PWE-095 CT colonography: incidental findings and their impact on further investigations in an urban UK teaching hospital: Abstract PWE-095

Abstract

<h3>Introduction</h3> CT Colonography (CTC) availability is increasing and is being utilised more frequently for patients with lower gastrointestinal symptoms as an alternative to colonoscopy. Increased use of CTC at our hospital led us to determine the frequency and potential impact of the incidental findings (IF) found at CTC. <h3>Methods</h3> We performed a retrospective analysis of consecutive patients undergoing CTC over 12 months between Jan and Dec 2008 using the radiological database. All IF were extracted and then medical records were reviewed to see if patients received further intervention based on these incidental findings. <h3>Results</h3> Of 531 analysed CTC procedures 276 patients (52.3%) had one or more IF documented on the CTC report. 173 patients (63%) were over the age of 70. Total IF were 508, with non-colonic malignancy (new diagnosis) found in 59 patients (11%), most frequently in the form of liver metastases. Documented follow-up (further imaging and multidisciplinary team involvement) occurred in all but two cases. The most common non-malignant IF were renal or liver cysts, gallstones or hiatus hernias accounting for 248 (49%) of the documented IF. Surgical intervention was required in 41 patients (7.7%) in cases that included appendicitis, strangulated hernia, abdominal aortic aneurysm, renal calculi and cholecystitis. 149 IF (29%) required follow-up in the form of clinic review, further imaging or blood tests which was 117 of the 531 patients (22%) who underwent CTC (Abstract 095). <h3>Conclusion</h3> Incidental findings were surprisingly common compared to the published literature. While many of the documented IF had little clinical relevance the incidence of new malignancy requiring follow-up investigations is very high in our urban city cohort compared to the published literature.1 This may reflect the indication for the CTC as over 12% had weight loss as a part of the referring indication (see abstract J Iqbal). Many of the benign IF required further investigation before confirming a diagnosis which results in increased cost and patient worry for limited clinical benefit in the majority. Therefore, all doctors requesting CTC should make sure this is the most appropriate test and that the patient is aware of the potential for increased investigations required following CTC.