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Unlike colonoscopy, sedation is not required in computed tomography colonography and requires additional reassurance endoscopy. The objectives of the study were to compare the diagnostic performance of computed tomography colonography against colonoscopy for a diagnosis of colorectal cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data regarding any polyp \u226510\u2009mm diameter (\u00f8) and\u2009&lt;\u200910\u2009mm \u00f8 but suspicious polyps of computed tomography colonography (<jats:italic>n<\/jats:italic>\u2009=\u2009318), colonoscopy (<jats:italic>n<\/jats:italic>\u2009=\u2009318), and surgical pathology (<jats:italic>n<\/jats:italic>\u2009=\u200977) for symptomatic colorectal cancer patients were collected and analyzed. Lesion ulceration, extramural invasion, and\/ or lesion shouldering was considered as a suspicious polyp. Beneficial scores for decision making of curative surgeries were evaluated for each modality. The cost of diagnosis of colorectal cancer was also evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Either of diagnosis showed polyps \u226510\u2009mm \u00f8 in 27 patients and polyps of 50 patients were\u2009&lt;\u200910\u2009mm \u00f8 but suspicious. Therefore, a total of 77 patients were subjected to surgery. With respect to surgical pathology, sensitivities for computed tomographic colonography and colonoscopy were 0.961 and 0.831. For detection of \u226510\u2009mm \u00f8 polyp, benefit score for computed tomographic colonography and colonoscopy were 0\u20130.906 diagnostic confidence and 0.035\u20130.5 diagnostic confidence. For polyps, \u2265 10\u2009mm \u00f8 but not too many large polyps, colonoscopy had the risk of underdiagnosis. For &lt;\u200910\u2009mm \u00f8 but suspicious polyps, &lt;\u20090.6\u2009mm \u00f8 and\u2009&lt;\u20092.2\u2009mm \u2300 polyps could not be detected by computed tomographic colonography and colonoscopy, respectively. The computed tomographic colonography had less cost than colonoscopy (1345\u2009\u00b1\u2009135 \u00a5\/ patient vs. 1715\u2009\u00b1\u2009241 \u00a5\/ patient,<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) for diagnosis of colorectal cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Computed tomographic colonography would be a non-inferior alternative than colonoscopy for a diagnosis of colorectal cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>III.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12880-020-00446-7","type":"journal-article","created":{"date-parts":[[2020,5,18]],"date-time":"2020-05-18T15:05:37Z","timestamp":1589814337000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Computed tomography colonography versus colonoscopy for detection of colorectal cancer: a diagnostic performance study"],"prefix":"10.1186","volume":"20","author":[{"given":"Junping","family":"sha","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuguang","family":"lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaoxin","family":"liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruihong","family":"chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3477-1327","authenticated-orcid":false,"given":"Zhibing","family":"zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,5,18]]},"reference":[{"key":"446_CR1","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1186\/s12885-017-3968-z","volume":"18","author":"MJ Gu","year":"2018","unstructured":"Gu MJ, Huang QC, Bao CZ, Li YJ, Li XQ, Ye D, Ye ZH, Chen K, Wang JB. 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The study reporting adheres to the law of China, strengthening the reporting of observational studies in epidemiology (STROBE) statement: Cross-sectional study, and the V2008 of Helsinki Declarations. An informed consent form was signed by all participating patients regarding diagnosis, endoscopy, and surgery (if required) during hospitalization.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"An informed consent form was signed by all participating patients regarding the publication of the study including personal data during hospitalization.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declared that they have no conflict of interest or any other competing interest regarding results and\/or discussion reported in the research.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"51"}}