B Dustin Pooler1, David H Kim1, Perry J Pickhardt1. 1. 1 Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/366 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252.
Abstract
OBJECTIVE: The purpose of this study was to analyze the incidence and outcomes of unsuspected indeterminate but likely unimportant extracolonic findings (CT Colonography Reporting and Data System [C-RADS] category E3) at screening CT colonography (CTC). MATERIALS AND METHODS: Over 99 months (April 2004 through June 2012), 7952 consecutive adults without symptoms of colorectal cancer (4277 women, 3675 men; mean age ± SD, 56.7 ± 7.3 years) underwent first-time screening CTC. Findings prospectively placed into C-RADS category E3 were retrospectively reviewed, including follow-up (range, 2-10 years) and ultimate clinical outcome. RESULTS: Unsuspected C-RADS category E3 extracolonic findings were detected in 9.1% (725/7952) of our patient population. A total of 751 category E3 findings were detected among these 725 patients; 25 patients had multiple findings. Commonly involved organ systems included gynecologic (24.4%, 183/751), genitourinary (20.9%, 157/751), lung (20.6%, 155/751), and gastrointestinal (16.1%, 121/751). Consideration for further imaging, if clinically warranted, was suggested in 83.8% (608/725). Sixty-five patients were lost to follow-up. Conditions requiring treatment or surveillance were ultimately diagnosed in 8.3% (55/660), including eight malignant neoplasms. In the remaining 605 patients, 25 (4.1%) underwent invasive biopsy or surgery to prove benignity (including 18 complex adnexal masses), and 278 (46.0%) received additional imaging follow-up. CONCLUSION: Indeterminate but likely unimportant extracolonic findings (C-RADS category E3) occurred in less than 10% of adults without symptoms of colorectal cancer who underwent screening CTC. Over 90% of these findings ultimately proved to be clinically insignificant, with fewer than 5% requiring an invasive procedure to prove benign disease, the majority of which (> 70%) were complex adnexal lesions in women.
OBJECTIVE: The purpose of this study was to analyze the incidence and outcomes of unsuspected indeterminate but likely unimportant extracolonic findings (CT Colonography Reporting and Data System [C-RADS] category E3) at screening CT colonography (CTC). MATERIALS AND METHODS: Over 99 months (April 2004 through June 2012), 7952 consecutive adults without symptoms of colorectal cancer (4277 women, 3675 men; mean age ± SD, 56.7 ± 7.3 years) underwent first-time screening CTC. Findings prospectively placed into C-RADS category E3 were retrospectively reviewed, including follow-up (range, 2-10 years) and ultimate clinical outcome. RESULTS: Unsuspected C-RADS category E3 extracolonic findings were detected in 9.1% (725/7952) of our patient population. A total of 751 category E3 findings were detected among these 725 patients; 25 patients had multiple findings. Commonly involved organ systems included gynecologic (24.4%, 183/751), genitourinary (20.9%, 157/751), lung (20.6%, 155/751), and gastrointestinal (16.1%, 121/751). Consideration for further imaging, if clinically warranted, was suggested in 83.8% (608/725). Sixty-five patients were lost to follow-up. Conditions requiring treatment or surveillance were ultimately diagnosed in 8.3% (55/660), including eight malignant neoplasms. In the remaining 605 patients, 25 (4.1%) underwent invasive biopsy or surgery to prove benignity (including 18 complex adnexal masses), and 278 (46.0%) received additional imaging follow-up. CONCLUSION: Indeterminate but likely unimportant extracolonic findings (C-RADS category E3) occurred in less than 10% of adults without symptoms of colorectal cancer who underwent screening CTC. Over 90% of these findings ultimately proved to be clinically insignificant, with fewer than 5% requiring an invasive procedure to prove benign disease, the majority of which (> 70%) were complex adnexal lesions in women.
Authors: Perry J Pickhardt; J Richard Choi; Inku Hwang; James A Butler; Michael L Puckett; Hans A Hildebrandt; Roy K Wong; Pamela A Nugent; Pauline A Mysliwiec; William R Schindler Journal: N Engl J Med Date: 2003-12-01 Impact factor: 91.245
Authors: Michael E Zalis; Matthew A Barish; J Richard Choi; Abraham H Dachman; Helen M Fenlon; Joseph T Ferrucci; Seth N Glick; Andrea Laghi; Michael Macari; Elizabeth G McFarland; Martina M Morrin; Perry J Pickhardt; Jorge Soto; Judy Yee Journal: Radiology Date: 2005-07 Impact factor: 11.105
Authors: Michael Macari; Gregory Nevsky; John Bonavita; Danny C Kim; Alec J Megibow; James S Babb Journal: Radiology Date: 2011-04-05 Impact factor: 11.105
Authors: Cesare Hassan; Perry J Pickhardt; Perry Pickhardt; Andrea Laghi; Daniel H Kim; Daniel Kim; Angelo Zullo; Franco Iafrate; Lorenzo Di Giulio; Sergio Morini Journal: Arch Intern Med Date: 2008-04-14
Authors: Andrew A Plumb; Darren Boone; Heather Fitzke; Emma Helbren; Susan Mallett; Shihua Zhu; Guiqing L Yao; Nichola Bell; Alex Ghanouni; Christian von Wagner; Stuart A Taylor; Douglas G Altman; Richard Lilford; Steve Halligan Journal: Radiology Date: 2014-05-22 Impact factor: 11.105
Authors: Perry J Pickhardt; Peter M Graffy; Benjamin Weigman; Nimrod Deiss-Yehiely; Cesare Hassan; Jennifer M Weiss Journal: Radiology Date: 2020-08-11 Impact factor: 11.105
Authors: Gerard Lambe; Peter Hughes; Louise Rice; Caoimhe McDonnell; Mark Murphy; Ciaran Judge; Michael Guiney Journal: Ir J Med Sci Date: 2021-03-24 Impact factor: 1.568