Extracolonic findings at CT colonography: Evaluation of prevalence and cost in a screening population

Gluecker, Thomas M.; Johnson, C. Daniel; Wilson, Lynn A.; MacCarty, Robert L.; Welch, Timothy J.; Vanness, David J.; Ahlquist, David A.

doi:10.1053/gast.2003.50158

Cited by 226 publications

(153 citation statements)

References 13 publications

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“…Although the overall rates of extracolonic findings have been reported to range from 15% to 69%, the incidence of clinically significant extracolonic findings at CTC has ranged from 4.5% to 11% in various patient cohorts. [194][195][196][197] In an asymptomatic screening population, the incidence of unsuspected but potentially important extracolonic findings is approximately 4.5%, but findings of minimal or moderate potential clinical significance, such as cholelithiasis (6%) and nephrolithiasis (8%), are more common. 197 While there are potential benefits from serendipitous findings, there also are associated risks and costs that need to be considered when these findings are false positives.…”

Section: Ctcmentioning

confidence: 99%

Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology

Levin

Lieberman

McFarland

et al. 2008

CA: A Cancer Journal for Clinicians

1,567

916

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In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer. CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized. In 2006 to 2007, the American Cancer Society, the US Multi Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average-risk adults. In this update of each organization's guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy. When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps and a screening test that primarily is effective at early cancer detection. It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening. (CA Cancer J Clin 2008;58:130-160.)

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Section: Ctcmentioning

confidence: 99%

Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology

Levin

Lieberman

McFarland

et al. 2008

CA: A Cancer Journal for Clinicians

1,567

916

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“…As a result, our study does not allow an estimation of the (health) effects of reporting incidental fi ndings in primary care patients with acute cough. Apart from such benefi ts as earlier diagnosis and treatment or prevention, 8,22 there are several negative consequences that should be considered: radiation exposure, iatrogenic illness, patient inconvenience from additional testing, potentially unnecessary costs, and the psychological burden of false-positive results, as well as the detection of untreatable disease or diseases that might never have become symptomatic during life (overdiagnosis). 10,11 Finally, patients volunteering to participate in an observational study may differ from the general population in primary care with acute cough.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Incidental Chest Radiographic Findings in Adult Patients With Acute Cough

Vugt

Broekhuizen

Zuithoff

et al. 2012

The Annals of Family Medicine

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PURPOSE Imaging may produce unexpected or incidental fi ndings with consequences for patients and ordering of future investigations. Chest radiography in patients with acute cough is among the most common reasons for imaging in primary care, but data on associated incidental fi ndings are lacking. We set out to describe the type and prevalence of incidental chest radiography fi ndings in primary care patients with acute cough. METHODSWe report on data from a cross-sectional study in 16 European primary care networks on 3,105 patients with acute cough, all of whom were undergoing chest radiography as part of a research study workup. Apart from assessment for specifi ed signs of pneumonia and acute bronchitis, local radiologists were asked to evaluate any additional fi nding on the radiographs. For the 2,823 participants with good-quality chest radiographs, these fi ndings were categorized according to clinical relevance based on previous research evidence and analyzed for type and prevalence by network, sex, age, and smoking status. RESULTSIncidental fi ndings were reported in 19% of all participants, and ranged from 0% to 25% by primary care network, with the network being an independent contributor (P <.001). Of all participants 3% had clinically relevant incidental fi ndings. Suspected nodules and shadows were reported in 1.8%. Incidental fi ndings were more common is older participants and smokers (P <.001).CONCLUSIONS Clinically relevant incidental fi ndings on chest radiographs in primary care adult patients with acute cough are uncommon, and prevalence varies by setting. Ann Fam Med 2012;10:510-515. doi:10.1370/afm.1384. INTRODUCTIONA cute cough is one of the most common reasons for consulting in primary care. 1,2 Prompt, accurate diagnosis of pneumonia in these patients is important to rule in the need for timely appropriate antibiotic treatment in some patients and to rule out the need for antibiotic treatment in others. Responsible general practitioners order chest radiographs in a minority of patients with acute cough. 3 These radiographs confi rm pneumonia in 5% to 19% and exclude pneumonia in most patients. 2,4,5 Imaging provides information relevant to the acute illness but may also reveal incidental fi ndings. 6-9 Such fi ndings can benefi t patients through earlier diagnosis and treatment, for example, in as yet undiagnosed heart failure or malignancy. Incidental fi ndings, however, may have unknown or doubtful clinical relevance and lead to patient anxiety, expensive workup, and potentially harmful investigations and treatment without improving quality and length of life. 10,11 The nature and prevalence of incidental fi ndings on chest radiographs of patients who consult their general practitioner for acute cough is unknown. Such data may inform decisions about clinical indications for ordering chest radiographs. We studied incidental fi ndings on chest radiographs obtained METHODSWe undertook a cross-sectional observational study using data from the GRACE-09/10a study (Genomics to comba...

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“…One additional study was located in this search. 10 We excluded studies that were performed outside the U.S. because we planned to compare reported screening prevalence with U.S. incidence rates of renal carcinoma.…”

Section: Methodsmentioning

confidence: 99%

Screening computed tomography

Fenton

Weiss

2004

Cancer

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BACKGROUNDDespite uncertain benefits and harms, screening computed tomography (CT) is being marketed to consumers in the U.S. One plausible harm is the detection and treatment of renal carcinoma cases that otherwise would have remained clinically silent during the patient's lifetime.METHODSAfter estimating the prevalence of preclinical renal carcinoma using meta‐analysis of five series of asymptomatic, middle‐aged Americans who received CT screening, the authors divided the prevalence by U.S. incidence rates of clinical renal carcinoma among persons of similar age. This calculation would estimate the mean duration of the detectable preclinical period (the “sojourn time”) of renal carcinoma if the incidence of preclinical and clinical renal carcinoma were equivalent.RESULTSThe 5 series included 16,174 screenees (mean age range, 58–64 years; 61% male). The prevalence of asymptomatic renal carcinoma ranged from 0.11% to 0.76%; the pooled prevalence was 0.21% (95% confidence interval, 0.14–0.28%). The estimated mean sojourn time for renal carcinoma was between 3.7 years and 5.8 years among middle‐aged Americans.CONCLUSIONSBecause most renal carcinomas grow slowly during the preclinical period, the authors' estimated mean sojourn time did not seem unduly long. Therefore, the incidence rate of clinical renal carcinoma most likely is a reasonable surrogate for the incidence rate of preclinical renal carcinoma, implying that most renal carcinomas detected by CT screening among middle‐aged Americans are likely to progress to clinical diagnosis. Cancer 2004;100:986–90. © 2004 American Cancer Society.

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Extracolonic findings at CT colonography: Evaluation of prevalence and cost in a screening population

Cited by 226 publications

References 13 publications

Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology

Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology

Incidental Chest Radiographic Findings in Adult Patients With Acute Cough

Screening computed tomography

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