CHICAGOAccording to early experience at one imaging center in Massachusetts, whole-body screening CT is attracting individuals who may benefit from early detection of disease, such as current or former smokers and persons with other risk factors for cancer and heart disease. These researchers found that whole-body screening CT is not, as some have feared, leading to additional unnecessary invasive and expensive testing. However, a California study found that nearly half of persons with an abnormality found on screening required follow-up testing.
Further, the California study suggests that the procedure may be costly to patients who may not receive the reassurance they are looking for in return for an $800 to $1,000 charge, as well as to insurers who pay for laboratory and other follow-up imaging tests.
Speaking at the 88th Annual Meeting of the Radiological Society of North America (RSNA), Giovanna Casola, MD, recommended that whole-body CT screening should be confined to individuals who are at the highest risk for serious disease, and it should be provided in a facility that also can perform any indicated follow-up tests. Dr. Casola is professor of radiology and chief of body imaging, University of California, San Diego (UCSD), and lead author of a study on whole-body screening CT at a private outpatient imaging center in San Diego.
She also suggested that the facilities that provide whole-body screening CT should be sure to use contrast media for imaging the abdomen in patients with a previous known malignancy. "If we are truly trying to find cancers, it is okay to do a CT scan in the chest without intravenous contrast. But in the abdomen, you will miss cancers if you don’t give intravenous contrast, and therefore a negative examination would give patients a false sense of security," she said.
San Diego Center Study
Of 1,192 patients scanned in Dr. Casola’s study, 86.5% had at least one abnormality, and 13.5% had a totally negative exam (RSNA abstracts 319 and 320). Of the patients with an abnormality, 54% had benign findings of only minimal clinical significance that did not require further screening. Among the 46% who had more substantial abnormalities requiring follow-up, 15% had significant benign disease such as emphysema and 25% had a possible malignancy.
Of the 25% of persons screened who were classified as high risk, 24% had a suspicious lesion in the chest or abdomen that required additional testing, but less than 1% had a potential malignancy or life-threatening condition such as an aortic aneurysm, Dr. Casola said.