| Background: It is of great significance to select the appropriate tools to early screening,diagnosis and removal of the colorectal cancer and adenoma.Colonoscopy and CT colonography is the most commonly used tools,but it is not conclusive for which one is better to detect the colorectal cancer and adenoma.This study systematically reviewed the published articles to analyze the detection rate of colorectal cancer and adenoma.Objective: The primary purpose of this study was to systematically review studies with a focus on the detection rate of colorectal cancer,adenoma and advanced adenoma between colonoscopy and CT colonography.An additional aim was to estimate the participation rate for these two procedures.Methods: A search was performed using Pub Med,Web of Science,Cochrane Library,CNKI,Wan Fang,CBM.All abstracts of the primary studies were independently screened by two reviews who excluded clearly ineligible studies.The quality of all selected articles was ranked in accordance to the Jadad composite scale.According to this scale,low-quality studies have a score of ≤2 and high-quality studies have a score of ≥3.The software Stata 12.0 was used to calculate the data.The Higgins I2 statistic was used to determine the total variation across studies due to heterogeneity.If the I2 statistic was ≤50%,the findings among the studies were considered homogeneous,and the fixed effects model was used to pool studies;otherwise,the random effects model was used.To test whether any particular study skewed the results of this meta-analysis,we excluded the studies one by one and recalculated the pooled results.Egger linear regression test was used to test the publication bias.The analysis was based on the intention-to-treat principle.Results: After excluding duplicates and articles that did not match the inclusion criteria,seven articles were included in this systematic review.Five of the seven studies were with high quality.Four of the seven studies reported the detection rate of colorectal cancer.The pooled detection rate of colorectal cancer was slightly higher for CT colonongraphy than that for colonoscopy,but the difference between these two groups was not statistically significant(RR=1.11,95% CI:0.77 to 1.61,P=0.55,I2=0%).Three studies reported the detection rate of advanced adenoma.The pooled results indicated the lack of statistically significant difference in the detection of advanced adenoma between the CT colonogaphy and colonoscopy groups,although the detection rate of advanced adenoma was slightly higher for CT colonography than that for colonoscopy(RR=1.08,95% CI:0.89 to 1.30,P=0.44,I2=0%).But the detection rate of adenoma in the colonoscopy group was significant higher than that in CT colonography group(RR=0.46,95% CI:0.30 to 0.70,P=0.004,I2=77%).All included trials reported the participation rate.The pooled participation rate in the CT colonography group was slightly higher than that in the colonoscopy group,but the differences were not with statistically significant(RR=1.19,95% CI:0.88 to 1.60,P=0.26,I2=98%).But when excluded the two studies with low quality in screening studies,we found the participation rate in CT colonography group was significant higher than that in colonoscopy group(RR=1.32,95% CI:1.03 to 1.70,P=0.03,I2=93%).Egger’s regression test showed there was publication bias existed in the detection rate of colorectal cancer,but there was not published bias existed in the other results.The results of the sensitivity analysis showed that any study was excluded and the results of the study did not change significantly.Conclusion: There may not be significant difference in detection rate of cancer and advanced adenoma between CT colonography and colonoscopy.However colonoscopy can detect more adenoma than CT colonography.The pooled participation rate in the CT colonography group was slightly higher than that in the colonoscopy group,but the differences were not with statistically significant.Screening populations were more likely to participate in CT colonography in high quality studies. |
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