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Optimizing Urgent Suspected Colon Cancer Referrals and Reducing Colonoscopy Wait Times in Wales.

Atreya Subramanian¹, Ashwin Nair¹, Parinita Swarnkar¹

¹General Surgery, Aneurin Bevan University Health Board, Newport, GBR.

|December 31, 2024

Summary

This summary is machine-generated.

Recent colonoscopies and CT scans can help downgrade urgent suspected cancer referrals. A negative colonoscopy and CT scan, regardless of FIT results, may safely reduce unnecessary referrals for colorectal cancer screening.

Keywords:

cancer colon fit test urgent suspected cancer colonoscopy ct

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Area of Science:

Gastroenterology
Diagnostic Imaging
Oncology

Background:

Urgent suspected cancer (USC) referrals for colorectal cancer (CRC) place a significant burden on healthcare resources.
Accurate risk stratification is crucial to optimize patient pathways and manage waiting lists.

Purpose of the Study:

To evaluate the utility of recent colonoscopies and CT scans, alongside the fecal immunochemical test (FIT), in potentially downgrading USC referrals.
To identify combinations of diagnostic tests that accurately predict negative colonoscopy outcomes.

Main Methods:

A retrospective single-centre study analyzed 500 USC referrals for colonoscopy in 2022.
Findings from CT scans and colonoscopies within two years prior to referral were reviewed.
The fecal immunochemical test (FIT) results were correlated with imaging and endoscopic findings.

Main Results:

Out of 500 USC referrals, 160 were positive for CRC.
A prior negative colonoscopy and CT scan combination, irrespective of FIT results, correctly identified cases without cancer.
Potentially, 8% (40 referrals) could have been safely downgraded based on combined negative test results.

Conclusions:

A prior negative colonoscopy and CT scan strongly suggest downgrading of colorectal USC referrals, even if the FIT result is unknown or positive.
Negative CT scans with negative FIT, or normal colonoscopies within two years, support safe downgrading.
This approach may improve waiting times and reduce costs within the USC pathway, though larger validation studies are needed.