Incidental Colorectal Computed Tomography Abnormalities: Would You Send every Patient for a Colonoscopy?

Abstract

METHODS: Ninety-four consecutive patients found to have largebowel abnormalities on abdominal CT were referred for colonoscopy. Of these patients, 48 were referred for a suspected colorectal tumour and 46 for CRWT. Colonoscopy was performed and findings were compared. RESULTS: Of the 48 suspected colorectal tumours, 34 were determined to be neoplastic lesions on colonoscopy. Of these, 26 were malignant and eight were benign. Colonoscopy revealed no abnormality in 30 of 46 patients with CRWT as a solitary finding, and revealed some abnormality in 16 patients (12 had diverticular disease, four had benign neoplastic lesions). CONCLUSIONS: CRWT as an incidental and solitary finding on CT should not be regarded as a pathology prompting a colonoscopy. Approximately two-thirds of the patients had a normal colonoscopy and the remaining patients had benign lesions (12 had diverticular disease and four had benign neoplastic lesions). However, many of these patients seem to warrant colonoscopy regardless of CT findings, particularly patients who have a family history of colorectal cancer, have positive fecal occult blood test results or who are older than 50 years of age.

Characteristics of colorectal cancer diagnosed with screening abdominal ultrasonography

“…In our study, the thickness of normal colonic wall was <3 mm. Our data were consistent with previous results (15). A threshold value for colonic wall thickness has not been determined for the diagnosis of CRC.…”

“…W, wall thickening; M, mass. Stermer et al performed colonoscopy in patients who had a wall thickened to >3 mm (15). Of the 46 patients, 30 had a wall thicker than 3 mm, but showed no abnormalities, suggesting that false-positive results may be found in patients with walls thicker than 3 mm; thus, the threshold value may be >3 mm.…”

Computed tomography findings of bowel wall thickening: its significance and relationship to endoscopic abnormalities

“…7 Stermer et al argued against the routine use of colonoscopy but agreed that high risk patients (family history, positive faecal occult blood, age >50 years) with incidental BWT would benefit. 8 In the present study, lesions affecting the caecum and ascending colon on CT were least likely to yield abnormal findings on endoscopy (48.4%) compared with left-sided lesions (62.4%). This confirms the results of Cai et al 9 They showed an 81% correlation with rectosigmoid lesions but only a 13% correlation with caecal lesions in patients with CT reports of BWT.…”

“…[2][3][4][5][6][7][8][9][10][11][12] In addition, several reports in the literature have attempted to differentiate benign and malignant cases of BWT. [13][14][15] These studies are relatively small and, as yet, no consensus has emerged on how this issue should be tackled.…”

Colonic bowel wall thickening: Is there a need for endoscopic evaluation?

“…In 71% of patients, tumorous lesions were found, whereas in 26 patients, these lesions were malignant. According to this study result, the authors recommend further endoscopy when bowel wall thickening occurs simultaneously with further risk factors such as positive family history or positive fecal occult blood test [8].…”