December 30, 2008 - Widespread adoption of computed tomographic colonography (CTC) will lead to the detection of numerous incidental extracolonic findings (ECFs), which may result in unexpected costs, said Lincoln L. Berland, M.D., author of Incidental Extracolonic Findings on CT Colonography: The Impending Deluge and Its Implications, an article that will appear in the January issue of the Journal of the American College of Radiology (JACR).
According to the study, defining, characterizing and making diagnostic and management recommendations for such ECFs are likely to be inconsistent and, averaged over the patient population, may be more costly than CTC itself. Dr. Berland points out that the reports suggesting a modest cost for evaluating ECFs did not include all of the downstream costs of diagnosis and treatment, while studies that more closely tracked costs arrived at figures up to five times as high.
The ECF aspect of CTC is analogous to total-body screening, which has been widely criticized, and the cost-effectiveness of evaluating and managing ECFs is unproven and controversial, which also has implications for managing incidental findings from other applications for abdominal and pelvic computed tomography.
Dr. Berland suggests establishing national or local criteria for detecting ECFs and providing recommendations for referring clinicians may be an important step toward achieving the most effective patient care for ECFs, which are the inevitable consequence of performing CTC.
Source: Journal of the American College of Radiology (JACR)
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