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Lambe G, Hughes P, Rice L, McDonnell C, Murphy M, Judge C, Guiney M. The bowel and beyond: extracolonic findings from CT colonography. Ir J Med Sci 2021; 191:909-914. [PMID: 33761095 PMCID: PMC7988374 DOI: 10.1007/s11845-021-02595-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/09/2021] [Indexed: 10/25/2022]
Abstract
CT colonography has emerged as the investigation of choice for suspected colorectal cancer in patients when a colonoscopy in incomplete, is deemed high risk or is declined because of patient preference. Unlike a traditional colonoscopy, it frequently reveals extracolonic as well as colonic findings. Our study aimed to determine the prevalence, characteristics and potential significance of extracolonic findings on CT colonography within our own institution. A retrospective review was performed of 502 patients who underwent CT colonography in our institution between January 1, 2010 and January 4, 2015. Of 502 patients, 60.63% had at least one extracolonic finding. This was close to other similar-sized studies (Kumar et al. Radiology 236(2):519-526, 2005). However, our rate of E4 findings was significantly higher than that reported in larger studies at 5.3%(Pooler et al. AJR 206:313-318, 2016). The difference may be explained by our combination of symptomatic/screening patients or by the age and gender distribution of our population. Our study lends support to the hypothesis that CT colonography may be particularly useful in identifying clinically significant extracolonic findings in symptomatic patients. CT colonography may allow early identification of extracolonic malignancies and life-threatening conditions such as an abdominal aortic aneurysm at a preclinical stage when they are amenable to medical or surgical intervention. However, extracolonic findings may also result in unnecessary investigations for subsequently benign findings.
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Affiliation(s)
- Gerard Lambe
- Radiology Department, St. James's Hospital, James's Street, Dublin 8, Ireland.
| | - Peter Hughes
- Radiology Department, St. James's Hospital, James's Street, Dublin 8, Ireland
| | - Louise Rice
- Radiology Department, St. James's Hospital, James's Street, Dublin 8, Ireland
| | - Caoimhe McDonnell
- Radiology Department, St. James's Hospital, James's Street, Dublin 8, Ireland
| | - Mark Murphy
- Radiology Department, The Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Ciaran Judge
- Gastroenterology Department, St. James's Hospital, James's Street, Dublin 8, Ireland
| | - Michael Guiney
- Radiology Department, St. James's Hospital, James's Street, Dublin 8, Ireland
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JOURNAL CLUB: Extracolonic Findings at CT Colonography: Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018; 211:25-39. [DOI: 10.2214/ajr.17.19495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Weiss JM, Kim DH, Smith MA, Potvien A, Schumacher JR, Gangnon RE, Pooler BD, Pfau PR, Pickhardt PJ. Predictors of primary care provider adoption of CT colonography for colorectal cancer screening. Abdom Radiol (NY) 2017; 42:1268-1275. [PMID: 27864601 DOI: 10.1007/s00261-016-0971-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To examine factors influencing primary care provider (PCP) adoption of CT colonography (CTC) for colorectal cancer (CRC) screening. MATERIALS AND METHODS We performed a retrospective cohort study linking electronic health record (EHR) data with PCP survey data. Patients were eligible for inclusion if they were not up-to-date with CRC screening and if they had CTC insurance coverage in the year prior to survey administration. PCPs were included if they had at least one eligible patient in their panel and completed the survey (final sample N = 95 PCPs; N = 6245 patients). Survey data included perceptions of CRC screening by any method, as well as CTC specifically. Multivariate logistic regression estimated odds ratios and 95% confidence intervals for PCP and clinic predictors of CRC screening by any method and screening with CTC. RESULTS Substantial variation in CTC use was seen among PCPs and clinics (range 0-16% of CRC screening). Predictors of higher CTC use were PCP perceptions that CTC is effective in reducing CRC mortality, higher number of perceived advantages to screening with CTC, and Internal Medicine specialty. Factors not associated with CTC use were PCP perceptions of less organizational capacity to meet demand for colonoscopy, number of perceived disadvantages to screening with CTC, PCP age and gender, and clinic factors. CONCLUSION Significant variation in PCP adoption of CTC exists. PCP perceptions of CTC and specialty practice were related to CTC adoption. Strategies to increase PCP adoption of CTC for CRC screening should include emphasis on the effectiveness and advantages of CTC.
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Affiliation(s)
- Jennifer M Weiss
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Room 4230, Madison, WI, 53705-2281, USA.
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
| | - David H Kim
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Maureen A Smith
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Aaron Potvien
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jessica R Schumacher
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ronald E Gangnon
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - B Dustin Pooler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Patrick R Pfau
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Room 4230, Madison, WI, 53705-2281, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline. Eur Radiol 2015; 25:331-45. [PMID: 25278245 PMCID: PMC4291518 DOI: 10.1007/s00330-014-3435-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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de Haan MC, Pickhardt PJ, Stoker J. CT colonography: accuracy, acceptance, safety and position in organised population screening. Gut 2015; 64:342-50. [PMID: 25468258 DOI: 10.1136/gutjnl-2014-308696] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-related deaths in Europe. The introduction of CRC screening programmes using stool tests and flexible sigmoidoscopy, have been shown to reduce CRC-related mortality substantially. In several European countries, population-based CRC screening programmes are ongoing or being rolled out. Stool tests like faecal occult blood testing are non-invasive and simple to perform, but are primarily designed to detect early invasive cancer. More invasive tests like colonoscopy and CT colonography (CTC) aim at accurately detecting both CRC and cancer precursors, thus providing for cancer prevention. This review focuses on the accuracy, acceptance and safety of CTC as a CRC screening technique and on the current position of CTC in organised population screening. Based on the detection characteristics and acceptability of CTC screening, it might be a viable screening test. The potential disadvantage of radiation exposure is probably overemphasised, especially with newer technology. At this time-point, it is not entirely clear whether the detection of extracolonic findings at CTC is of net benefit and is cost effective, but with responsible handling, this may be the case. Future efforts will seek to further improve the technique, refine appropriate diagnostic algorithms and study cost-effectiveness.
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Affiliation(s)
- Margriet C de Haan
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands Department of Radiology, University Medical Center, Utrecht, The Netherlands
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Jaap Stoker
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
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The Challenges of CT Colonography Reimbursement. J Am Coll Radiol 2013; 10:937-42. [DOI: 10.1016/j.jacr.2013.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 09/13/2013] [Indexed: 12/21/2022]
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Badiani S, Tomas-Hernandez S, Karandikar S, Roy-Choudhury S. Extracolonic findings (ECF) on CT colonography (CTC) in patients presenting with colorectal symptoms. Acta Radiol 2013; 54:851-62. [PMID: 23761550 DOI: 10.1177/0284185113486371] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Computed tomographic colonography (CTC) is now an established method for imaging the colon and rectum in the screening and symptomatic setting. Additional benefit of CTC is the ability to assess for extracolonic findings especially in patients presenting with colorectal symptoms. PURPOSE To determine prevalence of extracolonic findings (ECF) in symptomatic patients undergoing CTC and determine accuracy of CTC for exclusion of significant abdominal disease and extracolonic malignancy (ECM). MATERIAL AND METHODS A total of 1359 unenhanced prone and postcontrast supine CTC studies were performed between March 2002 and December 2007. ECF were retrospectively classified according to C-RADS criteria into E1 to E4 findings. For ECM, a gold standard of clinical and/or radiological follow-up supplemented with data from the regional cancer registry with a median follow-up of 42 months was created. Sensitivity and negative predictive values for ECM was calculated. RESULTS Following exclusions, 1177 CTCs were analyzed. Of 1423 extracolonic findings reported, 328/1423 (23%) E3 and 100/1423 (7%) E4 (including six eventual FP studies) findings were identified. Thirty-two ECMs were confirmed following further investigations. Seven further small ECMs were detected during the entire follow-up, of which two were potentially visible in retrospect (false-negative studies). Additional tests were generated from 55/1177 (4.7%) studies. Sensitivity and negative predictive value for ECM was 94.1% (95% CI 78.9-98.9%) and 99.8% (95% CI 99.3-99.9%), respectively. CONCLUSION One in 37 patients were found to have an ECM. Two potentially detectable cancers were missed. Only a small proportion of patients underwent additional work-up.
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The time has arrived for national reimbursement of screening CT colonography. AJR Am J Roentgenol 2013; 201:73-9. [PMID: 23789660 DOI: 10.2214/ajr.13.10656] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE CT colonography (CTC) has been fully validated as an accurate screening test for colorectal carcinoma and is being disseminated globally. There is an abundance of new literature addressing the prior concerns of the U.S. Preventive Services Task Force and the Centers for Medicare & Medicaid Services. Specific areas related to radiation dose, extracolonic findings, and generalizability of CTC to senior patients are discussed. CONCLUSION The time has arrived for national reimbursement of CTC in the United States.
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Wernli KJ, Rutter CM, Dachman AH, Zafar HM. Suspected extracolonic neoplasms detected on CT colonography: literature review and possible outcomes. Acad Radiol 2013; 20:667-74. [PMID: 23465379 DOI: 10.1016/j.acra.2013.01.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 01/25/2013] [Accepted: 01/26/2013] [Indexed: 12/21/2022]
Abstract
RATIONALE AND OBJECTIVES This study summarizes the literature on the detection of cancer among indeterminate extracolonic findings on computed tomographic (CT) colonography in five targeted organs. MATERIALS AND METHODS We searched PubMed for English-language literature published between January 1, 1994, and December 31, 2010. We describe extracolonic findings in the kidney, lung, liver, pancreas, and ovary suspect for malignancy as they are associated with high mortality. For each organ, we calculated the median prevalence, positive predictive value (PPV), and false positive rate of malignancy and a pooled false-positive rate across studies. RESULTS Of 91 publications initially identified, 24 were eligible for review. Indeterminate renal masses on CT colonography had 20.5% median PPV and low pooled false positive rate of 1.3% (95% confidence interval 0.6-2.0). In contrast, indeterminate masses of the lung, liver, pancreas, and ovary had low PPV (median values ranged from 0% to 3.8%). Indeterminate masses of the ovary resulted in the highest pooled false-positive rate of 2.2%. Results were similar in studies of both screening and nonscreening populations. We estimated the probability of false positive results through the detection of significant extracolonic findings as 46 per 1000 for men and 68 per 1000 for women. CONCLUSIONS Indeterminate renal masses newly detected on CT colonography have an estimated one in five chance of malignancy and therefore warrant further follow-up to provide a definitive diagnosis. Conversely, indeterminate masses of the lung, liver, pancreas, and ovary are associated with high false positive rates and merit more conservative clinical follow-up.
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Sutherland T, Coyle E, Lui B, Lee WK. Extracolonic findings at CT colonography: a review of 258 consecutive cases. J Med Imaging Radiat Oncol 2011; 55:149-52. [PMID: 21501403 DOI: 10.1111/j.1754-9485.2011.02244.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Computed tomographic colonography (CTC) is a non-invasive method of examining the colon and is used for colorectal polyp and mass diagnosis. As the entire abdomen is examined, incidental extracolonic pathologies can be diagnosed. The types of extracolonic findings (ECFs) and their frequency have not been explored in an Australian setting. METHODS A retrospective review of all CTC examinations performed in an Australian tertiary hospital between February 2004 and July 2009 were reviewed to extract patient demographic data, reason for referral, presence of colonic polyps and masses, presence of other colonic and extracolonic pathologies. Statistical significance was determined using a Student's t-test or Fisher's exact test where appropriate. RESULTS Two hundred fifty-eight CTC examinations were performed and an ECF was present in 70.1% and were more common with increasing age (P ≤ 0.01), but were not related to gender, or source of referral or the presence of colonic findings. Major ECFs were diagnosed in 8.9% of patients. CONCLUSIONS ECFs are more frequent with increasing age and although they are common, only a minority are of high significance.
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Affiliation(s)
- Tom Sutherland
- Medical Imaging Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
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Abstract
Computed tomographic colonography (CTC) is a validated tool for the evaluation of the colon for polyps and cancer. The technique employed for CTC includes a low-dose CT scan of the abdomen and pelvis that is typically performed without the administration of intravenous contrast. Using this technique it is possible to discover findings outside of the colon. By far, most extracolonic findings are determined to be clinically inconsequential on CTC and most patients are not recommended for further testing. However, some findings may result in additional diagnostic evaluation or intervention, which can lead to patient anxiety and increased morbidity and health care costs. Alternatively, some findings can lead to the earlier diagnosis of a clinically significant lesion, which could result in decreased patient morbidity and mortality as well as overall savings in downstream health care costs. The controversies of detecting and evaluating these incidental extracolonic findings on CTC are discussed.
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