CT colonography (CTC), when used in elderly patients, can detect a high number of new and significant abnormalities outside the colon (including cirrhosis and tumors) and is well tolerated, according to a recent study conducted by researchers at St. James's University Hospital in Leeds, United Kingdom (UK).
“We decided to target older patients (over age 70) with lower gastrointestinal tract symptoms, who were referred to radiology for work up, as this group generally tolerates barium enema examinations less well than those under age 70,” said Damian Tolan, MD, lead author of the study. “Our study centered on the initial analysis of CT colonography examinations in this patient group. We only looked for significant pathology, excluding common benign incidental findings; for example gallstones or adrenal adenomas. It is important to note that CT colonography is not used for colorectal cancer screening in the UK and is reserved for symptomatic patients only,” he said.
The study included 400 patients, who underwent CTC over a 14-month period. The study found 100 significant lesions that were previously unknown in 96 patients. The study also showed that 49 of the patients had at least one malignancy, including 23 extracolonic malignancies and 29 colorectal malignancies.
“Lower gastrointestinal symptoms in older patients over 70 are less specific for colorectal cancer than in younger patients. In our study, patients had a high yield for significant colonic pathology, including colon cancer and advanced adenomas,” said Dr. Tolan. “While these would almost certainly have been detected by colonoscopy and barium enema, CT colonography detected a wide range of other abnormalities as well,” he said.“In all, 29% of patients had significant pathology outside the colon, and in 24% this was a newly diagnosed condition. These included gastric, lung and renal cancers (5.8%), complications of diverticular disease (2%) and a range of other conditions from abdominal aortic aneurysms to cirrhosis,” he said.
“CT colonography also allowed simultaneous full staging of patients, determining whether tumors were localized or advanced with evidence of metastatic spread, thereby providing important prognostic information for referring physicians when deciding treatment options,” he said.