Unsuspected Extracolonic Findings at Screening CT Colonography: Clinical and Economic Impact¹

Abstract

Detection of relevant unsuspected extracolonic disease at CT colonographic screening is not rare, accounting for a relatively large percentage of cases in which additional workup was recommended. Judicious handling of potential extracolonic findings is warranted to balance the cost of additional workup against the potential for early detection of important disease, because many findings will prove to be of no clinical consequence.

ESUR guidelines for MR imaging of the sonographically indeterminate adnexal mass: an algorithmic approach

“…CT colonography and urography, unenhanced CT for detection of urinary calculi) [2][3][4]. Such incidental findings result in further utilisation of imaging to allay patient and physician anxiety about their nature with significant economic consequences [3].…”

The economic implications of unsuspected findings from CT urography performed for haematuria

“…This lies in part with the scans themselves, but also in the incidental extra-urinary findings from these scans. Other studies have evaluated the costs of incidental findings in CT colonography or coronary CT [6][7][8] and have demonstrated a significant economic burden in the follow-up and investigation of these patients. The vast majority of incidental findings do not need definitive treatment, so the costs cannot be completely balanced by the early identification of treatable disease.…”

Alternatives to colonoscopy for population-wide colorectal cancer screening

“…40,41 Furthermore, Abbreviations: CI = confidence interval; CRC = colorectal cancer; gFOBT = guaiac faecal occult blood testing; iFOBT = immunohistochemical faecal occult blood testing; N/A = not available; NNScope = the number of colonoscopies needed to diagnose an advanced adenoma after screening revealed a likely significant lesion; NNScreen = the number of average-risk individuals needed to recruit in a screening programme to detect one advanced adenoma; PPV = positive predictive value * gFOBT1 = Hemoccult II; gFOBT2 = Hemoccult Sensa; iFOBT1 = OC-Light; iFOBT2 = OC-SENSOR; iFOBT3 = RIDASCREEN Haemoglobin; iFOBT4 = RIDASCREEN Haemo-/Haptoglobin Complex; iFOBT5 = FOB-Gold; iFOBT6 = Magstream; iFOBT7 = FlexSure OBT † Studied distal colorectal cancer only ‡ Cut-off value at 100 ng/mL § Cut-off value at 75 ng/mL ∥ Sensitivity ratio (ratio of true positives with iFOBT to that with gFOBT) was estimated as sensitivities could not be directly calculated assessment of the extra-colonic organs can be performed at the same time. 42 A lower volume bowel preparation may be used 43 and the radiation risk is negligible. 41 Its main disadvantage is that biopsy is not possible, and the patient may require a second procedure with another bowel preparation, thus imposing additional costs and discomfort to the patient.…”