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Polyp Measurement Reliability, Accuracy, and Discrepancy: Optical Colonoscopy versus CT Colonography with Pig Colonic Specimens¹

¹ From the Department of Radiology and Research Institute of Radiology (S.H.P., E.K.C., S.S.L., H.K.H.) and Internal Medicine (J.S.B., J.Y.J.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Korea (Y.H.K., K.H.L.); and Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea (J.K.H.). Received May 5, 2006; revision requested June 27; revision received July 18; accepted August 23; final version accepted November 1. Address correspondence to J.K.H.

Purpose: To prospectively evaluate the reliability and accuracy of optical colonoscopy and computed tomographic (CT) colonography in polyp measurement, by using direct measurement as the reference standard, and to understand the basis for measurement discrepancy between both modalities.

Materials and Methods: Eighty-six simulated polyps that ranged from 3 to 15 mm were constructed by using pig colons obtained from an abattoir. Approval of the animal care and use committee for the study was not required. CT colonographic measurement was performed by two independent radiologists by using two-dimensional (2D) optimized multiplanar reformatted planes and three-dimensional (3D) endoluminal views. Optical colonoscopic measurement was performed by two independent gastroenterologists by using open biopsy forceps. Interobserver agreement, measurement error, measurement discrepancy defined as the result of subtracting the optical colonoscopic measurement from the CT colonographic measurement, and false-mismatch (ie, designation of matched polyps as mismatched between both modalities) rates according to different matching criteria were analyzed.

Results: Intraclass correlation coefficients were 0.879 (95% confidence interval: 0.780, 0.930) for optical colonoscopy, 0.979 (95% confidence interval: 0.956, 0.989) for 2D CT colonography, and 0.985 (95% confidence interval: 0.976, 0.990) for 3D CT colonography. The mean standardized polyp size ± standard deviation for each observer was 76.3% ± 14.7 and 85.3% ± 18.8 for optical colonoscopy, 104.6% ± 11.6 and 101.6% ± 10.1 for 2D CT colonography, and 114% ± 12.4 and 113.4% ± 13.2 for 3D CT colonography. These values indicated that there was a statistically significant difference among the methods (P < .001). Measurement discrepancy was not proportional to polyp size. A percentage-of-error criterion showed increasing false-mismatch rates with decreasing polyp size, whereas a fixed margin-of-error criterion resulted in more uniform false-mismatch rates across polyp size.

Conclusion: CT colonography is more reliable and accurate than optical colonoscopy for polyp measurement. A fixed margin-of-error criterion is better than a percentage-of-error criterion for polyp matching between CT colonography and optical colonoscopy with open biopsy forceps.

© RSNA, 2007

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