Virtual colon scan readies for prime time

After scoring high marks in a new cost-effectiveness study, virtual colonoscopy is poised to crawl out of clinical obscurity and boost colorectal screening rates.

CT colonography (average Medicare reimbursement $478) beat optical colonoscopy (average cost $696) and flexible sigmoidoscopy ($401), as long as the CT technique excluded follow-up on polyps smaller than 6 mm, according to a study published in Cancer online in April. Research and consensus guidelines suggest that colonoscopy and polypectomy are not cost-effective and clinically efficacious for polyps below this size threshold.

"This study provides further support for virtual colonoscopy as a frontline screening tool and may help lead to reimbursement by insurance companies. Third-party reimbursement will bring this test into the mainstream," said lead author Dr. Perry Pickhardt, an associate professor of abdominal imaging at the University of Wisconsin-Madison.

Colorectal cancer is the second leading cause of cancer-related deaths in men and women in the U.S. Chances for survival are strong if the disease is caught at an early stage, but only an estimated 39% of cases are found early. Only 42% of eligible adults underwent colorectal screening in 2003, up from 39% in 2000, according to the American Cancer Society.

CTC will not replace other screening tests but rather provide another option that could help boost compliance rates.

"The best screening test for an individual may well be the test they are willing and able to undergo," Pickhardt said. "Radiologists need to prepare for the implementation of widespread VC screening by receiving appropriate training and keeping up to date with advances in VC interpretation and technique."