The optimal cut-off value in fit-based colorectal cancer screening: An observational study.

BACKGROUND: Colorectal cancer (CRC) screening programs using fecal immunochemical test (FIT) have to choose a cut-off value to decide which citizens to recall for colonoscopy. The evidence on the optimal cut-off value is sparse and based on studies with a low number of cancer cases. METHODS: This observational study used data from the Danish Colorectal Cancer Screening Database. Sensitivity and specificity were estimated for various cut-off values based on a large number of cancers. Traditionally optimal cut-off values are found by weighting sensitivity and specificity equally. As this might result in too many unnecessary colonoscopies we also provide optimal cut-off values for different weighting of sensitivity and specificity/number of needed colonoscopies to detect one cancer. RESULTS: Weighting sensitivity and specificity equally gives an optimal cut-off value of 45 ng Hb/ml. This, however, means making 24 colonoscopies to detect one cancer. Weighting sensitivity lower and for example, aiming at making about 16 colonoscopies to detect one cancer, gives an optimal cut-off value of 125 ng Hb/ml. CONCLUSIONS: The optimal cut-off value in an FIT population-based screening program is 45 ng Hb/ml, when as traditionally sensitivity and specificity are weighted equally. If, however, 24 colonoscopies needed to detect one cancer is too huge a burden on the health care system and the participants, 80, 125, 175, and 350 ng Hb/ml are optimal cut-off values when only 19/16/14/10 colonoscopies are accepted to find one cancer.

[Diagnostic imaging techniques for hepatic metastases from colorectal cancer]. / Billeddiagnostik ved levermetastaser fra kolorektal cancer.

Hepatic metastases (HM) are amongst the most important prognostic factors in patient survival from colorectal cancer. The diagnostic imaging techniques for accurate detection and characterization of colorectal metastases are therefore vital. In a review of the literature, MRI showed the highest sensitivity for detection of HM lesions < 1 cm, but the amount of MR scanners is insufficient. Contrast-enhanced ultrasound and computed tomography have similar sensitivity for detection of HM, but each method also have limitation such as operator dependency or enhanced risk of cancer due to ionizing radiation.

[Pyomyositis]. / Pyomyositis.

Pyomyositis is a bacterial infection of skeletal muscle. It is a rare condition which cannot easily be diagnosed. A fatal case of pyomyositis in a 78-year-old man is presented. The clinical signs and diagnostics of pyomyositis are discussed.

[CT-colonography after incomplete conventional colonoscopy]. / Computertomografisk kolografi ved inkomplet koloskopi.

INTRODUCTION: CT-colonography (CTC) is recommended in the case of an incomplete conventional colonoscopy (CC). The present study was initiated to assess feasibility and outcomes in same-day CTC after incomplete CC. MATERIALS AND METHODS: Out of 480 consecutive patients who had CC for symptoms or for surveillance, 50 were incomplete for reasons other than insufficient preparation. If possible, CTC was performed on the same day in dual positions without contrast. Where CTC found suspected polyps, patients had a re-CC for verification and removal, and subsequent surgery in the case of cancer. RESULTS: Reasons for incomplete CC were loop formation (24%), pain (48%), kinking or external compression (24%) or benign strictures (4%). 43 of 50 CTCs (86%, 95% CI 73-94%) were conclusive. The organization allowed for 25 patients (50%) to have CTC on the same day. CTC detected 17 suspected polyps/masses, 13 of which were verified in 12 patients (28%). Re-CC or surgery verified 3 out of 4 of the suspected polyps < or = 5 mm, 5 out of 6 of those sized 6-9 mm, and 5 out of 7 of the masses > 9 mm (including 2 cancers). 19 (38%) had previously undetected extra-intestinal disease, including metastases in 4 patients, a uterine cancer in one, and a 7 cm abdominal aortic aneurism in one. CONCLUSION: Same-day CTC after incomplete CC is feasible and effective.