Suspected extracolonic neoplasms detected on CT colonography: literature review and possible outcomes

Abstract

Rationale and objectives: This study summarizes the literature on the detection of cancer among indeterminate extracolonic findings on computed tomographic (CT) colonography in five targeted organs.

Materials and methods: We searched PubMed for English-language literature published between January 1, 1994, and December 31, 2010. We describe extracolonic findings in the kidney, lung, liver, pancreas, and ovary suspect for malignancy as they are associated with high mortality. For each organ, we calculated the median prevalence, positive predictive value (PPV), and false positive rate of malignancy and a pooled false-positive rate across studies.

Results: Of 91 publications initially identified, 24 were eligible for review. Indeterminate renal masses on CT colonography had 20.5% median PPV and low pooled false positive rate of 1.3% (95% confidence interval 0.6-2.0). In contrast, indeterminate masses of the lung, liver, pancreas, and ovary had low PPV (median values ranged from 0% to 3.8%). Indeterminate masses of the ovary resulted in the highest pooled false-positive rate of 2.2%. Results were similar in studies of both screening and nonscreening populations. We estimated the probability of false positive results through the detection of significant extracolonic findings as 46 per 1000 for men and 68 per 1000 for women.

Conclusions: Indeterminate renal masses newly detected on CT colonography have an estimated one in five chance of malignancy and therefore warrant further follow-up to provide a definitive diagnosis. Conversely, indeterminate masses of the lung, liver, pancreas, and ovary are associated with high false positive rates and merit more conservative clinical follow-up.