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The utility of surveillance CT scans in a cohort of survivors of colorectal cancer

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Abstract

Purpose

Colorectal cancer (CRC) is the third most common cancer worldwide. After curative intent treatment, international guidelines recommend surveillance protocols which include annual CT chest, abdomen and pelvis (CAP) and serum carcinoembryonic antigen (CEA) monitoring which aim to improve overall survival by early detection of recurrence. Despite the widespread recommendations, robust evidence of an overall survival benefit is lacking. Our study aimed to quantify the utility of annual CT CAP as a surveillance modality in comparison to the rate of potentially harmful false-positive and incidental findings.

Methods

High-risk stage II and stage III CRC patients were retrospectively identified from the Sydney Cancer Survivorship Centre database. Findings on surveillance CT were classified into confirmed recurrence or the potentially harmful findings of (a) false-positive or (b) clinically significant incidental finding.

Results

A total of 376 surveillance CT CAPs were performed in 174 survivors between 12 September 2013 and 30 June 2020. The recurrence rate during the study period was 23/174 (13.2%) with the majority of recurrences detected by abnormal CEA (14/23, 60.9%) versus surveillance CT (4/23, 17.4%), with the remainder identified on non-surveillance CT (5/23, 21.7%). Curative intent surgery was performed in 12/23 people with CRC recurrence. Surveillance CT was shown to result in high levels of false-positive (31/174, 17.8% of patients) or clinically significant incidental findings (30/174, 17.2% of patients). The risk of identifying these potentially harmful findings was ongoing with each year of surveillance CT.

Conclusion

Surveillance CT was associated with low detection rates and high rates of potentially harmful findings bringing this surveillance modality under further scrutiny.

Implications for Cancer Survivors

An increased emphasis should be placed on educating survivors on the benefits of surveillance CT weighed against the risk of potentially harmful findings.

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Author information

Authors and Affiliations

  1. Medical Oncology, Concord Repatriation Hospital, Concord, NSW, Australia

    Jorja Braden, Prunella Blinman, Ashanya Malalasekera, Kim Kerin-Ayres, Natalie Southi & Janette L. Vardy

  2. Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia

    Prunella Blinman, Ashanya Malalasekera & Janette L. Vardy

  3. Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Jarrah Spencer

Authors
  1. Jorja Braden
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  2. Prunella Blinman
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  6. Natalie Southi
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  7. Janette L. Vardy
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Contributions

JB contributed data entry, performed data analysis and wrote the manuscript.

PB devised the study concept, design of protocol and planning.

AM contributed to development of protocol, redcap design and data collection.

KA contributed to development of protocol, redcap design and data collection.

JS contributed to data extraction, data analysis and interpretation.

NS contribute to data entry.

JV contributed to study design and directed overall planning of the project, coordination of ethics and implementation of research.

All authors discussed results of study and provided critical feedback of the manuscript and approved the final version of the manuscript.

Data with principal investigator and available on request.

Not applicable.

Corresponding author

Correspondence to Janette L. Vardy.

Ethics declarations

Ethics approval (include appropriate approvals or waivers)

Ethics approval was obtained from Concord Repatriation General Hospital Human Research Ethics Committee (HREC/14/CRGH/23).

Consent to participate

All participants gave consent for their data to be used for research and quality assurance purposes.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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Braden, J., Blinman, P., Malalasekera, A. et al. The utility of surveillance CT scans in a cohort of survivors of colorectal cancer. J Cancer Surviv 17, 1202–1210 (2023). https://doi.org/10.1007/s11764-021-01155-y

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  • DOI: https://doi.org/10.1007/s11764-021-01155-y

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