CT Colonoscopy Detects More Than Colon Cancer - CME Teaching Brief - MedPage Today

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CT Colonoscopy Detects More Than Colon Cancer

By Jeff Minerd, MedPage Today Staff Writer

Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of

Pennsylvania School of Medicine.

July 26, 2005

REVIEW:

SAN FRANCISCO, July 26-A substantial number of patients undergoing

so-called virtual colonoscopy were found to have significant medical

problems outside the colon, a finding that enthusiasts say underscores

the benefit of screening with this method.

In 9% of patients undergoing the screening procedure, also known as CT

colonoscopy, investigators detected clinically important extracolonic

problems ranging from kidney cancer to aortic aneurysm, said Judy Yee,

M.D., and colleagues at the San Francisco Veterans Affairs Medical

Center in the August 2005 issue of Radiology.

" That's a fairly large percentage, " said Dr. Yee, " Depending on the

patient population you look at, this finding suggests that it may be

more common to find something significant outside of the colon than in

the colon with this technique, because there is more likely to be a

problem outside the colon. "

The study was conducted on 500 male patients with an average age of

62.5 years. Of these, there were 39% at average risk for colon cancer

and had routine screening. The other 61% were referred for screening

because of possible colon cancer symptoms and were considered at high

risk. The participants were followed for more than three years after

screening.

Although 63% of the extracolonic lesions found by CT colonoscopy turned

out not to be clinically significant, the investigators argued that the

cost of follow up on these was relatively low. The additional cost for

follow-up work-ups was $14,058.43 for 48 studies adding about $28 to

the cost per CT colonographic exam for the patients in the study, and

resulted in no increased morbidity. The average cost for follow-up per

patient studied at follow-up for clinically significant lesions was

approximately $562.

There were no significant differences in extracolonic findings between

the patients at high-risk and those at average risk for colon cancer.

The study did not address findings in the colon.

Because a CT colonoscopy views the entire abdomen and pelvis, including

solid organs such as the liver, kidneys, pancreas, and spleen, it has

the potential to detect a variety of medical problems at an early stage

when they are more amenable to treatment, Dr. Yee and colleagues

concluded.

In addition, the procedure is less invasive and time-consuming than

standard colonoscopy or a lower GI series, the investigators noted.

However, the preparation for the studies is similar and if a colonic

lesion is found with CT colonoscopy, standard colonoscopy will be

necessary.

" The message here is, go out and get screened for colon cancer, " Dr.

Yee said. " If you have a virtual colonoscopy, we will find clinically

significant lesions in the colon and can find significant disease

outside of the colon as well. " Only about 30% of Americans older than

50 have regular screening for colon cancer.