Gabriella Iussich MD, Presenter: Consultant, im3D SpA

Loredana Correale PhD, Abstract Co-Author: Researcher, im3D SpA

Carlo Senore MD, Abstract Co-Author: Speaker, Given Imaging Ltd

Nereo Segnan, Abstract Co-Author: Nothing to Disclose

Cesare Hassan, Abstract Co-Author: Nothing to Disclose

Daniele Regge MD, Abstract Co-Author: Nothing to Disclose

Paolo Falco, Abstract Co-Author: Employee, im3D SpA

Stefania Montemezzi MD, Abstract Co-Author: Nothing to Disclose

Alberto Bert PhD, Abstract Co-Author: Employee, im3D SpA

To evaluate the frequency and costs of additional diagnostic workup for extracolonic findings (ECFs) detected at CTC in a public organized screening program.  

CTC cases performed within a randomized multi-center screening trial were included in this study. The trial enrolled asymptomatic persons aged 58-60 years undergoing low-dose CTC screening without contrast material. CTCs were prospectively read by experienced radiologists; positive patients (ie, polyps >5-mm) were referred for colonoscopy. All ECFs reported in the initial report were reviewed by two radiologists and were classified as being of high/moderate significance (E4 or E3) vs. minor (E2). Any ambiguity regarding clinic significance of ECFs was resolved with meeting consensus. ECFs assigned to E4 or E3 category were referred for additional workup. Costs of diagnostic procedures due to these ECFs were evaluated. Regression analysis was also performed to assess the related factors in ECF detection.  

Of the 1652 (851 men) included subjects, 71 ECFs were found in 68 (4.1%) patients, with 31 (1.9%) of minor significance; 26 (1.5%) moderate and 11 (0.7%) high. The most common E4 findings were ovarian mass (n=2), urinary tract mass (n=2) and, pulmonary nodule >9mm (n=2). Further diagnostic workup was recommended in 37 (2.2%; one per 45 patients) of patients, including 3 patients having previously identified ECFs. Additional testing included: ultrasound (n=19); CT scan (n=6) and other diagnostic imaging (n=8). The mean costs for additional evaluation were $2 (95% CI: $1.3-$3.0) per participant and $101 (95% CI: $78-$126) per individual with detected high/moderate ECFs. Detection of important ECFs was not related to patient gender (P=0.31) and age (P=0.13). However, important ECFs were more likely to be detected in positive screening results vs. negative screening results (ORs, 4.1; 95% CI:1.8-8.1; P<0.001).  

About 2% of asymptomatic subjects participating in a public organized CTC screening program will present important ECFs (one per 45 examinations). Early detection of important diseases may add benefit to screening intervention outweighing the incremental costs for diagnostic procedures (mean cost, $2 per participant).    

Our results provide information regarding the estimate of important ECFs rate in an organized CTC screening program and should be considered carefully to evaluate ECFs related costs and benefit.  

Iussich, G, Correale, L, Senore, C, Segnan, N, Hassan, C, Regge, D, Falco, P, Montemezzi, S, Bert, A, CT Colonography (CTC): Extracolonic Findings in a Public Organized Screening.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13015999.html