Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

Comparative effectiveness of conventional computed tomography (CT), multidetector computed tomography (MDCT) (CT colonography), fludeoxyglucose positron emission tomography (FDG-PET) or FDG-PET/CT, magnetic resonance imaging (MRI), ultrasound (US), and endoscopic ultrasound (EUS) for the pre-therapy staging (including the assessment of liver metastasis) of colorectal cancer Which imaging test or test that can “see” some functions of a cancer (e.g. blood flow, consumption of sugar etc) is the best test to tell how advanced a colorectal cancer is and if spread has occurred outside it to other organs?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

conventional CT, MDCT (CT colonography), FDG-PET or FDG-PET/CT, MRI, US, and EUS

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Patients diagnosed with colorectal cancer who require pre-therapy staging

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

N/A

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Improvements in morbidity and mortality outcomes from treatment among patients with colorectal cancer based on staging and risk stratification

Describe any health-related risks, side effects, or harms that you are concerned about.

Risk of missed metastases diagnosis, errors in pre-therapy staging, errors in staging decisions that may cause unnecessary medical treatments and stress

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cancer

AHRQ Priority Populations

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

Accurate preoperative staging is essential for the planning of optimal therapy. Mesorectal involvement in the circumferential margin (CRM) is an important factor in deciding the need for neoadjuvant treatment, extent of surgical excision and determines prognosis. EUS, CT and MRI and functional PET imaging with CT have all found roles in the initial staging; however, whether one modality is superior to another is unclear.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

This topic was recommended by a diverse panel of stakeholders as a high priority question for an evidence review.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

EUS, CT and MRI and functional PET imaging with CT have all found roles in the initial staging; however, whether one modality is superior to another is unclear.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

The answer(s) to this research question will be disseminated by the Effective Health Care Program to clinical providers and policy makers who will be able to use this information to make more informed treatment recommendations and coverage decisions.

Describe the timeframe in which an answer to your question is needed.

As soon as possible, in order to benefit as many patients as possible

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

The risk of colorectal cancer affects a large percentage of the general US population, men and women. It includes many individuals representative of both vulnerable populations and those unequally screened for diagnosis.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

The answer(s) to this research question will be disseminated by the Effective Health Care Program to clinical providers and policy makers who will be able to use this information to make more informed treatment recommendations and coverage decisions.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program