STAYIN’ ALIVE: CAN VIRTUAL COLONOSCOPY SURVIVE AS A SCREENING METHOD?

Computed tomography colonography (CTC), or "virtual colonoscopy," uses low dose multidetector CT to generate three-dimensional reconstructions of the colon and rectum.The technique can reveal polyps, cancers, and extracolonic findings without sedation and with minimal invasiveness.Yet, when lesions are detected, therapeutic colonoscopy remains necessary, creating an intrinsic limitation for population-based screening.Two decades ago, enthusiasm for CTC was high.It promised to combine safety, patient comfort, and comprehensive visualization of the colon in a single, non-invasive test.Today, however, its role has become far less clear.Two recent large-scale studies -a 10-year national analysis from the United States (Abbas et al., 2024) and a 20-year single-center experience from the University of Wisconsin (Pickhardt et al., 2024) -provide a remarkably coherent picture of both the strengths and the decline of this modality.The Wisconsin group reported 15,431 examinations in 11,830 patients over two decades, with 9,168 performed for primary screening.Among these, 15.9% detected polyps ≥6 mm, 5.7% had lesions 10-29 mm, and 0.6% revealed masses ≥3 cm.The referral rate for optical colonoscopy was 11.5%, and the positive predictive value for lesions ≥6 mm reached 91.6%.Histological analysis confirmed adenocarcinoma in 0.2%, advanced adenoma in 4.0%, non-advanced adenoma in 3.4%, sessile serrated lesions in 0.5%, and hyperplastic polyps in 1.2%.No perforations or major complications occurred, and extracolonic findings prompted additional investigation in 6% of cases, including extracolonic malignancies (0.4%) and abdominal aortic aneurysms (0.3%).Yet the most striking result was the collapse in screening volume-from 1,589 studies in 2005 to only 72 in 2023, a 96% decline.The only indication that remained stable was evaluation after an incomplete colonoscopy (1) .On a national scale, Abbas et al. analyzed 58,058 adults in the U.S. National Health Interview Survey between 2010 and 2021.The prevalence of CTC use remained below 2% until 2019, rising modestly to 3.5% in 2021, coinciding with the COVID-19 pandemic and the need for socially distanced procedures.Utilization was higher among Black and Hispanic individuals, patients with lower income, and those with chronic diseases such as COPD, EDITORIAL