher PCT-CRC rate compared with what is known from colonoscopy. A substantial proportion of complications occurred, and quality reporting was often lacking. This underlines the need for a structured quality assurance program for CTCs performed in FIT-positives. Critical appraisal of who to refer for CTC and communication about the benefits and pitfalls of CTC are warranted.

AB - Background & Aims In the Dutch colorectal cancer (CRC) screening program, fecal immunochemical test (FIT)-positives are offered computed tomography colonography (CTC) instead of colonoscopy in case of comorbidities or patient refusal. Literature on CTC in FIT-positives is scarce, and the risk of post-CT interval CRC (PCT-CRC) in this population is unknown. Methods In this cohort study, we assessed CTC yield, clinical management, and risk of PCT-CRC in FIT-positives who underwent CTC between 2014 and 2019 in the Dutch CRC screening program. Data were linked with the National Cancer Registry to identify PCT-CRCs. Results Of 4506 FIT-positives scheduled for CTC (1.32% of all FIT-positives), 2794 (62%) underwent CTC (median age, 69 years; 58.8% male, 72.2% due to comorbidities). CRC was detected in 160 (5.7%), polyps ≥10 mm in 554 (19.8%), and polyps 6 to 9 mm in 512 (18.3%). A total of 1047 additional endoscopies (37.5%) were indicated for polyps ≥6 mm or CRC. A total of 987 additional endoscopies (35.3%) were performed. Histologically confirmed advanced neoplasia (AN) was present in 590 (21.1%), CRC in 112 (4.0%), and advanced adenomas in 502 (18.0%). Sixteen PCT-CRCs (0.6%) occurred during a median follow-up of 49 months (interquartile range, 36–64 months). Quality reporting was often lacking, and 5 complications (0.2%) occurred. Conclusions CTC in FIT-positive screenees was associated with a lower AN detection rate and a higher PCT-CRC rate compared with what is known from colonoscopy. A substantial proportion of complications occurred, and quality reporting was often lacking. This underlines the need for a structured quality assurance program for CTCs performed in FIT-positives. Critical appraisal of who to refer for CTC and communication about the benefits and pitfalls of CTC are warranted.

KW - CT-colonography

KW - Colorectal Cancer Screening

KW - Fecal Immunochemical Test

KW - Post-CT Interval Colorectal Cancer

U2 - 10.1016/j.cgh.2025.03.009

DO - 10.1016/j.cgh.2025.03.009

M3 - Article

SN - 1542-3565

VL - 23

SP - 2616-2624.e3

JO - Clinical gastroenterology and hepatology

JF - Clinical gastroenterology and hepatology

IS - 13

ER -

Computed Tomography Colonography in Fecal Immunochemical Test Positives in a Colorectal Cancer Screening Program

Abstract

Keywords

Access to Document

Fingerprint

Cite this