Frequency and Importance of Extracolonic Findings

The results of the major studies published after 2000, and reporting upon extracolonic findings and their follow-up, are tabulated in Tables 10.1-10.3 and Figs. 10.1 and 10.2.

The reported percentages of incidental lesions is high, but shows a rather high inter-study variability, with a median of 68.9% of patients with incidental extracolonic findings.

The reported percentages of highly important lesions also show great inter-study variability, but is also high, with a median of 12.5% of patients, and 11.7% of lesions.

Table 10.1. Extracolonic findings on CT colonography from primary papers published since 2000 reporting details upon further follow-up. Overall evaluation

IV con-

Dose

Screening or

No. of

Avg

Extracolonic findings

trast?

diagostic

patients

age

Lesions

Lesions/

Patients

%

patient

patie

Edwards JT et al. 2001

No

70 mAs

Diagnostic

1 100

65

1 16

0.2

15

15.0

Ginnerup Pederson et al. 2003

No

70 mAs

Diagnostic

75

61

68

0.9

49

65.3

Gluecker et al. 2003

No

70 mAs

Screening

681

64

858

1.3

469

68.9

Hara et al. 2000

No

70 mAs

Screening

264

64

151

0.6

109

41.3

Hellstrom et al. 2004

No

125 mAs

Diagnostic

111

66

232

2.1

94

84.7

Pickhard PJ et al. 2003

No

100 mAs

Screening

1233

58

?

?

?

?

Spreng A et al. 2005

No

200 mAs

Diagnostic

30

66

88

2.9

23

76.7

Spreng A et al. 2005

Yes

200 mAs

Diagnostic

72

66

215

3.0

68

94.4

Table 10.2. Extracolonic findings on CT colonography from primary papers published since 2000 reporting details upon further follow-up. Evaluation according to importance and outcome. Per patient analysis

IV con-

Total number % Low

% Moderate

% High impor-

% Immediate % Cancers

trast?

of patients

importance

importance

tance (A)a

treatment

Edwards JT et al. 2001

No

100

?

?

11

2.0

1

Ginnerup Pederson et al. 2003

No

75

?

?

12

2.7

1.3

Gluecker et al. 2003

No

681

50

26.9

10.4

1.3

1

Hara et al. 2000

No

264

20.8

24.2

12.9

2.3

0.7

Hellstrom et al. 2004

No

111

26.1

52.3

23.4

0.9

3.6

Pickhard PJ et al. 2003

No

1233

?

?

4.5

0.1

0.4

Spreng A et al.2005

No

30

?

?

13.3

6.7

6.6

Spreng A et al. 2005

Yes

72

?

?

30.6

18.1

6.9

aAs defined by author aAs defined by author

Table 10.3. Nature of extracolonic findings on CT colonography from primary papers published since 2000 reporting details upon further follow-up. Evaluation according to importance and outcome. Per lesion analysis

IV con- Total number % Low % Moderate % High importrast? of lesions importance importance tance (A)a

Table 10.3. Nature of extracolonic findings on CT colonography from primary papers published since 2000 reporting details upon further follow-up. Evaluation according to importance and outcome. Per lesion analysis

IV con- Total number % Low % Moderate % High importrast? of lesions importance importance tance (A)a

Edwards JT et al. 2001

No

15

?

?

73.3

Ginnerup Pederson et al. 2003

No

68

?

?

11.7

Gluecker et al. 2003

No

858

66.9

22.8

10.3

Hara et al. 2000

No

151

45

32.4

22.5

Hellstrom et al. 2004

No

166

27.7

50

22.3

Pickhard PJ et al. 2003

No

?

?

?

?

Spreng A et al. 2005

No

88

?

?

4.5

Spreng et al. 2005

Yes

215

?

?

10.2

aAs defined by author aAs defined by author

The reported percentages of patients with immediate treatment is much lower, as is the same looking at patients with extracolonic cancers: median of 2.15% of patients with immediate treatment and 1.3% of patients with cancer.

A total of 2566 patients are included in those 7 studies, with 233 patients (9%) having extracolonic findings of high importance, 31 patients having immediate treatment (1.2%), and 27 patients having cancer (1%).

Thus, the total incidence of lesions is high, the number of lesions requiring further investigation is also high, but the incidence of serious disease is low, relative to the total number of lesions found. This is in conjunction with the findings of Xiong et al. (Xiong et al. 2005).

Edwards JT et al. 2001 Ginnerup Pederson et al. 2003 □ Gluecker et al. 2003 a et al. 2000

Edwards JT et al. 2001 Ginnerup Pederson et al. 2003 □ Gluecker et al. 2003 a et al. 2000

m. ruh

JL Jtln à

„ JL .

ílrti

1 „ n n _

hepatic : 13,3333333

hepatic: non-cystic

vascular 6,66666667

gall -bladder

pulmonary

musculo -skeletal

renal cyst

renal calcul

cancer

normal a

drenal :

adrenal:

benign

ovarian cancer

fibroid

bladder

card

0,5e27505e

1,4705ee24 0,5e27505e

0,46620047

1,4705ee24 3,26340326

1,4705ee24 2,56410256

0,23310023

2,

M117647 1655012

2

94117647

1,47058824

0,66225166 0,4310344e

0,66225166 2,15517241

1,9e675497 0,4310344e

2,64900662

3,97350993 3,44e275e6

1,32450331 0,4310344e

0,43103448 2,

2450331 5517241

]Ginnerup Pederson et al. 2003

] Hellstrom et al 2004

]Ginnerup Pederson et al. 2003

] Hellstrom et al 2004

Hellstrom et al 2004

Spreng A et al. 2005

Fig. 10.1. CTC without IV contrast: nature and percentage of total number of lesions causing additional investigations

renal cyst renal calculi renal cancer renal no

0,93023256 3,72093023 0,93023256

peritoneum hernia pancreatic mesentery

0,23310023

0,e6206e97

,13636364

,13636364

13636364

,13636364

hepatic cystic repatic: non cystic bladder adrenal adenom adrenal: non adenoma uterine fibroid peritoneum ovarian cancer vascular pulmonary bladder cardiac splenic pancreatic mesentery

Fig. 10.2. CTC with IV contrast: nature and percentage of total number of lesions causing additional investigations

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