Radiology

CT colonography outperforms stool DNA for CRC screening

June 16, 2025

Study details: A Markov model evaluated a hypothetical cohort of 10,000 average-risk 45-year-olds, comparing triennial multitarget stool DNA (mt-sDNA), conventional CT colonography (CTC) with immediate polypectomy for ≥6 mm polyps every 5 years, and a surveillance CTC strategy (3-year CTC follow-up for 6–9 mm polyps, colonoscopy for ≥10 mm polyps). Model validation and sensitivity analyses were performed.

Results: Without screening, cumulative colorectal cancer (CRC) incidence was 7.5% (n = 752). This was reduced by 59% (n = 310) with mt-sDNA, 75% (n = 190) with conventional CTC, and 70% (n = 223) with surveillance CTC. Programmatic costs per person were highest for mt-sDNA ($6,011) and lowest for surveillance CTC ($3,913). Both CTC strategies were cost-saving and more effective than mt-sDNA, with surveillance CTC providing the optimal cost-effectiveness profile. Results were similar when CRC screening began at 50 and 65 years of age.

Clinical impact: CT colonography outperformed both mt-sDNA, offering superior clinical outcomes at lower costs. The most effective approach combined 3-year monitoring for small polyps with colonoscopy for larger lesions.

Source:

Pickhardt PJ, et al. (2025, June 10). Radiology. CT Colonography versus Multitarget Stool DNA Test for Colorectal Cancer Screening: A Cost-Effectiveness Analysis. https://pubmed.ncbi.nlm.nih.gov/40492916/