Hanna Maryam Zafar MD, Presenter: Nothing to Disclose

Ilana F. Gareen PhD, Abstract Co-Author: Nothing to Disclose

Jorean Sicks MS, Abstract Co-Author: Nothing to Disclose

Amy Kiyo Hara MD, Abstract Co-Author: Nothing to Disclose

Bettina Siewert MD, Abstract Co-Author: Nothing to Disclose

William C. Black MD, Abstract Co-Author: Nothing to Disclose

Judy Yee MD, Abstract Co-Author: Research Grant, EchoPixel, Inc

To compare American College of Radiology Imaging Network National CT Colonography Trial (NCTCT) radiologist recommendations for additional follow-up testing of extra colonic findings (ECFs) with those of an expert panel of radiologists. 

Radiologists in the NCTCT recorded follow-up recommendations for ECFs using standard forms. Using the Delphi method to obtain consensus, a panel of five radiologists classified follow-up for each of the 182 types of ECF recorded in the NCTCT as benign (no further evaluation), further evaluation recommended, and cannot categorize without additional information. Panel classification was based on the standard ECF categories from the NCTCT rather than on images or reports. All patients were presumed asymptomatic. For each type of ECF, we compared the recommendations of the NCTCT radiologist with those of the expert panel. Reports, but not images, were reviewed for disagreement cases.

Among 2,662 ECFs in 1,488 patients, both the NCTCT radiologists and the panel agreed follow-up was not recommended for 85% of ECFs (2,257/2,662) and was recommended for 8% of ECFs (215/2,662); most commonly lung nodules > 4 mm in size (32%, 70/215) and indeterminate masses in the kidney > 1 cm (15%,33/215) and in the liver > 0.5 cm (11%, 23/215). Disagreement on management recommendations was found in 7% of cases (190/2,662). The majority of disagreement cases were located in the kidneys (22%, 41/190) and liver (14%, 27/190) involving two diagnostic categories: indeterminate masses > 0.5 cm (12%, 23/190) and simple cysts (11%, 21/190). Manual review of these reports revealed that both diagnostic categories described probable benign lesions (e.g., cysts) for which NCTCT radiologists recommended follow-up due to lesion size and low dose technique.

Both the NCTCT radiologists and the panel agreed no further follow-up was advised for 85% of ECFs. Disagreement in 7% of cases was mainly due to divergent categorization of similar hepatic and renal lesions, most of which were favored by Trial readers to be benign. Standardized definitions of hepatic and renal ECFs on CT Colongraphy and evidence based outcomes of these findings may help reduce variability in ECF follow-up recommendations.

Standardized definitions of probable benign hepatic and renal ECFs and evidence based outcomes of these findings may help reduce variability in CTC follow-up recommendations.

Zafar, H, Gareen, I, Sicks, J, Hara, A, Siewert, B, Black, W, Yee, J, Probable Benign Hepatic and Renal Extracolonic findings Drive Variability in Recommendations for Follow-up of between the National CT Colonography Screening Trial and a Consensus Panel.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015906.html