Inku Hwang, MD; Roy K.H. Wong, MD
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Hwang I., Wong R.; Limitations of Virtual Colonoscopy. Ann Intern Med. 2005;142:154-155. doi: 10.7326/0003-4819-142-2-200501180-00022
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Published: Ann Intern Med. 2005;142(2):154-155.
TO THE EDITOR:
Pickhardt and colleagues (1) reported that the miss rate for optical colonoscopy (OC) using virtual colonoscopy (VC) was 12% for polyps 10 mm or greater. This and another paper (2), where these data originated, shed a very favorable light on VC. As co-investigators in the original study and as gastroenterologists, we would like to point out as-yet-unadvertised aspects of these data to provide a more balanced view of VC.
Sensitivity and specificity of VC were high in the original study, but VC had a high false-positive rate of 51.1% (95% CI, 40.4% to 61.7%) (47 of 92) for polyps 10 mm or greater and a low positive predictive value of 48.9% (CI, 38.3% to 59.6%) (45 of 92). For polyps 6 mm or greater, the false-positive rate was 59.3% (CI, 54.1% to 64.4%) (217 of 366) with a positive predictive value of 40.7% (CI, 35.7% to 45.9%) (149 of 366) (2). Thus, if patients with polyps 6 mm or greater on VC were referred for OC, 217 would have potentially received OC unnecessarily. Van Gelder and associates (3) reported similar results with VC: false-positive rates of 41% for polyps 10 mm or greater and 64% for polyps 6 mm or greater. The OC miss rate in that study was 17% for polyps 10 mm or greater.
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