TP1.2.4The incidence, implications and risk factors for extracolonic findings at CT colonography in a bowel screening population

Aim CT virtual colonoscopy (CTC) is increasingly relied upon in bowel screening programmes. Concern remains regarding the prevalence of incidental extra-colonic findings (ECF). The present study reports on the prevalence and implications of ECF as part of a UK bowel screening programme. Methods Reports for 400 consecutive CTCs carried out as part of the Scottish Bowel Screening Programme were examined. Intra and extracolonic findings were recorded using the CT Colonography Reporting and Data System (C-RADS). Medical records pertaining to ECF follow-up were examined. Cost analysis was performed. Results 394 patients were included. 146 (37%) were males. Median age was 65 years, median follow-up was 72 months (Range 32-110). 92 (23%) patients had CTC as their primary investigation, 302 (77%) patients underwent CTC due to failed colonoscopy. Overall, 244/394 (62%) patients had ECF with only 45/394 (11%) found to have colonic pathology. 65/394 (16%) had moderately or highly significant ECF, (C-RADS E3-4). Of the 244 patients with ECF, 59 (24%) underwent further investigation, estimated cost £17,589. The majority, 37/59 (63%) were found to have benign disease after follow-up. Conclusion ECF at CTC are more frequent than colonic findings. The majority of ECF investigated are found to be benign yet a quarter of ECF are further investigated at a cost to the health service and the patient. Clinicians should be judicial when ordering and consenting patients with regards ECF and its implications if CTC is considered. Particularly when the test is part of a public funded and voluntary screening programme.

The bowel and beyond: extracolonic findings from CT colonography

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.

Incidental Extra-Colonic Findings in CT Colonography at Riyadh Region (Preprint)

BACKGROUND Computed tomography colonography (CTC) is a new radiologic technique for examination of the colorectum. The search for, analysis and interpretation of extracolonic findings (ECFs) are a matter of permanent debate and review, given the arguments for and against them. OBJECTIVE To assess the prevalence and type of extracolonic findings (ECFs) in a screening population undergoing computed tomography colonography (CTC) in Riyadh region. METHODS This retrospective study was conducted in Riyadh region. To achieve the objectives of this study 305 subjects medical records were reviewed, where male represented 55% of participants and female represented only 45%. RESULTS About 21% of subjects had any type Extra Colonic Findings (ECFs) where about 74 incidental findings were identified in 65 patients. Out of these findings; 6 patients (9%) required immediate medical attention or urgent imaging/intervention, these included high suspicious of extracolonic malignancy or active infection, 16 patients (25%) required either further imaging and characterization, or follow up imaging, these included undetermined masses or nodules, while 43 patients (66%) required either reassurance or life style modification, which included extensive atherosclerotic changes, fatty liver or spondylolisthesis. CONCLUSIONS Colon cancer is one of the leading cause of mortality and morbidity in our Saudi Arabia community. Early detection of colon cancer and its precursor (i.e. polyps) is essential for successful management.