Yee Judy, Kumar Naveen N, Godara Suchitra, Casamina Janice A, Hom Robert, Galdino Gregory, Dell Peter, Liu Darice
Department of Radiology, Veterans Affairs Medical Center (114 4150 Clement St, San Francisco, CA 94121, USA.
Radiology. 2005 Aug;236(2):519-26. doi: 10.1148/radiol.2362040166.
To evaluate prospectively the prevalence of incidental extracolonic findings at computed tomographic (CT) colonography and to estimate the cost of their imaging work-up in male patients with high and those with average risk of colorectal cancer.
This study was approved by the institutional review board, and informed consent was obtained from all patients. The study was compliant with requirements of the Health Insurance Portability and Accountability Act. CT colonography was performed in 500 men (mean age, 62.5 years). Of these patients, 194 (38.8%) were at average risk for colorectal cancer and presented for routine screening. The other 306 (61.2%) were at high risk for colorectal cancer. Extracolonic findings were recorded and categorized as either clinically important or clinically unimportant. Clinically important findings were defined as those that necessitated further diagnostic studies or medical or surgical follow-up. The cost of additional imaging required to further characterize important lesions was estimated. Chart review was performed (mean length of follow-up, 3.6 years) to determine whether any important findings were missed at CT colonography. The Fisher exact test was used to determine whether there was a difference between the percentages of average- and high-risk patients with extracolonic findings.
Of the 500 patients in the study, 315 (63.0%) had extracolonic findings, and 45 (9.0%) had clinically important extracolonic findings. Of the 596 extracolonic findings identified, 50 (8.4%) were thought to be clinically important. The mean additional cost to work up important findings was $28.12 per CT colonographic examination. There were no significant differences between average-risk and high-risk patients in the percentages of extracolonic findings (P = .25) or clinically important extracolonic findings (P = .11).
A substantial number of both average- and high-risk patients undergoing CT colonography will be found to have clinically important extracolonic findings. There was no increased morbidity or mortality associated with the additional evaluation of extracolonic findings. The cost of evaluating these lesions is low, given the potential for positive effects on patient care.
前瞻性评估计算机断层扫描（CT）结肠成像时偶然发现的结肠外病变的患病率，并估计在患结直肠癌高风险和平均风险的男性患者中对这些病变进行成像检查的费用。
本研究经机构审查委员会批准，并获得所有患者的知情同意。该研究符合《健康保险流通与责任法案》的要求。对500名男性（平均年龄62.5岁）进行了CT结肠成像检查。其中，194名（38.8%）为结直肠癌平均风险患者，接受常规筛查。另外306名（61.2%）为结直肠癌高风险患者。记录结肠外病变并分类为临床重要或临床不重要。临床重要病变定义为那些需要进一步诊断性检查或医学或手术随访的病变。估计进一步明确重要病变所需的额外成像检查费用。进行病历审查（平均随访时间3.6年）以确定CT结肠成像时是否遗漏任何重要病变。采用Fisher精确检验确定平均风险和高风险患者中出现结肠外病变的百分比是否存在差异。
在研究的500名患者中，315名（63.0%）有结肠外病变，45名（9.0%）有临床重要的结肠外病变。在识别出的596个结肠外病变中，50个（8.4%）被认为具有临床重要性。对重要病变进行检查的平均额外费用为每次CT结肠成像检查28.12美元。平均风险和高风险患者在结肠外病变百分比（P = 0.25）或临床重要的结肠外病变百分比（P = 0.11）方面无显著差异。
大量接受CT结肠成像检查的平均风险和高风险患者会被发现有临床重要的结肠外病变。对结肠外病变进行额外评估未增加发病率或死亡率。鉴于对患者护理可能产生的积极影响，评估这些病变的费用较低。
